Please note: Charles Nduka has never used PIP breast implants and only uses FDA-approved implants for primary breast augmentation.
Causes of small breasts
Genes determine the size of the breasts. 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.
An implant placed either under the breast tissue or behind the muscle on which the breast lies can make breasts larger. Mr. Nduka usually inserts implants through incisions in the fold under the breast (Infra-mammary fold). Alternatively, he may rarely opt to make the incisions around the areola or in the armpit, with the implants placed either under the breast tissue (subglandular) or behind the chest muscle (subpectoral), both possible incision areas for breast implants.
At your consultation, you will discuss your preferred approximate bust size following surgery. The ‘rice test’ can give you some idea of what you will look like. 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.
You should not take aspirin or any medication containing aspirin 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.
Mr. Nduka usually performs the operation under a light general anaesthetic for a one night stay in the hospital. Mr Nduka inserts implants in the dual plane in about 80% of his patients. Studies have shown that this provides greater coverage to the implants, lowers implant encapsulation, and reduces the chance of the implant becoming visible, especially in the cleavage area.
Some surgeons express a preference for placing the implant above the muscle because the operation is technically easier and faster. Whilst it is true that having a dual plane implant will be a little more uncomfortable for a few days, Mr Nduka feels that in the majority of patients (particularly slim patients) the advantages far outweigh any downsides.
Silicone gel fills the outer layer of a breast implant. For some types of breast augmentation (for example for breast asymmetry), salt water may fill the breast implant. Some implants are round and others are shaped more like a natural breast (anatomical). Either can give excellent results and the selection will depend on the desired result and the amount of breast tissue that you already have. Typically, if the implant is placed behind the muscle, a round implant is used, as the pectoral muscle helps to ensure a smooth transition in the cleavage area.
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 longer time. You should 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
It is important that you are aware of the longer term issues that can occur. Leakage of silicone can occur either as a slow seepage or following rupture of the implant. The fibrous capsule, which the body forms around the implant, contains the silicone. 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. This usually starts months or years after surgery. This can lead to pain, and/or an abnormally hard feeling of the implant in the breast. This may require treatment and even occasional removal of the implant.
Breast augmentation does not usually interfere in breastfeeding. 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.
You should expect swollen breasts which appear bigger 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. Mr. Nduka will place scarring 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. You may usually treat an infection that may occur in the tissue around the implant with antibiotics, but may require surgical removal of the implant.
Safety of silicone
Silicone usually makes up the outer layer of the implant regardless of the filling. When combined with carbon hydrogen and oxygen, silicone, a naturally occurring element, becomes silicone.
There have been many studies to establish whether silicone breast implants cause certain diseases. Based on these studies, there is no evidence to suggest that silicone breast implants are associated with an increased incidence of breast cancer. 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.