Breast Augmentation

What starts around the age of 10 and continues throughout life? Hint: It’s not menstruation (which stops before we do). The answer (unfortunately, but so true) is: our dissatisfaction with our breasts. Complaints begin almost immediately: they don’t grow enough, they grow too much, they’re not symmetrical, the nipples are too big, the nipples are too small, they’re sagging, they’re shriveled, they’re drooping.

Add to that the changing fashion trends, where at one point Twiggy’s flat chest is the model to emulate, and at another Pamela Anderson’s large breasts are the object of admiration. Keep in mind that body structure is not like the length of a skirt or dress that can be shortened or lengthened every season, and you’ll understand why the breast industry thrives. And thrive it does:

Push-up bras, minimizer bras, bras that enlarge the chest, silicone bras that just give a fuller look, cotton bras, lace bras, microfiber bras, in flesh tones and a variety of colors, front-opening bras, back-opening bras, bras with silicone straps, padded bras, bras with underwire, bras without underwire, sizes that range alphabetically, and apparently, all of this is still not enough. Fact: For quite a few years now, surgery has also been done on the breast itself, and breast augmentation surgeries continue to grow in popularity.

And why is all this happening?

Because breasts have long since exceeded their biological function. The original design was to provide a food pouch, where instead of a knife and fork, there was a straw (the nipple). But even today, with the resurgence of breastfeeding being fashionable, breasts are seen more as an ornament with an erotic role than a basic need for small babies. They play an important part in sexual attraction, they participate in foreplay and sexual intercourse, and most women view them as an integral part of their female identity, which includes not just body image but also a significant portion of their self-esteem.

What can breast augmentation surgery do? Enlarge, reduce, lift, and create symmetry. Now let’s break it down.

Among cosmetic surgeries, breast augmentation is considered the one that not only produces good results but also, and mainly, high satisfaction. The most common complaint after the surgery is “Why didn’t I go bigger?”

And yet—please take our advice seriously—a larger breast will indeed change how you feel about yourself, but it won’t necessarily improve the relationships you have, nor will it bring you the love you’ve been waiting for. Never, but never, undergo breast augmentation to please or gain approval from someone else.

If you’ve decided to go for it, please ensure you’re doing it for yourself.

Who is a candidate for breast augmentation surgery? In general, we can outline three groups of women seeking breast enlargement:

• Young women, who suffer from underdeveloped breasts.
• Women who have had children, whose breasts have shrunk and wish to restore them to their original shape.
• Women who need larger breasts for professional reasons, such as models, sex workers, and porn actresses.

What can be achieved with breast augmentation surgery? Enlarge the breast volume by up to two cup sizes.

At what age can you start? After puberty, when the body structure has stabilized. Unlike organs such as the nose, for example, which reach their final size by the end of puberty, breasts don’t have a final size. This doesn’t mean they continue to grow, but it does mean their size continues to change over a lifetime due to pregnancies, childbirth, and hormonal changes. So why did we say that the age to start is after puberty? Because generally, the breast size at this stage will be correct for the next ten years (unless these ten years include pregnancy and childbirth).

About Numbers and Letters Bra sizes appear as a combination of a number and a letter: 85A, 36C, etc. The letters represent the cup size, reflecting the size of the breast, and the numbers represent the chest circumference. Numbers like 70, 75, 85, etc., indicate the chest circumference in centimeters. Numbers like 32, 36, 38 indicate the chest circumference in inches, according to the American system.

It’s important to know that there’s a very close relationship between these two figures: cup size depends on chest circumference. This means you can be narrow in circumference (70) with a C cup, but if the chest circumference increases (80-85) and the breast size stays the same, you’ll drop to a B or A cup.

How do you increase the size of the breasts? By inserting implants, in the desired and appropriate size.

What are the implants made of? Silicone, or more precisely, dimethylsiloxane, a polymer based on silicon atoms. Silicone comes in various forms—liquid, “oily,” gel, and solid—properties that allow it to be used for various purposes in technology and medicine. For example: all syringes are coated inside with a thin layer of silicone, pacemakers are wrapped in silicone, there are artificial joints made of silicone, implants for the face, artificial tendons made of silicone, and there are medications that contain silicone. Silicone implants have been used in plastic surgery since the early 1960s, and today over two million women in the U.S. have undergone silicone breast implants.

Is silicone guilty or innocent? In the early 1990s, rumors spread about medical complications caused by silicone. As a result, the U.S. Food and Drug Administration (FDA) decided to stop allowing silicone gel for breast implants (but allowed its use for breast reconstruction after malignant tumors). For cosmetic purposes, the FDA allowed only silicone shells filled with saline solution.

Since then, numerous studies have been conducted, and committees have been appointed to investigate the truth of these allegations against silicone: The Israeli Ministry of Health received in 1993 a recommendation from a committee of doctors who concluded that there is no connection between silicone and breast cancer or other diseases. The U.S. federal court appointed a committee that studied the issue for two years. In January 1999, the committee concluded that there is no link between silicone and cancer or other diseases. A similar conclusion was reached by a committee in the U.S. House of Representatives and a committee of the American Internal Medicine Association.

Which type of silicone is best for breast implants? The answer to this question is quite clear: silicone gel provides a better cosmetic result, mainly because its volume remains constant and its texture is closer to that of natural tissue.

The volume of an implant made from a silicone shell filled with saline solution can change, and the shell itself may rupture. In such a case, the saline will be absorbed by the body, but the new breast will simply disappear.

In recent years, a type of silicone called cohesive gel has been used for implants. It is a form of silicone whose polymer is structured differently. Cohesive gel implants are somewhat firmer, and their advantage is that they tend to retain their shape and, even if the implant ruptures, the silicone is more likely to stay in place rather than spill. The downside of cohesive gel is that there’s only a short experience with it (around 5 years).

Besides these, there are other types of implants containing different substances, like soy oil, which was discontinued due to concerns it might be carcinogenic, peanut oil, hydrogel, and more. None of these materials have significant advantages over silicone gel, and they are all wrapped in a layer of silicone.

What does an implant look like? Most implants are shaped like a half-ball, not completely full and a little loose. There are now new implants on the market that are overfilled, meaning they are more prominent and somewhat firmer.

Cohesive gel implants are slightly firmer, and among them are “anatomical” implants—those that are somewhat round, but from the side they look like a teardrop. Does this sound better? Not exactly. It turns out that implants don’t always stay in place in the body and may rotate. An anatomical implant that rotates distorts the shape of the breast.

What sizes do implants come in? Implant sizes range from 75 to 800 cc. Implants larger than these sizes must be specially ordered, and their cost increases accordingly. It’s important to note that inserting particularly large implants can cause premature sagging due to the heavy weight of the implants.

For women seeking extremely large breasts—such as going from an A to a D cup or from B to DD—they cannot use regular silicone implants because their breast tissue is not enough to cover the desired volume.

In such cases, a tissue expander needs to be inserted into the breast to gradually increase its size to the desired volume, and only then will a special implant be ordered.

Do you need to replace silicone implants every few years? No. New silicone shells are stable, and if no issues such as hardness or loss of breast shape due to a ruptured shell arise, there’s no need to replace the silicone. Silicone companies, lacking data on what happens to silicone after 50 years (as with many medical innovations), recommend checking the implants manually once a year and considering replacement after 10-15 years.

Warranty It’s very important to ensure that you receive from your surgeon an accurate record of the implant size, type, and manufacturer so that the implant can be replaced if necessary. Also, make sure to keep the manufacturer’s warranty.

Breast Augmentation Surgery Where is the incision made? Silicone implants can be inserted through several locations. The incision location depends on the chosen insertion method: through the armpit, through the inframammary fold, or through the areola’s edge. Each method has its pros and cons.

The most popular method is the one that uses an incision along the inframammary fold. 

Possible Complications and Side Effects:

– Firm and High Breasts: In the first few weeks after the surgery, your new breasts may feel high and firm. Don’t worry, within a few weeks, they will soften and settle into their desired position.

– Uneven Sensitivity: You might notice that one breast feels more sensitive than the other. This is also normal and should pass.

– Tight and Shiny Skin: Not on your face, but on your breasts. This happens because the skin that once covered a smaller breast is now stretched over a much larger one. Give it some time, and you’ll see how your skin returns to normal.

– Feeling of Heaviness: Here’s some news for you: yes, you are indeed heavier. The additional weight on the front of your body can definitely affect your posture and the center of gravity of your body.

– Sore or Aching Muscles: This usually occurs in the chest muscles, but it should pass after three to four days.

Possible Complications:

1. Breast Deformation: A breast deformation occurs when a capsule (scar tissue) forms around the implant, creating a box-like structure around it. When this capsule tightens, it creates a feeling of hardness or rupture of the implant. The degrees of capsule hardness are classified into four stages:

   • In mild (stage 1 and 2), the implant can be felt upon touch, but there’s no visible hardening.
   • In stages 3 and 4, the breast becomes firmer and more spherical in shape, and the nipple may no longer be in its proper position (it may move to another location). The firmness may make the breast stay in place even when lying on your back (normally, breasts shift a little to the side when lying down). In rare cases, this causes pain, especially when lying on your stomach.

   What to do in such a case? The breast is opened, the implant is removed, the capsule is excised, and sometimes the implant is replaced with a new one.

2. Asymmetry Between Breasts: Unlike initial asymmetry in size, this refers to a mismatch in implant positioning, where one breast is higher than the other. This may occur due to improper implant placement during surgery (more common when the implant is placed under the muscle), or sometimes as a late complication due to capsule tightening on one side.

3. Infection: The risk of infection is higher in such surgeries due to the introduction of a foreign object into the body. Antibiotics are usually given before and after the surgery to prevent infection. In case of infection, symptoms may include localized redness, severe pain, fever, and sometimes purulent discharge from the incision. Initial treatment involves antibiotics, but sometimes the implant may need to be removed, the area treated, and surgery repeated after a few months.

4. Bleeding: Internal bleeding into the implant pocket usually absorbs on its own (if it’s minor). However, significant bleeding can cause swelling and pain, requiring the surgeon to drain the blood and stop the bleeding before re-positioning the implant.

5. Numbness: Temporary loss of sensation in the breast or nipple is common after surgery, and it usually resolves within a few months. In rare cases (1-3%), sensation may not return. Loss of sensation is more common with incisions around the nipple. The good news is that, despite the lack of sensation, the nipple will still become erect, and unless you tell someone, they won’t know you can’t feel it.

6. Implant Rupture: Silicone gel is encased in a flexible, solid silicone shell (like rubber). While the silicone is durable and resistant to extreme conditions, due to movement, the shell may sometimes tear due to “material fatigue.” In most cases, the silicone stays within the implant, and no significant issue arises. However, in some rare cases, the breast may become softer or harder, and it may feel different. This usually signals a rupture of the implant’s shell.

   Since there is no lab test to detect small ruptures, the decision to replace the implant is made clinically (based on physical examination and palpation). Ruptures are often discovered incidentally during mammograms or biopsies. What to do? Open the breast and replace the implant.

Clarifications Regarding Allergan Textured Implants:

You’ve likely heard reports in the media about Allergan breast implants and a rare type of cancer called BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma).

• BIA-ALCL is not breast cancer; it is a rare, treatable form of lymphoma that originates in the immune system’s lymphocytes and typically develops as a fluid collection around textured implants like Allergan or Silimed.
• This cancer is rare. In Israel, the incidence is about 1 in 10,000 women with textured implants (in Australia, the highest incidence is 1 in 3,500).
• It’s important to note that the risk of developing regular breast cancer is much higher (1 in 8). Therefore, BIA-ALCL is a very rare condition.

The disease is detectable because it often begins with fluid accumulation around the implant, which causes noticeable swelling of the breast (up to 2-3 times its normal size). Other less common symptoms include capsule hardening (capsular contracture) or severe pain.

The standard treatment is to remove the implant and surrounding capsule. Chemotherapy or radiation is rarely needed.

• FDA and European guidelines do not recommend the removal of textured implants unless there is a clear clinical indication.
• The recall mentioned in the media refers to products that have not yet been sold, not to the removal of existing implants.
• As the disease is rare and treatable, most cases only require implant and capsule removal, with replacement of the implant if necessary.

Leaks and Complications:

• Leakage: All silicone implants experience some level of microscopic leakage, but current evidence suggests that this has no significant medical impact. For example, breastfeeding is still possible with silicone implants.

• Wrinkling: Women with less breast tissue may experience wrinkling or folds in the skin above the implant. This can be minimized by placing the implant under the muscle or using cohesive gel implants (which do not wrinkle as easily).

• Double-Bubble Deformity: If there’s mild breast sagging, placing the implant under the breast (instead of under the muscle) is the best option to avoid a double-bubble effect, where the implant creates one contour and the sagging tissue another.

When to Contact the Doctor:

• In cases of severe bleeding or excessive swelling.
• If you develop a fever or any other signs of infection.

How Long Will the Results Last?

The results of breast augmentation are generally permanent. However, just like any other body part, the breasts will continue to age. While the silicone implant itself will not change over time, it provides additional support for the breast tissue as it sags with age.