Breast Augmentation Surgeries

Breast augmentation or breast implantation is a procedure in which doctors insert silicone or saline filled breast implants under the breasts to make them larger

What are breast augmentation surgeries

Breast augmentation or breast implantation is a procedure in which doctors insert silicone or saline filled breast implants under the breasts to make them larger. This can result in increased breast size, particularly in women who have lost weight and want to look more youthful. Breast augmentation is a cosmetic surgery procedure used to restore the loss of fullness after pregnancy, to balance a difference in breast sizes or shapes, or as a reconstructive technique after breast cancer surgery. It can be done in Bangkok with Dr. Chartchai.

The physiology of breasts

Breasts are made of glandular tissue (which produces milk after pregnancy), ducts that connect the glandular tissue to the nipple, fat, and connective tissue. Breasts sit above the pectoralis muscles and the muscular fascia (the strong connective tissue covering the pectoralis muscles). Aging makes this thin tissue looser and stretched. Over time, gravity taking its toll, it pulls the tissue down and makes breasts sag.

Choices of implants

There are several types of breast implants available today, depending on needs and desires. Dr. Chartchai uses silicone gel-filled implants—the more popular type globally—for his patients who wish to increase their cup size from what they had before surgery by 1-2 cup sizes.

There are two core subjects to understand about these synthetic bags:

– content inside the bags. At present, the element is either silicone gel or saline water.

– type of surface of the silicone envelope or shell. It can be either smooth or textured, with varying degrees of roughness.

The history of breast implants

The earliest developments of breast implants can be traced back to the year 1962, when plastic surgeon Dr. Norman H. Nackenbaum developed the first silicone implant for breast augmentation. Since then, the science of breast implant has been continually researched on and modernized since its first introduction for human breast enlargement in 1962. That very pair of implants contained silicone fluid, which was ideal thanks to its pleasantly soft feel and more natural-to-touch character.

Breast implants on the market used to have a variety of different materials to fill them. These materials yielded mixed outcomes. However, for the current global medical practice, silicone gel and saline water are the most professionally accepted substances used in manufactured implants. Each has its own pros and cons. The type of surface on which your implants are placed is important. Both silicone gel-filled and saline water-filled implants have a different kind of surface that might affect how they perform. We’ll look at this more in our next section.

As a result of medical literature reports regarding adverse events, the USFDA amended its ranking of breast implant devices to class III in the Medical Device Amendment ratification. According to the 1982 USFDA statement, breast implants were deemed to present “…a potential unreasonable risk of illness or injury…” Between 1992-2009, the USFDA called for a voluntary withdrawal of silicone gel-filled implants from the US market. Germany, France, Spain, Austria and Italy followed suit; however, other countries still use silicone gel filled implants.

In the case of silicone gel-filled implants, capsular contracture is the most common type of complication. Capsular contracture is a common complication of breast augmentation surgery. Capsule forming is not an issue unique to plastic surgeons or medical procedures—it happens with all kinds of surgery, including liposuction, abdominoplasty (tummy tuck), and rhinoplasty (nose job).

Capsular contracture occurs when fibrous tissue overly builds up around an implant, which can cause it to become too firm for some patients. If it becomes too tight, it can make it difficult for the implant to move as it should, which can result in pain and discomfort for patients.
In 1968, coating the silicone shell with polyurethane was the attempt to counteract capsular contracture. Despite significantly reduced rate of capsular contracture during its early years of usage, polyurethane-coated implants were removed from the US market in 1991. This was due to the possibility of coating degradation in the long run, which is a safety concern.

What to know prior to your surgery

In 1997, the first case of BIA ALCL was published in the medical literature. BIA ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) is a rare type of cancer of the immune system. But it was in 2011 that the USFDA first report a possible link between breast implants and ALCL in the scar capsule surrounding the implant. And it was not until 2016 that an association between textured implants and ALCL was recognized (even the first textured implants was introduced in the 1980s).

However, there are many ways to reduce this risk.

First, it’s important to choose silicone gel-filled implants that have been appropriately sized. The size should be based on your body measurements as well as your breast size goals. When selecting a size, you also want to make sure that you’re getting an implant that matches your body type: round versus square or pear-shaped versus inverted triangle-shaped breasts can all affect how well the implant sits in your body—and how much it will contract over time.

It’s also important to make sure that you’re getting an implant with a proper profile, so it doesn’t stick out too much from your chest wall. This will help keep your skin looking smooth by preventing irritation and wrinkling caused by rubbing against other parts of your body or clothing when you move around (which can happen if an implant is too large for the cavity space).

Breast implants are not lifetime devices, and you should assume that you will need additional surgeries (operations) to have them replaced or removed. The choice of your surgeon is of uttermost importance. An experienced surgeon will know how to reduce the risks of capsular contracture that may bring complications later on.

In 2019, Allergan produced BIOCELL textured breast implants (with the model name of Natrelle®) were recalled after strong specific relationship of these particular implants to BIA ALCL cases and the followed death cases. Textured implants which reduce the chance of capsular contracture are still available from other manufacturers with different technology of production.

Breast implants will need to be monitored for as long as you will have them, any abnormal change in the implant should be reported to your health care professional for further investigation.

Have a list of questions when meeting Dr. Chartchai for your first consultation. It is an opportunity to learn about his approach to breast augmentation surgery, his training, experience, and qualifications, and exchange expectations about your surgery.

You may ask Dr. Chartchai, a board-certified plastic surgeon, to see before and after pictures from his previous patients. Dr. Chartchai possesses a considerable degree of artistry in his work, allowing him to sculpt the breast to meet a very pleasing aesthetic balance. Moreover, he is willing and able to give each patient the proper care and attention needed, a critical factor in achieving the best expected results.

Making up an informed decision

Silicone gel filled breast implants contain a reasonable assurance of safety and effectiveness if applied as labeled and strictly by professionally trained plastic surgeons.

In spite of the eventuality of complications, we agree that it is generally safe for patients to receive a breast augmentation operation. It is also highly recommended that patients should always be fully informed about the accompanying benefits and/or risks. While implant manufacturers and physicians should continue to provide accurate and up-to-date information for patients to help inform their decisions, we believe that patients should have access to the most up-to-date information regarding the safety of an operation.

The surgery

Most surgeons prefer to position the implants behind the pectoral muscles. This allows for more accurate mammograms, and may reduce infection and capsular contracture, so the implants will stay softer. But it is not the rule for everyone because it can result in an unnatural look in some patients. Other choices for positioning can be discussed at the consultation.

Implants are inserted under general anesthesia in a hospital setting, usually through a discreet incision made in the crease of the lower part of the breast, in the axilla of the armpit, or through the lower edge of the pigmented skin part around the nipple, called the areola.

Recovery time

The following 2 days, the patient will be given pain medication and a light dressing. The breasts will feel sore and be bruised for the following 14 days. They shall remain swollen for several months. Compression bandages shall be worn for days. Right after the operation, you might feel that the implants are sitting too high on the chest wall. This is to be expected, and you must allow some time for them to fall into a normal position over the following days or weeks.

You may get back to work after 2 weeks, but you should allow at least a good couple of months before resuming any strenuous exercise.

Possible complications

The expertise of Dr. Chartchai’s surgical techniques are meant to minimize the likelihood of any complication. Complications or side effects could be asymmetry (uneven breasts or nipples), hematomas (a collection of blood and blood clots around the implant), poor scarring, changes in nipple sensitivity (less of it, none of it or at times more of it), capsular contracture (see above), and deflation of saline implants. Should the milk ducts be severed, breast feeding might no longer be possible.

As for any surgery, it is recommended that the patient should stop taking on blood thinners, smoking and drinking at least 2 weeks prior to the operation, and after. If you have decided on this intervention, you should discuss the particular pros and cons of that surgery with Dr. Chartchai at the time of your in-person consultation.