Lotus Medical Int.

Breast Augmentation

The future of Medical Tourism

In this module

• Breast augmentation introduction

• Breast augmentation surgical procedure

• Different types of breast implants

• Breast implant placement

• Types of incision

• Round and Teardrop implants

• Implant profiles

• Recovery from breast augmentation

• Possible complications

• Other important information

Learning outcomes

By the end of this module you will:• Understand the Breast Augmentation surgery• Know the different types of implants available.• Know some of the complications that may arise

Breast Augmentation

Surgical Procedure

• General Anaesthetic• 1 - 2 Hours• 1 night in hospital• Minimum 10 day stay recommended, surgery in BHP can facilitate

shorter stays• Implants placed through incision under the crease in the breast or

underneath the armpit.• We do not offer surgery though the nipple as it can desensitise the

breast and stop the ability to breast feed.

Types of Implants• There are two primary types of material used in breast implants,

silicone-filled and saline-filled.• In both cases, the implants have a silicone shell, but while silicone

implants are also filled with a silicone material, saline-filled implants are filled with a sterile and contained saltwater.

• Overall, silicone is lighter in weight than saline, and after proper healing, they tend to have a more natural soft feel. Saline-filled implants are generally lower in cost, and although they may sound like they are simply filled with water, causing many women to worry about leakage, in fact they are created from a gelatin-like material that resembles a solid more than it does a liquid.

Types of Implants• More rupturing with saline• Years ago they were taken off the market now back• Saline is filled once inserted so more likely to rupture

Breast implant placement

Breast implant can be placed by any one of four different methods:• Sub-glandular Breast Implant Placement (also known as “Overs”):

The breast implants are placed below the breast gland but above the muscle. The term ‘over’ derives from the placement of the breast implant over the muscle.

• Partial Sub-muscular Placement (also Known as Dual Plane Placement): This placement has many names, but essentially the implant is placed partially below the muscle. This can also be referred to as partial submuscular, partial subpectoral, and, although it’s not really correct, submuscular and subpectoral. Sometimes people even refer to this placement as ‘unders’, but that term should really be used for complete submuscular placement.

Breast implant placement

• Complete Sub-muscular Breast Implant Placement (also known as “Unders”): Here the breast implant is placed completely below the muscle. This is correctly referred to as submuscular or subpectoral.

• Sub-facial Breast Implant Placement: There is a thin layer of tissue called the fascia covering the muscles of the chest. Some surgeons will separate the fascia from the muscle and place the breast implant under the fascia. Sub-fascial placement is offered by few plastic surgeons.

Types of incisionThere are four primary incision methods used to place the implant in breast augmentation. These methods are:

Types of incision• The most common is the inframmary incision. One benefit to this

method is that both silicone implants and saline can be placed through the incision. Additional benefits include the greater likelihood the procedure will not inhibit breast feeding along with the reduction of possibility for breast asymmetry resulting from inaccurate placement. Some women, however, are not fond of this method in breast enhancement because of the noticeable scar it leaves.

• The transaxillary and transumbilical methods are excellent methods to hide the scar because both types are well away from the breast. Due to the distance away from the breast, however, only saline implants can be placed this way because they are not filled until they are placed. One possible concern with either of these methods is that the surgeon may have more of a difficult time to place the implant in its ideal location for natural looking results.

Types of incision• Under the breast is much less invasive

Round & Teardrop implants

Breast implants also vary according to shape, with the primary choices being round or teardrop shaped.

Round breast implants•Round breast implants are the most common choice for breast augmentation surgeries, since they have the ability to create the maximum amount of lift and fullness in the breast. They provide more fullness on the top of the breast, which can enhance the appearance of the woman’s cleavage. •However, some women feel that round implants look artificial, and prefer the less pronounced appearance of the teardrop implants.

Round vs. TeardropTeardrop Implants•Teardrop implants create a naturally sloping breast contour, with the majority of the breast volume being placed on the lower portion of the breast as opposed to the top. •Teardrop implants do not provide as much cleavage enhancement as do round implants, but they can provide a more anatomically natural appearance. •Round implants are less expensive than teardrop implants. •Additionally, using round implants eliminates the concern of the implant slipping and changing position, since even if some rotation occurs, the symmetrical shape will prevent an unnatural breast contour. A consultation with the doctor can help determine which type of breast implant is right for the patient depending on their desired look.

Round vs. Teardrop

Teardrop Implants•Teardrop offered in women with little breast tissue and a round implant will not have an natural look.•They are quite often offered to women with a VERY slight droop in the breast as it can slightly raise the level of the nipple line•They will not be offered to people who are highly active or do a lot of sport due to the high risk of rotating.

Implant profiles

Implant profiles• Profiles are available in either low, moderate, or high. The decision

upon which is right for the patient is going to be highly dependent upon what the surgeon determines is necessary to achieve the desired look.

• Lower profiles tend to be used for women with a wider breast diameter, such as is normally the case for women with a bra band size of 38 inches or greater.

• Higher profiles might be more appropriate for a woman with a smaller breast width but who wants a larger breast size such as a D cup or DD cup.

• The higher profile implant will have a smaller diameter so that it can fit within the dimensions of the breast, but will offer a higher projection so as to achieve the goal size.

Recovery• This question depends upon a variety of issues, not the least of which

is the size of the implant. The larger the implant the greater the skin tissue and muscles will need to stretch which can increase the intensity and time to recover. Additionally, health, incision method chosen, and attention to recovery instructions can impact the length of the patients recovery.

• That said, recovery from Breast Augmentation Surgery is usually very easy. Most patients describe a feeling of being ‘uncomfortable’ rather than being in pain.

• Patients can start non physical activities within a few days.• Patients cannot swim until the incisions have healed over, usually

about 10 – 14 days..• Patients can resume physical activities after 6 – 8 weeks

Possible complications• The most common is capsular contracture. This occurs in less than

5% of patients. The body recognises the implant as a foreign object and the immune system starts to attack it forming a capsule around the implant. This can eventually lead to hardening of the Implant which may after time mean that the surgery needs to be redone.

• Capsular contraction is twice as high in smokers as in non-smokers.• Regular massage stops capsular contracture and textured implants• If you have CC once its likely t happen again• CC can only be corrected through the removal of the implant or

removal and replacement. Some surgeons will replace them some will not, this is dependent and on the surgeon and the patient.

Other important informationDo I need a sports bra?

Surgeons suggest these some don’t. If you are sure about what size you would like to be after your surgery then take a bra with you. Buy it at a shop where you can return it just in case you do not use it. Otherwise we can advise you on where to get one when you are here.They are not included as part of the package and you can buy one from your medical host of a sports store.

What is the difference between Breast Augmentation and Breast Lift?Many women who want to change the shape of their breasts think that Breast Augmentation is the way to do this. Breast Augmentation does not alter the shape of the breasts it only makes them larger. If women are unhappy with the shape of their breasts due to sagging then a Breast Lift or possibly Reduction is required. This is where the level of the nipple is lifted and it is much more inlvoled surgery than just Breast Augmentation alone. Quite often Breast Lift Surgery is done in combination with Breast Augmentation Surgery.

Should I go Over or Under the muscle• The trend towards placing under the muscle developed in the early 1990s

as saline implants were the only choice for women to use. Prior to that, silicone implants were placed over the muscle because they would create a fuller looking breast and the implant would not show through the breast tissue.

• If placed over the muscle, the saline implant can actually show a rippling effect through the breast tissue creating an unnatural appearance.

• Now that silicon implants are back you may find more surgeons recommending placement of the implant either over the muscle or only partially under the muscle.

• Over or under will be decided during the consultation and depend on the expected look the patient wishes to achieve.

How soon can I return to work• Generally speaking it is advisable to take at least 7-10 days off work after

breast augmentation.• Remember, in most cases the patient will be required to stay in Thailand for

9 days after surgery. Meaning they should be fine to return to work once they get back home.

• It would be advisable not to return to work while still taking prescription pain medications.

• If you job involves heavy lift or physical activity you may need to discuss your return to work with your surgeon.

How soon can I exercise•There should be no physical activity for the first two weeks, with the exception of static stretching. •At weeks 2 – 6 The patient can add light cardio and lower body workouts but be smart about impact! They won’t don’t want to be trying out their newfound bounciness on the treadmill for at least the first four weeks. •They should stick to low or non-impact machines like the elliptical or the stationary bike. It’s ok to work hard. Remember it is only 2 weeks post op, and the implants need time to settle and heal properly.•At 6 weeks after surgery, they can start slowly back into resistance training with low-weight, high-rep exercises designed to recondition the pectoral major and shoulder girdles since they will be weak and tight. Put into practice, this means starting with kneeling push-ups and light dumbbell bench presses. These upper body exercises are not to be attempted until after 6 weeks in submuscular patients and breast reconstruction patients.

I want to go from a B cup to a D cup•Implants do not come in cup sizes it is not possible to ask for a D cup implant. Instead, implants are available in sizes measured in cubic centimetres such as 250cc, 375cc, 450cc and so on. These differing sizes range from as small as 100cc to as much as 1200cc, with the average size measuring about 350cc.•Since the body of each patient is different, the different implant sizes can look quite different on each body. This is why it is important o focus on the approximate size the patient would like to end up. •They can communicate this accurately to the doctor during the consultation so they can decide upon which breast implant size will achieve their desired look.

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Recap

By now you should:• Understand the Breast Augmentation surgery• Know the different types of implants available.• Know some of the complications that may arise