Breast augmentation is designed to achieve a desirable and attractive size and shape of the breast. The most common method of breast augmentation is the use of silicone implant. The latest generation of silicone breast implants from renowned manufacturers is generally excellent in terms of quality and safety. Round and anatomical implants are available. Round implant is a versatile device that gives satisfaction to patients. Anatomical implant provide a more natural looking breast especially in thin patients with tissue deficiency in the upper chest. The other method of breast augmentation is the use of the patient’s own fat. Fat graft is harvested from the patient’s own body, usually from the tummy or thighs and injected into the breast according to the required shape and size.
Breast augmentation with silicone implants is usually performed under general anaesthesia although in selected cases this can be done under sedation and local anaesthesia. The implant can be inserted through a number of routes. The inframammary route is a popular method in which an incision is made on the skin fold just below the breast. Axillary route is popular for many Asian patients where the incision is made in the armpit and the implant is inserted through the incision. Implant can also be inserted through an incision made around the areola of the breast. The implant is placed either beneath the breast or beneath the chest muscle. In some cases part of the implant is under the breast and part of it is under the chest muscle.
Many women experience unattractive changes in their breasts due to pregnancy, weight loss, gravity pull and aging process. The breast loses the youthful shape, firmness and contour. The skin elasticity is lost, the suspensory ligaments of the breast are stretched, and the breast undergoes atrophy and becomes smaller. The breast appears saggy and the nipple-areola points downward and outward. This condition is called breast ptosis.
Breast lifting (mastopexy) is a surgical procedure designed to correct breast ptosis. The aims of this procedure is to reshape and re-suspend the substance of the breast to it’s normal shape and position. At same time loose excessive skin is removed. The shape and size of the nipple-areola can also be adjusted as well. Breast lift procedure can rejuvenate the breast to a more youthful and attractive profile. Depending on the various factors that are considered during assessment, breast lift is performed as a standalone procedure or as a part of a combined procedure. If the volume of the breast is adequate, breast lift alone is performed. In cases where the saggy breast also loses significant volume, then a breast implant can be used to augment the breast and at the same time uplift the breast to a more projected position. On the other hand, if the saggy breast is also very voluminous, then breast lift can be combined with breast reduction where the size of the breast is reduced simultaneously.
Breast lift is performed in a proper operation room setting in a hospital. Standard breast lift generally requires general anaesthesia. The incision is made around the nipple-areola complex. Depending on the extent of the breast ptosis and skin excess, an addition vertical incision may be made from the nipple-areola to the lower pole of the breast. After the surgery a special supporting bra is applied to support the breasts.
Patients with excessively large breasts may feel awkward and even embarrassed at times. In addition, the condition may also cause difficulty in breathing, back and shoulder pain, bra-strap indentation on the shoulder skin, poor posture and problems during exercise. In many cases the breast is also saggy and ptotic.
Breast reduction is a surgical procedure specially designed to address this condition. It can be performed as a daycare procedure where the patient can go home on the same day, but on occasions an overnight stay is recommended. Breast reduction is performed under general anaesthesia. The incision is made around the nipple-areola complex with a vertical extension on the lower part of the breast. Excessive breast tissue is removed, the nipple-areola complex is repositioned to a higher position, and the extra skin is excised to conform to the new shape and position of breast. Postoperatively patient is advised to wear a special bra for support. Depends on the nature of their jobs, patients may return to work 5-10 days after the operation.
Breast Reduction (Male Patients)
Gynecomastia essentially means breast enlargement in men. The condition is fairly common in males during the puberty due to hormonal changes. Some drugs such as cimetidine, digoxin, spinonolactone are known to cause gynecomastia. Other causes of gynecomastia include liver disease, malnutrition and hormonal disturbances. However in many cases the underlying cause remains unknown.
Gynecomastia is a condition that can cause great embarrassment to male patients. Management involves identify and correct the underlying cause. Treatment of the enlarged breasts may be performed with either liposuction or excision, or in certain cases combination of both. In mild to moderate gynecomastia without excessive skin, liposuction is an ideal treatment modality. Excision method employ a semicircular incision around the areola to move the unwanted breast tissue. The operation can be performed either under local or general anesthesia. Patient is discharged on the same day. In severe cases excision of the excess skin has to be performed as well and this can be done under general anesthesia.