Breast Augmentation

Breast augmentation or enlargement is a surgical procedure to enhance the size and shape of your breasts. This procedure is most commonly performed by the insertion of implants into the breasts, but other techniques are now available and may be suitable for some women (see Autologous fat breast augmentation). Breast augmentation may be combined with breast lifting or with other plastic surgery procedures such as lipo.

Breast augmentation should only be considered once you have achieved physical maturity and the breasts have ceased to develop further, in general this is after the age of 18. Some women simply have small or under-developed breasts while in others the breasts shrink or deflate after having had children. Breast augmentation may be used to correct congenital defects of the breast such tuberous breasts or Poland's syndrome.

At the breast augmentation consultation a full history will be taken, your breasts will be examined, measured and photographed and then some time is spent on sizing. Although I have a method of computer simulation of what your breasts will look like post-augmentation (see below), I do not find this to be that helpful and still find the sizing method with a bra and sizers to be best. Before and after pictures will be viewed and this also helps me to know where you want to go. Usually I will try to match you up with a past patient or two who has a similar body to you in terms of size and shape and that will give you a good idea of what a particular implant will do for you. It is important for me to understand your goals and I will then guide you and help you decide what is best. In the end, sizing is not as onerous as most patients anticipate it will be.

I do all my breast augmentations as day case surgery (in and out the same day) in my own, private facility. I use women anaesthetists who will put you under a light sedation. This will be supplemented with local anaesthesia. You will be asleep, pain-free and unaware at the time of surgery - breathing and sleeping on your own - and you will have a quick and comfortable recovery.

I almost invariably, these days, use an infra-mammary crease incision under the breasts. This is carefully measured and placed to be as small and inconspicuous as possible. If a lift is required as well, then the incision will be modified accordingly (see breast lift), but a breast augmentation does provide some lift as well. More on the incision site options...

Implant positionOnce the incision is made, a pocket is created into which the implant can be placed. This pocket may be above or below the muscle depending on your requirements and anatomy. Thinner patients benefit from more padding over the implant and a deeper placement of the implant under the muscle while patients with more "padding" can have a quicker, simpler and slighltly less painful placement above the muscle. Above the muscle is directly below the gland of the breast and is also called sub-glandular. Below the muscle is sub-muscular although I do a modern form of sub-muscular placement which required some division of the lower muscle fibres to allow better implant placement and breast shape: dual plane placement. More on implant placement...

After creation of the pocket I will usually confirm the pre-operative sizing with tester implants before washing out and checking the cavity. The implants will then be placed: these days cohesive silicone gel with a textured surface. Modern, generation 5 implants have a soft, natural feel and look and there is no medical evidence now to support the use of saline or other filler materials. More on implant choice...

Intra-operatively I confirm the correct size with testers placed in the dissected cavity. Once the correct size has been confirmed and the implants have been placed, the cuts are closed with dissolving sutures, a light dressing is applied and a post-operative surgical bra is used. I do not routinely use drains (less pain, less risk of infection). The whole procedure usually takes me about an hour.

Post-operative recovery is relatively quick and normal activities can be resumed after about 1-2 weeks. Overseas patients can return home approximately 12 days following surgery.

Complications are rare, but can include bleeding, infection and capsular contracture. The surgery gives immediate and predictable results, the effect is long lasting and the procedure is associated with a very high degree of patient satisfaction.

A lot of women coming to me for breast augmentation are concerned about size. They are fearful of being made too big, yet do not want to go through the pain and expense of surgery only to be left too small. While I use the regular methods of pre-operative sizing at consultation - in-bra sizers - I acquired in August 2010 Crisalix3D, an online application that allows me to load your pre-operative photographs, generate a 3 dimensional image of you and then virtually place a range of implants into your breasts to give you a visual indication of what you are likely to look like with different implants after surgery. I believe I am the first surgeon in South Africa to have this technology which is enourmously helpful in helping you make the pre-operative choices you need to make.

More on breast augmentation.

For more detailed information on breast surgery download the Breast Augmentation Info document.

Download a PDF on breast implants.

Read my newsletter on breast augmentation: Choice and consequence.

Testimonials from patients who have had breast augmentations.

Last updated 21 July 2011