Augmentation

This is a very good procedure for women born with hypoplastic breasts. The tiny breasts become an embarrassment and help is sought for breast enlargement. The plastic surgeon makes a small incision either in the axilla or under the breast and inserts silicone prosthesis under the pectoralis major muscle. The prosthesis thus lies behind the breast and behind the muscle. This is a very effective operation and millions of women are walking about, happy with their 'new breasts'. There has been some controversy over the past few years concerning rupture or leakage of the silicone gel into the surrounding tissues. This sets up an inflammatory reaction, which has been claimed to be the start of various auto immune diseases in these unfortunate patients. Firstly, this leakage is: not a common occurrence. Secondly, scientific studies have disputed that gel leakage can cause these auto immune disorders

As a consequence of this controversy, a few points can be made:

• Prosthetic rupture is rare and by far the majority of patients are happy with their implants.

• Whether the auto-immune inflammatory effects occur or not, no one knows for sure; but the prosthesis can be filled with saline instead of silicone gel (this will remove the fears of gel leakage should it be a patient concern).

• The scientific literature on this topic disputes the claims that the silicone gel causes auto immune disorders, such as the connective tissue diseases e.g. lupus.

• There is no evidence whatsoever that the silicone prosthesis is carcinogenic i.e. that it could stimulate a cancer to develop.

A final point about augmentation is that the procedure is available to women who have had a mastectomy for breast cancer and were not offered immediate breast reconstruction. If after a period of time (about one year), there is no evidence of cancer recurrence, a breast enlargement using a silicone prosthesis can be offered to those patients who are unhappy with a padded bra. Some plastic surgeons are indeed prepared to do a breast reconstruction at the same time (same operation) as the mastectomy, for the removal of the breast cancer.

They feel that if the surgeon and the pathologist are happy that the cancer has been removed, they will do an immediate reconstruction.

This immediate reconstruction is becoming more popular today.

The methods of reconstruction are:

• tram flap (rectus abdominis myocutaneous flap) based on the epigastric artery

• lattissimus dorsi (muscle) flap

• free composite tissue transfer with a microvascular anastomosis

• tissue expander, followed by a silicone gel prosthesis (this is the simplest option).

Reduction

There are some women who have breast hypertrophy with consequent massively enlarged breasts. Occasionally they get so big, that their appearance becomes grotesque. This situation becomes intolerable and breast reduction is necessary. Other problems associated with these massive breasts are:

• pain in the spine (back pain)

• intertrigo (fungal infecltion under the breast, which is perpetually moist)

• breathing difficulties

• posture problems

• difficulty with playing sport.

So, a breast reduction may be strongly indicated in these unfortunate ladies. It can dramatically alter their self-image and psyche.

Droopy breasts

After a few pregnancies and breast feeding and especially after the menopause, most: women develop atrophic breasts droop and shrink. This is due, to atrophy of the breast, together with weakening of Cooper's ligaments, as well as weakening of the platysma muscle. This is the fan shaped muscle, which extends from the mouth (lower lip) to the top of the breasts.

Plastic surgeons can also help these women with severe droopy breasts by Iifting the breasts upwards i.e. a breast pexy procedure.

This is a relatively simple procedure called a mastopexy. Often times, the droop is not too severe. Most women accept: this as being quite natural, which of course it is.