KEY POINTS

• OTHER NAMES – Breast Enlargement Surgery or Breast Implant Surgery
• PROCEDURE TYPE – Surgical
• ANESTHESIA – Usually done under General Anesthesia, select cases can be done under Local Anesthesia
• DURATION OF SURGERY – Usually between 1 hour – 1 hour 30 min
• PATIENT DISCHARGE – Same day or Next Day
• ALTERNATIVE OR ADDITIVE PROCEDURES – Fat Transfer to Breasts and Mastopexy/Breast Lift

Breast Augmentation or Breast Enlargement Surgery is a surgery performed to enlarge the size of the breasts. Usually, this incorporates the use of breast implants, made of silicone, which are placed behind the breasts so as to give a natural feel to the breasts.

• Patients with small breasts which is familial
• Patients who have deflated breasts due to aging
• Patients with deflated breasts following weight loss
• Patients with deflated and saggy breasts following pregnancy and breastfeeding
• Patients with normal breasts desiring a size increase purely for aesthetic reasons
• Patients with uneven breasts such that one side is larger than the other
• Patients with congenital problems like Poland’s Syndrome
• Patients with removal of breast tumor leading to a reduction in size or complete absence of breast (post-mastectomy reconstruction)
• Transgender patients (male to female)

If you would like to go in for Breast Augmentation Surgery then it is essential that you meet Prof. (Dr.) Souvik Adhikari in person for a discussion and proper examination. This might not be possible for out of the state and overseas patients so, in those cases, videographic consultation would be done.

During the discussion, you should emphasize on why you are considering a breast augmentation surgery. Generally, you would fall into one of the categories mentioned above. Dr. Adhikari would then ask about the history, whether your breasts have been small right from the beginning or after pregnancy or weight loss or following any surgical procedure.

A detailed history of past ailments, addictions, any present medications and co-morbidities like diabetes, thyroid problems and so on would be obtained from you. A past surgical and allergy history would also be obtained.

Following this, an examination of your breasts would be done in presence of a female chaperone. The size of the breasts, the distribution of breast tissue, the position of the nipple-areolar complex and any sagging of the breasts would be looked for, following which, appropriate measurements would be done which would dictate implant size.

Depending on what you want, the projection most suitable for you would be highlighted to you.

The type of implant, whether silicone gel implant or saline implant would then be discussed with you. Prof. Adhikari usually prefers smooth, silicone gel implants.

Next, the incision sites would be discussed with you.

The consultation concludes with a detailed discussion of the procedure and the necessary investigations would be recommended to you.

A baseline breast imaging is recommended for all patients. This helps to exclude any other coexisting breast pathology in the patients while also serving as a future reference especially in cases of fat transfer to breasts where calcifications would develop following fat transfer. This is also important for patients with a familial history of breast cancer. Usually any of the following investigations are recommended –

1. Mammogram – usually recommended in patients more than 35 years of age.
2. Breast Ultrasound – in patients younger than 35 years of age.
3. MRI of Breasts – in patients planning for implant exchange because of some problems or where implant rupture is suspected.

A variety of incisions can be used for inserting the implants such as

1. Inframammary – the most common one, here, the incisions are placed under the breasts in the inframammary folds.
2. Periareolar – around the areola, usually used in insertion of saline implants and smaller size silicone gel implants.
3. Transaxillary – where incisions are made in the armpits.
4. Transumbilical – where an incision is made in the umbilicus, this is very rarely done.

A variety of planes can be chosen for placement of the breast implants, such as –

1. Submammary – the implants are placed just behind the breast tissue.
2. Subfascial – the implants are placed behind the fascia of the pectoralis major muscle.
3. Submuscular – the implants are placed entirely under the pectoralis major muscle.
4. Dual Plane – the upper part of the implant is placed under the muscle while the lower part is placed behind the breast tissue.

There are pros and cons of every plane. Prof. (Dr.) Souvik Adhikari prefers the Dual Plane approach because the long term results with this plane are excellent.

Have a light meal the night before surgery.
If you are feeling anxious, take an anxiolytic.
If you are taking any medications for blood pressure or any other problems you should take those unless prohibited by your surgeon.
Get a good night’s sleep!

Do not take anything by mouth, not even water from the morning of surgery as your surgery would be done under general anesthesia.
You can have a bath if you feel like.
If you are taking any morning medications and have been informed by your surgeon to take the same then take it with a small amount of water.
Go to the surgical facility in time and get admitted and sign all the forms.

Markings would be done first of the extent of dissection and the incision sites.
Any final questions the patient might be having are answered at this stage.
The patient is next put under general anesthesia and surgery started.
The incisions are made and the pockets for placement of the implants are created according to the plane decided earlier. Usually, the pockets are made quite large compared to implant size.
The implants are places in the pockets and final closure done.

• Take rest for 1-2 days, after that you can do light household work.
• Use a sports bra if it feels more comfortable, otherwise use a normal bra.
• Follow balanced diet and take plenty of water.
• Get more fibers and raw fruits in your diet to avoid constipation.
• Avoid aspirin and other blood thinners.
• Avoid smoking and alcohol consumption for 3 weeks after surgery.
• Walking is recommended but vigorous activity should be avoided for 6 weeks after surgery.
• For the first week, restrict excessive use of arms.
• Do not lift your arms above your head for 2 weeks.
• Physical contact with breasts should be avoided for 6 weeks after surgery.
• Resume office work after 2 weeks when all incision sites have healed.
• Avoid body contact sports for 8 weeks.
• Follow up with your surgeon on a regular basis.

• IMPROVED BODY IMAGE – This is one of the major advantages of breast augmentation surgery as it improves the body image immediately.
• FULLER BREASTS – For patients suffering from inferiority complex from small breast size, this improves immediately as fuller breasts are obtained.
• PROPORTIONATE BODY – Some patients may have excellent body curves which are depreciated by small breasts, this is improved after augmentation.
• POST MASTECTOMY RECONSTRUCTION – The depression associated with mastectomy in any forms is done away with breast augmentation surgery as the previous breast shape is returned back to the patient.
• YOUTHFUL BREASTS – In aged patients, incorporation of augmentation along with a breast lift can restore the youthful appearance of the breasts.
• DURABLE RESULTS – Breast implants tend to stay for years, therefore, long lasting results are obtained with breast augmentation surgery.
• IMPLANT EXCHANGE – In case of implant rupture, exchange of implants can be done to restore the original breast shape.

Please visit the gallery section to see before and after pictures of actual patients.
https://www.indiacosmeticplasticsurgery.com/cosmetic-gallery/

• PAIN & DISCOMFORT – This can be quite common after insertion of implants and a sense of something “pressing on” the chest can be felt which usually subsides by itself in a few weeks.
• SWELLING & BRUISING – Some amount of swelling and bruising in the chest can be seen after surgery which subsides within the first few weeks.
• SCARRING – There is usually a faint scar in the undersurface of the breasts which is barely noticeable. In patients predisposed to scar hypertrophy, there may be hypertrophic scar formation, though this is rare.
• CHANGES IN NIPPLE & BREAST SENSATION – This is usually a temporary side effect but in some cases may persist for longer duration of time.
• IMPLANT POSITION CHANGES – The implant may migrate from its normal position, this is seen especially where the pocket created is large.
• RIPPLING – Seen especially with saline implants or where the normal breast tissue is excessively thin, this is caused by adherence of a thin film of tissue to the implant creating rippling.
• INFECTION & IMPLANT EXTRUSION – In rare cases, there might be infection with resultant extrusion of the implant. In such cases, the implant would need to be removed and replaced with a new one after a few months.
• CAPSULAR CONTRACTURE – There can be hardening around the implant as there is development of scar tissue which progressively engulfs the implant. This is seen in cases where the pocket created is small at the time of implant insertion and where smooth implants are used. There might be quite a bit of pain for which the implant might need to be taken out.
• IMPLANT RUPTURE – In rare cases, there might be rupture of the implant leading to the contents (silicone or saline) being extruded out into the surrounding breast tissue. This is quite rare and is usually seen in cases where there is considerable force being applied on the implant or impaction with a sharp object.
• PERSISTENT BREAST PAIN – In some patients there might be persistent breast pain which can be due to an underlying capsular contracture or rupture of the implant.
• BREAST IMPLANT ILLNESS (BII) – A variety of symptoms have been attributed to the presence of implants like fatigue, joint pain and others and the link is still being investigated.
• BREAST IMPLANT ASSOCIATED – ANAPLASTIC LARGE CELL LYMPHOMA (BIA-ALCL) – In extremely rare cases, there can be development of a rare form of lymphoma attributed to the presence of breast implants. This is usually seen with textured implants for which Dr. Adhikari does not use textured implants in his patients.
• BREASTFEEDING COMPLICATIONS – Some patients may experience problems when they try to breastfeed after getting an implant surgery previously. In some cases, the amount of milk secreted is decreased. This is seen more with periareolar incisions.
• NEED FOR REVISION SURGERY – In some cases, the results may not live up to the expectations of the patient and they might have to opt for revision surgery. This is also true for complications associated with implants.