Breast augmentation is now the most frequently performed cosmetic surgery procedure in Ireland with more and more women considering the aesthetic and emotional aspects of breast surgery.

The first thing to do is to talk to your GP who can refer you to Mr Meagher. By talking to your GP and Mr Meagher you are more likely to get the results you want from the surgery. You can also contact Mr Meagher directly if you would prefer Contact us.

Breast augmentation can bring:

• More confidence and self-esteem
• A better-proportioned figure
• More clothing options

Why people choose breast augmentation

There are 4 reasons why people choose to have breast augmentation:

1. To increase the size or improve the shape of the breasts
2. To reconstruct a breast following mastectomy
3. To replace an existing implant for medical or cosmetic reasons
4. To correct a congenital deformity

The anatomy of breasts

The breast is a compound saccular gland with ducts that converge to the nipple and opening on its surface in large numbers. The breast gets its shape and feel from fatty tissue while the elasticity of the skin also determines the shape of the breast. Milk ducts, glandular tissue, blood vessels, nerves and lymph ducts are also present in the breast which lies in front of the pectoralis major muscle.

You have a wide choice of breast implant options and Mr Meagher will help you to decide which is the right one for you.

Design features of breast implants

Breast augmentation surgery was originally performed in the 19th century but procedures have obviously changed a lot since then. Advances in materials technology and testing methods have greatly improved the safety of implants.

The success of breast implant surgery is a function of surgeon skill, patient characteristics and implant design. Much of what you will read about the safety of silicone gel breast implants refers to older implants which are very different to the modern, safer, designs that we use.

Breast implant design has evolved through 3 different generations:

1. First Generation: These implants were used between 1962 and 1978 and featured a thick shell and viscous silicone gel.
2. Second Generation: Used from1978 to 1987, they had a thinner wall compared to the first generation but used a less viscous gel. These are the implants that got a lot of publicity because their thin walls led to cases of rupture.
3. Third Generation: Introduced in 1987 and still used today. This design includes a thicker silicone elastomer shell and incorporates a barrier layer within the shell which reduces the risk of gel diffusion into the body. The silicone inside is more cohesive so even if it ruptured the gel is unlikely to migrate or spread into the body and any complications would be localised.

The shell

Breast implants have an outer layer, or ‘shell’, which is made of silicone. The shell is filled with silicone gel, or with saline (salt and water). 90% of breast implants used in Europe are made of a silicone shell and filled with silicone gel. It is a proven safety record and also provides a natural feel to the breast.

The surface

The surface of a breast implant can be either smooth or textured. Textured implants provide a surface that encourages the breast tissue to integrate to the surface of the implant instead of growing in a linear pattern around the implant. This helps to prevent slipping and keep the implant in place. Textured breast implants also help reduce the risk of capsular contracture, which can occur if the scar, or capsule, around the implant tightens, squeezing the implant and causing the breast to harden.

The safety of silicone in breast implants

Silicone is a compound made from silicon, a natural chemical element. Silicones have been used in moisturising creams, suntan lotions, lipsticks, medicines, food preparation and many other everyday products for more than 50 years. Silicones can be liquid, gel, or solid. Because of their biocompatibility (i.e. accepted by the body without adverse reaction) they are used in medical devices such as heart valves and artificial joints.

Our silicone gel breast implants have stronger, less permeable elastomer shells and more cohesive gel compared to earlier designs. The new design shell greatly reduces the risk of gel leakage through the wall of the shell. The cohesivity of the gel ensures that in the rare incidence of a shell rupture or split the gel will have a tendency to stick together and not flow or migrate into the surrounding body.

There are different types of gel cohesivity which determines the degree of softness to the feel of the implant. Gels with a higher cohesivity tend to feel firmer and can reduce the risk of capsular contracture and can allow greater projection. Gels with lower cohesivity generally feel softer.

Your tissue and our placement technique also help determining the softness or firmness of the feel of implants within the surgical pocket. You should discuss your personal preferences and expectations with us to determine the ideal shape and size for your new breasts.

Implant sizes

You have a unique opportunity to not just change your bra size but to alter the shape of your breasts. Naturally, the larger you want your cup size, the larger the breast implant. For the most natural look, you will probably want your new breasts to be in proportion, or balance, with your body as a whole. The width of your breast will determine your cleavage. It also determines the outer curve of your breasts, a contour that is essential to the balance between your breasts and hips.

Implant shapes

When choosing the right implant option for you it’s important that your natural breast tissue will cover the breast implant you want. If you choose a breast implant that’s too large for your breast tissue to cover, the implant edges may be visible after your surgery. An over-large breast implant may also increase your risk of surgical complications and may not maintain as youthful an appearance over time. We’ll help you to choose the right size.

When it comes to shapes, you can choose either round or anatomical (‘teardrop’) shaped implants.

Round shaped implants

This is the traditional shape for breast implants. If there is enough breast tissue for adequate coverage, we can get flattering, natural looking results. Generally, round breast implants provide a full, rounded appearance to the upper portion of the breast and a flattering increase in cleavage. The procedure for inserting round breast implants is less complicated, and there is less concern in the rare occurrence that the implant rotates. It is important to note that, in the course of time, as a result of gravity and the ageing of the skin and breast, the upper part of round breast implants may become emptier, which means they may droop more than anatomical breast implants.

Anatomical (teardrop) shaped implants

Anatomical implants are a more recent innovation and are becoming more and more popular because they closely resemble the natural shape and projection of the breast. They are available in more than 200 sizes for a natural look and feel customised for your desired results and unique proportions.

Anatomical implants tend to produce a more natural-looking effect that follows your body’s natural lines. From the front, the implant appears oval and from the side it appears to have more volume at the bottom. Its upper area (Mr Meagher may refer to this as the upper pole) gently slopes downward and outward, thus projecting in a more natural way. This upper portion is less likely to settle over time in the way a round implant might.

There is a rare but possible complication of anatomical implants: They can rotate in the pocket created for the implant, causing a distorted shape to the breast. To help reduce the risk of implant rotation all anatomical implants are available with a textured surface. The tissue of the breast pocket grows into the pores of the textured surface to help keep the implant in place.

Before the operation

The most important thing to do is to talk with Mr Meagher so that there is a clear understanding of your desires and expectations, in light of any biological prerequisites. We want you to be well informed and have realistic expectations of the results.

Before we discuss your new breast shape and size in detail, we will evaluate your current physical health and health history and also explain the procedure. Because breast enhancement surgery is an elective procedure, we will carefully discuss the benefits and risks.

Mr Meagher will take dimensions of your breast and surrounding tissue to determine the size of implant and best surgical approach.

If you decide to proceed with the operation you will be required to confirm your understanding of all aspects of the surgery and agreement to proceed by signing a consent form.

You will have to stop taking medication which alters blood viscosity, e.g. aspirin. As for all surgery, patients are requested to stop smoking at least 6 weeks prior to the operation. We will also take photographs as a record and to help plan your surgery.

During the operation

On the day of your surgery, Mr Meagher will draw marks on your breast and chest to show where the incisions will be made. This is where we will insert the implant into the breast pocket.

Breast surgery is always performed under general anaesthesia. All anaesthetics carry a risk and you should discuss these risks with the anaesthetist. The surgery usually lasts from 1 to 2 hours. For your safety, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

During the operation, Mr Meagher will make an incision and create a pocket for the breast implant. The safest and most widely used method is to place the incision along the crease beneath the breast where it meets the chest wall (also known as a submammary incision). Another option is to make an incision around the nipple, though this may impact nipple feeling or, possibly, cause bacterial contamination from the mammary gland. Less common is an incision in the armpit. The incision is typically five to six centimetres in length, and the scar will most likely not be visible when standing or sitting.

Incision options

Mr Meagher has a choice of 3 incision options:

1. Axillary (armpit) incision

• Does not affect breast feeding
• Is the most difficult surgical option
• Cuts through sweat glands and hair follicles

2. Periarolar (nipple) incision

• May affect breast feeding
• Incision is at the junction of pale skin and darker areolar skin
• More likely to affect nipple sensation

3. Inframammary incision

• Regarded as safest and most popular option
• Scar can usually be hidden in fold underneath the breast
• Does not affect breast feeding

After the incision is made, a pocket for the implant is created, either partially under the pectoralis major muscle (submuscular) or on top of the muscle and under the glands (subglandular).

Subglandular (under the glands) positioning

• Is a shorter procedure and faster recovery time
• Can be less painful
• Results in more palpable implants, especially in slim patients
• Makes imaging of the breast with mammography more difficult

Submuscular (under the muscle) positioning

• Has a longer recovery time
• Can be more painful
• Decreases the risk of capsular contracture
• Helps breast imaging during mammography
• Facilitate smoother upper pole transition
• Is particularly useful in very slim patients
• Result in less palpable implants

Once the implant is placed, the incision is closed with stitches. It may also be taped. You may have a drainage tube in place for a day to allow any blood or fluid that may collect in the wound and around the implant, to escape. This also allows Mr Meagher to ensure that the procedure is progressing as planned.

After the operation

We strongly recommend an overnight hospital stay after your operation and you will need someone to take you home when you are discharged by Mr Meagher as you will not be able to drive. You may have some dressings around your breasts and a surgical bra or elasticised bandage. Initially, your breasts will feel firm and may be swollen and will be sitting high on your chest. As the swelling goes down, they will drop into a more natural position and shape.

For several days after the operation, you may feel tired and sore and your breasts may remain swollen and sensitive to physical contact for up to a month. It’s also normal to experience a feeling of tightness in the breast area as your skin adjusts to your new breast size. This tightness is particularly common if the implants were places submuscularly.

You won’t see the full results of your enhancement until your breast tissue and muscles adjust. If the breast implant was placed under the muscle, you may have difficulty raising your arms above your head until you heal and we will advise you in relation to movement and exercise.

Photos are usually taken post-operatively as a record, and to help manage your care.

Post-operative care

Mr Meagher will provide you with continuous and comprehensive post-operative care. For most patients this means using a post-operative bra or sports bra for extra support and positioning while you heal. Mr Meagher will tell you more about the recovery process and make recommendations based on your individual case. If any unusual symptoms occur after surgery, such as fever, or noticeable swelling or redness in one breast, you should contact us immediately. If outside working hours you should contact the ward of the hospital in which you underwent surgery.

You may be advised to tape the area of the incision for up to 6 months after the surgery. The tape should not be removed for baths or showers. Or you may be advised to apply moisturiser to the scars each day. You can resume gentle exercise within a couple of weeks and increase your exercise at a comfortable pace, but avoid intense physical activity for the first 6 weeks after your surgery.

Follow-up examinations

We will arrange for follow-up examinations shortly after your surgery. The exact timing of these will depend on your case and are followed by a check-up every 6 months to a year.

Longevity

The design of breast implants and advances in gel technology have improved considerably in that last few years. Breast implants generally last 10 years or more and, in some cases, they may last as long as 20 years. Breast implants can be removed at any time and, after 10 or more years, some women opt to replace older implants with newer models.

Potential complications

The vast majority of breast augmentation procedures don’t create any side effects or complications. However, there are risks associated with any type of operation and breast surgery is no exception. Mr Meagher will explain the possible risks, which are rare, but may include:

1. Pain: As with any surgical procedure, pain of varying intensity may occur following breast implant surgery. You will be prescribed some pain medicine to take in hospital and at home after your discharge, if you need it. Improper implant size, placement or surgical technique may result in additional pain. Very occasionally, severe pain with arm movement has been reported. Pain may also occur later with capsular contracture (see potential long-term side-effects below).

2. Swelling: Swelling post operation is unavoidable and may take 3 – 6 months to settle completely.

3. Infection: Infection does not happen very often and you will be given an antibiotic at the time of your surgery to prevent this. If you do develop an infection, see Mr Meagher as soon as possible. In most cases, the infection can be treated with an antibiotic but if that doesn’t work, we may need to remove the implant until the infection has cleared. Later, the implant can be replaced. Most infections can be treated but they can cause serious problems and increased scarring.

4. Bleeding/ Haematomas: Haematomas are a solid swelling of clotted blood within the tissue and they can happen after any surgery. The risk of infection is higher if a large haematoma or seroma (a collection of watery fluid within the tissue) collects immediately after surgery. Mr Meagher may use a surgical drain to help prevent small haematomas but, in some cases, Mr Meagher may need to re-operate to remove a large haematoma. Reported chances of haematoma after breast enhancement are only 1.6%.

5. Changes in nipple and breast sensation: The breast and nipple may become painfully sensitive or may lose all pleasurable sensation. In most cases, these changes are temporary but, in rare cases, nipple sensory changes are permanent. Breast feeding may not be possible afterwards.

6. Poor wound healing: Healing can take longer in cases of:

• Infection
• Bleeding
• Fluid accumulation
• Overly tight stitches
• Overlarge implants
• Improper support during healing
• Pressure against the scar tissue

To help your wounds to heal properly, we recommend you wear a sports bra 24/7 for 6 weeks until review . Wound healing may also take longer in patients who have diabetes, or other medical conditions, or who smoke.

7. Rotation: On some rare occasions the implant might rotate. Proper placement and pocket dissection reduces the risk of this and textured implants encourage adherence to the breast fibres, reducing the risk even further. If an implant does rotate we may need to operate again to reposition it.

Potential medium-term side effects

1. Scarring: There will be a scar where Mr Meagher has made the incision into your skin. The position, the length, and the type of scar will vary according to a number of factors. Some patients may develop a thick, red scar known as a hypertrophic scar. Sometimes, scar tissue can extend beyond the original incision. This is called keloid scar and is difficult to predict.

2. A breakdown of skin: This is called necrosis and can happen when the flap over the implant is too thin or there is trauma to the skin during surgery. It may require removal of the implant.

Potential long-term side effects

1. Capsular contraction: The body’s normal response to a foreign body, such as a breast implant, is to form a shell, or a capsule, of tissue around it. This tissue may tighten or contract and may cause:

• Extreme hardening of the breast
• Pain ranging from mildly uncomfortable to severe
• Extreme sensitivity to touch
• Wrinkling or distortion of the breast
• Movement or displacement of the implant

If the contracture is severe, we may need to remove the implant. Capsular contracture is poorly understood but may depend on many factors, including:

• The surface of the implant – capsular contractures are much less likely to form around textured implants
• Where the implant was positioned
• The technique used by Mr Meagher
• How well the surgical site was protected after surgery

There are fewer cases of capsular contraction in patients with submuscular placement of the implant and in those with textured implants.

2. Rupture or gel leakage: The implants used by Mr Meagher have a thicker shell which incorporates a barrier layer to reduce the risk of gel diffusion. They also feature high-viscosity silicone gel to reduce the possible effects of rupture. Improvements in manufacture and design have contributed to the lower rates of rupture and/or deflation. If a silicone gel implant ruptures, the gel is usually contained within the capsule around the implant and very rarely would it migrate within the body. If an implant ruptures, the symptoms may include:

• Lumps in the breast
• Decreased breast size
• Distorted breast shape
• Asymmetry
• Pain

If you think you have any of these symptoms, contact us immediately. We may need to remove or replace the implant.

3. Gel diffusion: This is when the gel bleeds through the shell into the surrounding breast tissue. This can happen even when there isn’t a rupture or a tear in the implant, although it’s very rare these days thanks to improvements in implant and gel design. Although most of this gel diffusion will be absorbed by the capsule surrounding your implant, your body’s scavenger cells, or macrophages, may try to destroy this silicone. If the silicone cannot be destroyed, it is carried by the scavenger cells to the lymph glands for disposal.

4. Calcification: Calcium deposits can form in the scar tissue surrounding the breast implants and this may cause pain, firmness and be visible during mammography. Your doctor must make sure that these deposits are not the calcium deposits that are a sign of breast cancer. Additional surgery might be necessary to remove and examine any calcifications.

5. Granulomas: Where silicone gel leaks into the breast and other body tissue, including the lymph nodes, sometimes small reactive lumps may form. If there’s a large amount of leaked silicone, larger lumps may form. These lumps are described as granulomas. They are not cancerous, but it may be difficult to distinguish them from cancer so we will examine these breast lumps using ultrasound or mammogram just to be sure.

Other potential issues

Because of the very nature of cosmetic surgery, sometimes patients can be dissatisfied with the results. It could be that the breasts are not exactly the same size and shape as each other, the implant may have moved or be the wrong size or shape. Patients may also be dissatisfied with the way the implant feels or the appearance of surgical scars. In the case of saline (salt and water) implants, the saline solution may lead to more pronounced ‘sloshing’ and movement, compared to cohesive gel silicone implants. Visible and palpable wrinkling and creasing may occur with all implants, particularly saline ones. These problems are more visible when there is very little breast tissue overlaying the implant and where the breast is unsupported by a bra or equivalent clothing. If you have any concerns at all, please talk to us about them at any time.