Whether it is done for cosmetic or reconstructive reasons, breast surgery is an important part of modern-day plastic surgery, with the potential to change a patient’s life for the better. Mr Seni Mylvaganam is a leading surgeon specialising in oncoplastic breast surgery and here he shares he expertise on implants.
What are the latest advancements in implant-based breast surgery?
The two key things are:
- The implants themselves
- The techniques
Over the years we have seen improvements in not only the shells of the implants, but also the cohesive gel within them. This has created the latest generation of implants, which are much more robust and hardy, with many now able to last patients their lifetime without rupture through wear or tear.
The most popular implants in use currently would quote “a one in ten or less risk of rupture at ten years through wear and tear”.
In addition, the adhesive silicone gel used to fill the implants is now more form-stable and therefore safer. This means they behave more like putty rather than for example honey where if a rupture to the shell occurs leakage would be minimised. This also means in terms of the feel and shape of the implant, the augmented or reconstructed breast looks and feels more natural.
Techniques continue to be evaluated and evolve to give the best cosmetic results and quickest recovery for patients whilst maintaining safety. The most recent of these advances in breast reconstruction is of placing the implants above the pectoralis major muscle. This reduces post-operative pain, quickens post-op recovery, and minimises one of the cosmetic adverse effects of placing implants under the muscle – animation of the implant, i.e. movement of the implant when that muscle contracts. This is because for selected patients the pectoralis muscle does not need to be disturbed when a mesh is used to help in securing the implant for the best cosmetic result.
How can you achieve a natural-looking shape?
A ‘natural-looking shape’ is best achieved when your surgeon effectively evaluates the body shape and dimensions of each patient, and then using the best technique and implants available to complement that. Techniques can vary between placing the implant beneath only the breast tissue or under both the breast tissue and muscle, in what is called a dual-plane in cosmetic breast surgery. In addition, choosing a round or anatomical (tear-drop) implant is important to achieve the desired look as either may be suitable, depending on the patient’s original body shape and desired final outcome. In cosmetic breast surgery making these choices will allow for increasing breast volume in a targeted way to achieve the breast shape as well as the size that the patients wish for.
For breast reconstruction, one can choose between placing a shaped or anatomical breast implant above or under the muscle, again, to ensure the most natural look. For individual patients, one of those techniques would be better suited to achieve the best outcome balancing safety, minimising complications and cosmetic result.
What aftercare do you need to do in the period following surgery?
Following surgery, a good, soft, supportive bra is essential. This should be worn for a minimum of four weeks, both day and night, following breast surgery. Wounds should heal within two weeks, with no suture removal required, as, generally, absorbable sutures are used. Patients can undertake light activities in the first two weeks after surgery, but should avoid driving and any significant gym work until after four weeks post-surgery.
For breast reconstruction patients, it is likely that a drain will be placed within the implant pocket. This may remain for up to two weeks after surgery, and your surgical team should guide you as to how to maintain these drains and when they will be removed.