Please note: Charles Nduka has never used PIP breast implants and only uses FDA-approved implants for primary breast augmentation.
Causes of small breasts
The size of breasts is genetically determined. Once developed, the breasts may fluctuate in size in response to changes in weight, pregnancy and breastfeeding. The ageing process causes the shape of the breast to change so that they gradually droop (called ptosis). This effect is greater following pregnancy, breastfeeding and in particular after a large weight loss. Most women have breasts of slightly different sizes, but occasionally a very marked difference may develop.
Breasts can be made larger by placing an implant either under the breast tissue or behind the muscle on which the breast lies. Implants are usually inserted through incisions in the fold beneath the breast (infra-mammary fold). Alternatively, the incisions may be made around the areola or in the armpit, with the implants placed either under the breast tissue (subglandular) or behind chest muscle (subpectoral), both possible incision areas for breast implants.
At your consultation, you will have discussed your preferred approximate bust size following surgery. Some idea of what you will look like can be obtained by the ‘rice test’. For this, place some uncooked rice in a freezer bag (or similar). Place this inside a plain (unpadded) bra similar to the type you usually wear and measure your desired cup size. Start with 250g of rice and add or remove some until you are comfortable with the additional weight. This procedure will not show you the actual appearance after surgery but will go some way towards letting you know what to expect”
The actual volume of implant used will depend on your skin elasticity, the amount of breast tissue that you already have, and on Mr Nduka’s judgement of what will look natural and appropriate.
No aspirin or medication containing aspirin should be taken for ten days before surgery. If you smoke you should cut down for one week before surgery and stop smoking completely three days before surgery to reduce the likelihood of post-operative complications. The operation is performed under general anaesthetic with a one night stay in a hospital.
A breast implant is made of an outer layer of silicone and is filled with silicone gel. For some types of breast augmentation (for example for breast asymmetry), a breast implant filled with salt water is used. Some implants are round and others are shaped more like a natural breast. Either can give excellent results and the selection will depend on the desired result and the amount of breast tissue that you already have.
The manufacturers expect that the life expectancy of breast implants is at least 10 years and good quality implants can stay in without problems for a much longer time. It is important to know that not all breast implants are the same, both in terms of quality and cost. If you are considering breast augmentation you should ask what manufacturer’s warranty or insurance is available to cover potential problems in the future.
Expectations and complications
Leakage of silicone can occur either as a slow seepage or following rupture of the implant. This silicone is almost always contained within the fibrous capsule in which the body forms around the implant. Silicone leakage has never been proved to cause serious health problems. The capsule which the body normally forms around the implant can become thickened and contracted. The newer designs of implants have features to reduce the likelihood of this happening. This occurs to some extent in around 10% of patients and usually starts six or more months after surgery. This can lead to pain, and/or an abnormally hard feel of the implant in the breast. Treatment may be needed and occasionally removal of the implant.
Breast augmentation does not usually interfere in breastfeeding, and there is no evidence of any significant quantities of silicone in breast milk (in fact there is more silicone in the milk of bottle-fed babies due to the teats). The presence of breast implants does make mammography more difficult.
You should tell the radiographer if you are due to have a mammogram that you have breast implants. Special X-ray views can be taken to minimise this interference. Most women have some degree of asymmetry between breasts and breast augmentation may occasionally exaggerate this difference.
The breasts are swollen and appear bigger than you expected immediately after surgery. A breast that has an underlying implant will not necessarily feel like a normal breast, and some women may be very aware of the implant as a foreign body within the breast.
There is usually a difference in skin and nipple sensation following breast augmentation. The size and shape of the breast following breast augmentation surgery will adjust with time and is to some extent unpredictable.
It is also not always possible to create a cleavage with breast augmentation. This depends on the shape of your rib cage. A very curved rib cage with a prominent breastbone makes creating a deep cleavage difficult.
The weight of the implant may influence the age-related changes that normally take place in breasts. Breast augmentation will always leave scars on the breast or in the armpit, and although the scars will settle over 12 or more months, the appearance of the scars does vary between different individuals. This scarring is placed in such a position as to minimise visibility even when wearing a swimming costume.
Complications that occur with breast augmentation include those associated with all forms of surgery, as well as the specific problems of bleeding and infection. Any infection that may occur in the tissue around the implant can usually be treated with antibiotics but may require surgical removal of the implant.
Safety of silicone
Whatever the filling of the implant, the outer layer is made of silicone. Silicon is a naturally occurring element which becomes silicone when it is combined with carbon hydrogen and oxygen. Silicone is manufactured into many items including cosmetics, foods and medical implants. Many studies have been conducted to establish whether silicone breast implants cause certain diseases. As a result of these studies, we can say that at present there is no evidence to suggest that silicone breast implants are associated with an increased incidence of breast cancer. There is also no evidence to suggest that these implants cause autoimmune diseases such as rheumatoid arthritis. For information about ALCL please see the advice from BAPRAS.