Breast augmentation is one of the most common cosmetic surgeries requested by female patients. It is worth emphasising that breast augmentation surgery is not just a procedure involving placing an implant to increase the cup size of the breast. It involves formal pre-operative consultation, clinical examination, patient education, implant selection that fits the patient’s overall aesthetic appearance (characteristics of hips, waist, chest and shoulders), optimum design and location of the incision, surgical placement of the implants at the correct location and post-operative management. The patient is strongly encouraged to be actively involved in the whole process in order to achieve the outcome which will satisfy both the patient and surgeon.
The breast is a very personal three dimensional structure of intimate tissue of the body. Therefore, it is important to think in multiple dimensions rather than just fixating on the implant shape (round or anatomical implants). A well selected implant requires more than just the measurable dimensions (base width, height and projection) and size. It must be in good equilibrium with all the soft tissues of the patient, and fit well with the aesthetic ideal for the patient which is variable in different cultures and ethnicity. Also, the approach and surgical planning for breast augmentation also differs amongst the young patients, patients with aging breasts and patients after significant weight loss.
There is considerable anatomical asymmetry of the breasts and nipples even among normal women. The asymmetry can be of either the contour, the volume, inframammary fold level(breast crease), nipple position or the pigmented areolar area around the nipple or all of the above resulting in a complex breast augmentation. Thus, it is critical that patient is carefully made aware of such asymmetry during clinical examination in front of the mirror, as almost all if not majority of such asymmetry will remain after the surgery despite the breasts having more fullness and overall aesthetic enhancement. Such attention to detail will also minimize dissatisfaction of the patients post-operatively.
During consultation, pre-op photographs and more importantly, the adoption of most advanced and latest computer generated 3D simulated images provide better communication as patient can appreciate where will these changes occur with different implant dimensions and sizes. Additionally, the 3D images will also be used intra-operatively as an additional surgical planning tool for the desired outcome. It is crucial to realize that the 3D computer imaging is a simulated result and cannot promise the patient the exact same outcomes but every effort is put in to achieve the most optimum appearance for each patient.
The potential risks or complications are grouped into 3 categories:
Examples includes bleeding, haematoma, infection, scarring, altered breast sensation, breast asymmetry, capsular contracture, implant rupture and wrinkling.
There is an emerging and expanding role for fat grafting in breast surgery including application of fat injection technique in breast augmentation. This combined use of fat grafting and breast augmentation is known as ‘composite breast augmentation’ or ‘hybrid breast augmentation’. The main indications are inadequate soft tissues, significant breast asymmetry, constricted breast or when the patient request an implant size that exceeds the breast width (diameter) and in the revision case after breast augmentation with implants.
Breast augmentation is a process and the first consultation can be the most difficult one. The first step is to ensure that patient is made as knowledgeable as possible through preoperative information. Nevertheless, patient presenting for breast augmentation can be overwhelmed with the basic and clinical information about the surgery. Thus, during the consultation, Mr. Fuan Chan will critically assess, perform clinical examination in front of a mirror and discuss the various components involved in the breast augmentation surgery and guide you through the process. Mr. Chan will explain the risks and complications, including the alternative options to the proposed breast augmentation surgery. You will have plenty of time to think over and come back with your questions for the subsequent consultations before committing to the surgery.
Breast lift surgery, known as mastopexy in plastic surgery, is a surgery performed on the breast to re-shape the drooping or sagging breast (breast ptosis). It is important to understand that breast lift surgery does not only lift the breasts but also the nipples. The causes of breast ptosis are multifactorial. Pregnancy, breastfeeding, aging, severe weight loss, gravity and hereditary factors can all be factors in the development of breast ptosis.
A grading system has been developed to assess the severity of breast droopiness (breast ptosis). The breast ptosis is graded based on the nipple postion in relation to the inframmary fold (breast fold underneath the breast). Such grading facilitates communication, documentation, pre-operative and post-operative comparison, and provide guidance for the choice of breast lift surgery.
There are 3 common types of breast lift surgical procedures.The type of breast lift procedure utilised is dependent on the severity of the breast ptosis(droopiness), nipple ptosis (droopiness) and the amount of skin laxity. The simplest type of breast lift surgery is only suitable for patient with minimum breast droopiness and vice versa.
Breast lift surgery can be performed as either a standalone procedure (Maxtopexy only) or with implant augmentation (Mastopexy Augmentation) surgery, which may be indicated in certain group of patients such as those patients looking for fuller breasts in addition to breast lift surgery.
Breast lift surgery with augmentation is a much more challenging procedure because the surgery is trying to achieve aesthetic outcome in the presence of the opposing competing forces between the implant insertion surgery (leading to expansion of the breast and skin tissue); and the breast lift surgery involving resection and reduction of the breast and skin tissue. Thus, the complication and revision rates are higher compared to breast lift surgery alone. Of note, the challenge is even more difficult and complex in patients who have severe weight loss.
In breast surgery, the consistent good outcomes are the result of a defined pre-operative plan. Pre-operative markings are performed with the patient standing on the morning of the surgery. The breast lift surgery is performed under general anaesthesia either as a day case or overnight stay if indicated. Examples of potential risks and complications include bleeding, haematoma formation, infection, seroma, wound breakdown, skin necrosis, altered nipple sensation, inability to breast feed and hypertrophic scarring, and may requires further revision in certain patients.
Breast reduction surgery attempts to transform symptomatic large breasts to a comfortable and aesthetically pleasing breast which fits the patient's overall form, function and aesthetic appearance. Ensuring that the operating surgeon and the patient are in agreement regarding the operative goals is the key to success in breast reduction surgery.
Patients seeking breast reduction surgery often complain of neck, shoulder and back pain with or without breast pain. Some patients will also complain of discomfort with rashes on the skin of the breast and breast fold (inframmary fold area). Socially, patients tend to avoid outdoor activities such as swimming or sporting activities with many patients wearing loose clothing to disguise or conceal their oversized breasts.
There are three main types of breast reduction surgical techniques, and majority of the outcomes are comparable with high patients' satisfaction rate. As breast reduction surgery involves surgical removal of breast tissue and the breast skin, the patient must be made aware of the fact that scars are unavoidable. Reducing the scar is good surgical practice and patient will be happier. Thus, one of the objectives is to get the same results with a shorter or smaller scar.
Pre-op markings are done with the patient standing on the morning before the surgery. The surgery is performed under general anaesthesia and an overnight stay is the standard practice. Patients will wake up with a supporting dressing on their breasts and surgical drains if necessary. Some patients may require additional nights stay for management of pain, post-operative nausea, vomiting, poor mobility due to generalised weakness, or for complications such as bleeding or haematoma formation. Examples of other complications include infection, seroma, wound breakdown, skin necrosis, altered nipple sensation, inability to breast feed and hypertrophic scarring.
During the consultation, Mr. Chan will critically assess and perform clinical examination in front of a mirror and discuss the various components involved in the breast reduction surgery and take you through the process. Mr. Chan will explain the risks and complications, including the alternative options to the proposed breast reduction surgery. You will have plenty of time to think things over and come back with your questions for the subsequent consultations before committing to the surgery.
New technology has enabled cosmetic surgeons to enhance the patient experience and better illustrate the results of their chosen procedure. For breast augmentation, the use of 3D imaging technology and Virtual Reality (VR) means the patient can see what a range of adjustment options will look like and get a panoramic 3D view of how their breasts will look on their body.
Mr Chan is one of only a few cosmetic surgeons in Ireland using 3D Imaging Technology to show patients a panoramic view of what can be achieved from their breast augmentation procedure and how it looks in the context of the rest of the patient’s body.
Crisalix, a 3D cosmetic surgery simulation app, allows the cosmetic surgeon to capture and upload a 3D image of a patient’s body and show them through gradual changes exactly what their proposed procedure will look like so that shape and size can be decided upon before the procedure takes place.
Wearing a pair of 3D Imaging Virtual Reality Goggles, the patient can actually see what the breast augmentation will look like on their body from every angle to get a perfect view of how it suits their body shape and build.
This imaging software can be emailed as a link to patients so that they can open it easily and at their own convenience at home, and see what adjustments will look like. No new software or programmes are needed for this. The patient can then discuss the changes with loved ones and decide, with certainty, on the size or level of breast augmentation they want and what suits their overall body shape.
Mr. Fuan Chan MD FRCSI(Plast) will be happy to answer your questions about aesthetic, plastic and reconstructive surgical procedures that
you may be considering.
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