🩺 Overview of Breast Augmentation
Breast augmentation enhances breast volume and shape using implants placed under breast tissue and/or pectoralis muscle. Indications include volume restoration post-pregnancy, aging, or weight fluctuations, and reconstructive purposes such as post-mastectomy.
🎯 Indications
- Cosmetic: Enhance body image, self-esteem, and sexual satisfaction; address volume loss.
- Reconstructive: Post-mastectomy, congenital anomalies, or asymmetry.
🎯 Surgical Goals
- Achieve a natural appearance with optimal volume and symmetry.
- Minimise complications associated with medical implants.
- Improve psychological well-being and quality of life.
🔪 Surgical Approaches
Incision Types
- Inframammary: Excellent access; visible scar.
- Periareolar: Discreet scar; potential for altered nipple sensation.
- Transaxillary: Scarless on breasts; less direct access.
Implant Position
- Subglandular: Fast recovery, minimal distortion.
- Subfascial: Implant sits above muscle fascia.
- Subpectoral (dual-plane): Lower capsular contracture risk, preserved nipple sensation; slower recovery.
🧬 Implant Options
| Implant Type | Pros | Cons |
|---|---|---|
| Saline | Adjustable, smaller incision, less costly | Heavier, more rippling, higher deflation risk |
| Silicone Gel | Natural feel, lower deflation risk | Fixed volume, larger incision, more expensive |
Meta-analyses show no major difference in safety, although silicone implants may have a higher capsular contracture rate (~7–13% vs ~4–8% for saline) Anthem+8Radiological Society of North America+8Allure+8impactfactor.org+4MDPI+4Allure+4.
⚕️ Prerequisites & Eligibility
- FDA age guidelines: ≥18 years for saline; ≥22 years for silicone implants Wikipedia.
- Medical clearance: exclude endocrine obesity, ensure good anesthetic fitness, require sustained follow-up.
- Lifestyle optimisation: Smoking cessation ≥6 weeks pre-op; informed consent.
🕒 Procedure & Recovery
- Surgery duration: 1–3 hours, typically under general anesthesia.
- Hospital stay: 1–2 days.
- Post-op care:
- Wear supportive garments (e.g., sports bra).
- Restrict heavy lifting/strenuous activity for 2 weeks.
- Resume normal activities within 2–6 weeks with permanent dietary and exercise changes.
⚠️ Complications & Long-term Safety
Early Risks
Bleeding, hematoma, infection, wound issues, sensory changes.
Late Outcomes
Capsular contracture, implant rupture/deflation, migration, chronic pain, hernia, nutritional issues, gallstones, need for reoperation.
BIA-ALCL
A rare T-cell lymphoma (~1:2,200 to 1:86,000 in textured implants) MDPI+2American Society of Plastic Surgeons+2Wikipedia+2. 1,380 cases and 64 deaths reported globally to FDA PMC+7U.S. Food and Drug Administration+7The Sun+7. Predominantly found around textured implants; treatable via implant removal and capsulectomy.
Breast Implant Illness (BII)
A minority report systemic symptoms such as fatigue and cognitive changes post-implant; data is still evolving American Society of Plastic Surgeons+15U.S. Food and Drug Administration+15American Society of Plastic Surgeons+15.
🔍 Surveillance & Imaging
- MRI surveillance: Begin 5–6 years post-placement; every 2–3 years thereafter American Society of Plastic Surgeons+1facingourrisk.org+1.
- Ultrasound: Valid alternative for rupture evaluation.
- Mammography is safe but images require technique adaptations.
✅ Evidence-Based Advantages & Limitations
Benefits
- Achieves 50–70% excess weight of cosmetic satisfaction improvement impactfactor.org+5Anthem+5Wikipedia+5.
- Enhances body image, psychosocial functioning, and sexual well-being.
Limitations
- Implants require eventual replacement (10–15 years) The Australian.
- Surgical risks exist: rupture, contraction, BIA-ALCL.
- Potential systemic symptoms (BII) under investigation.
💰 Costs
- UK: £5,000–£10,000 ($6k–12k)
- Bangladesh/India: ~$2k–5k
📝 Summary
Breast augmentation remains the most popular cosmetic surgery globally. Modern innovations like subfascial and dual-plane placements offer more natural results and fewer complications FDA Access Data+12American Society of Plastic Surgeons+12The Australian+12Allure. While generally safe, implants carry long-term risks including rupture and BIA-ALCL—especially with textured devices. FDA-approved patients require regular imaging surveillance. Decisions must balance aesthetic benefits with medical risks, ensuring comprehensive informed consent and lifelong monitoring.
