Here are some of the broad groups into which most women fall when presenting for breast augmentation;
1. Small firm breasts but not very thin.
Many women fall into this category. These women tend to be relatively straight forward to augment .Their skin and tissues are flexible and accommodate the implant very well giving a natural shape and soft natural feel. Because there is sufficient tissue cover , minor imperfections are difficult to see or feel. As long as the woman doesn’t develop capsular contractures , the results in this situation tend to be excellent and it is usually very difficult to tell if she has had implants.
2. Very small breast in a very thin woman
Many patient seeking breast augmentation are very thin (very low body fat) and have very small breasts, ‘A’ cup or less. These patients are often in their early twenties and have not had children. Breast augmentation can have very significant benefits for these women, however it is important not to be too ambitious in terms of the implant size (aiming for a size greater than B cup). Smaller implants deliver more natural results in most cases. It is usually necessary to place the implants in sub muscular pockets.
Sometimes, the results in this group of women can look a little unnatural , over firm and lacking the mobility of a normal breast. Their skin and tissues tend to be very tight and do not accommodate the sudden volume expansion so well. Because the skin cover in the lower half is so thin, minor ripples /kinks in the implant can be easily felt. Occasionally there is a tendency for the implant (particularly a big one ) to over expand the lower half of the breast which can lead to an unnatural shape with a high nipple. It is for these reasons that placing an over large implant is not recommended in many of these women.
It is possible , over a series of breast augmentation to create larger breasts in this group. Although the proportions are often wrong for their slim builds.
3. Droopy/empty breasts
Most women with this problem, have had children and may have breast-fed. Their breasts have been larger during and shortly after pregnancy, but later the breasts lose their volume and firmness , sometimes leaving excess skin.
If there is minor volume loss, then replacing the loss with an implant will yield the excellent and natural natural results. However if there is a significant excess of skin , the implant may drop to the lower end of the skin envelope , (like a ball in a sock), which is a very unnatural appearance and will leave most patients very unhappy with their result. In these cases a breast lift operation, which tightens the skin is necessary to achieve a good result. Breast lifting will create additional scars, which can be an issue for some patients.
Sometimes, in moderate cases of droopy breasts, it can be a very difficult call, deciding whether to lift the breasts and use implants, or try and address the issue with implants alone. It is also difficult to know whether to do these operations together or in two separate procedures. Patients prefer to have both done at the same time, but this can be more risky than doing the operations separately.
Another option for moderately droopy breasts may be to consider firmer shaped implants (tear shaped / gummy bear). These implants can occasionally rotate leading to a very unnatural result. A newer solution to this problem are conical implants which do not rotate.
These decisions can only be made, in careful consultation with an experienced aesthetic surgeon. Sometimes an unplanned second operation is required in these women because implants alone have produced a worse result than expected.
4. Breast asymmetry
Most women have a small degree of breast asymmetry, (one breast bigger than the other). Sometimes there can be a big difference in size between the breasts. Often, in this situation different sized implants are required to compensate for the size discrepancy.
A more unusual scenario can occur when the breasts are not only a different size but also a very different shape. This is a more complicated situation and may require a number of breast augmentation procedures. Often one or both the breasts can be mis-shapen and droopy (tubular breasts).
Sometimes the smaller breast may have to be enlarged gradually with a tissue expander (type of saline filled balloon), before insertion of the final implant. Frequently the larger breast requires a breast lift in order to achieve a good shape match. These breast augmentation cases require a good deal of planning and consultation with your plastic surgeon.
PIP implants Not used in Breast Augmentation
PIP implants were a range of breast implants which are now regarded as faulty. They were not produced according to the strict medical standards that all other implants are subject to.
They had a tendency to rupture and the contents were composed of non-medical grade silicone , which contained impurities. It is thought that only some product batches were faulty but none the less it has been recommended by most authorities that these implants should be replaced to avoid a possible risk of cancer.
None of the reputable /fully qualified plastic surgeons (FRCSIplast) used these implants in breast augmentation but some of the cosmetic clinics did.