Written by: Dr Nerina Wilkinson – MBChB (Stell), FCS Plast (SA)

Really beautiful and perfect breasts are a rarity in women, however the media present these very rare exceptions as the standard for breasts. No wonder many women are constantly seeking treatments to enhance and change the shape of their breasts.

Prosthetic breast implants have been the golden standard for decades

However many women are not ready to for surgery with the possible complications of an implant and therefore are looking at some of the newer more natural techniques to improve the size of the size of their breasts. So how do they decide between all the available options?

 

BRAVA SYSTEM:

This is a medieval looking breast pump on the market, which enlarges the breasts by creating a slight vacuum around them in 2 plastic domes, which then gently pulls on the skin and gland. It comes with a pump controlled by a little computer. You wear this pump and the 2 domes over the breast for 10-13 hours a day for 10-30 months.

Studies have shown a modest 150 cc increase in bust size i.e. ½ to 1 cup size.

(I am however personally not sure whether the ultimate small increase in breast size validates the discomfort of wearing a large device like the Brava for so many months, this is definitely a device designed by a man…)

Costs : over the 30 months this could amount to  R 40 000.

 

LOTIONS AND POTIONS:

There are many natural pills and creams being advertised to increase the size of breast tissue. Many of these herbal remedies theoretically increase the size of breasts due to their estrogen like effects on the body, as do birth control pills and HRT.  The estrogen causes fluid retention in the breasts with a resultant increase in size. The concern is that most of the websites selling natural breast enhancement pills do not list the potential risks.

“All natural” is interpreted by patients as being safe. No one however really knows what possible side effects they may have.

There is also no evidence that the results will last. Even though they cause the breasts to swell up a bit, as soon as the drug is withdrawn the effect wears off.

Adriane Fugh-Berman, M.D., professor of complementary and alternative medicine at the Georgetown University School of Medicine, said in an article published in Obstetrics and Gynecology, “The use of bust-enhancing products should be discouraged because of lack of evidence for efficacy and long-term safety concerns.”

Women considering these tablets should only be considered under a doctor’s supervision.

 

INJECTABLES:

Over the past 10 years the use of reabsorb able fillers have been explored. Macrolane is a hyaluronic acid gel-based technology, available on the French market since 2007. At the end of 2008 Macrolane received a CE mark for breast augmentation.

The procedure was widely marketed as a nonsurgical option to breast augmentation surgery. It was performed in the rooms in less than 2 hours, no scarring, rapid results and no down time. The indication is for a patient wishing to have a modest increase in the size of their breasts without undergoing surgery.

Macrolane has however not been approved by the Food and Drug Administration in the united States due to lack of scientific data of the use of this product in the breasts.

I strongly recommend that patients and doctors review the lack of data on Macrolane in the breasts before considering this as a treatment option.

Macrolane has been withdrawn from a few countries recently due to technique (injection) problems in Europe. It is not the product that is at fault but rather the way that it has been used. Macrolane is hyaluronic acid, which has been proven to be a safe and efficient filler. The main concern has been that the injection has caused “clouding confusion” problems on mammograms and ultrasound, which confuses the results of these radiology tests.

There have also been some reports of granulomas resulting in hard lumps of the breasts.

Costs: The hyaluronic filler effect lasts like other soft tissue fillers about 2 years. The product is however costly at a price of +/- R 50 000 every few years.

 

FAT TRANSFER:

Your own body fat can be harvested from one area of the body and injected into the breast to improve the shape.

Autogenous fat grafts offer several advantages over breast implants including decreased scarring and lack of complications associated with the implantation of a foreign material.

Women who desire a large, firm or round breasts may not be appropriate candidate for autogenous fat transplant as fat grafts result in a more natural looking appearance. Similarly, fat grafts to the breasts are not a viable option for women lacking significant sources of donor fat for liposuction i.e. very thin, as the volume required is very high.

Lipofilling can realistically only achieve a natural, small 100cc volume breast augmentation.

 

HOW DOES FAT TRANSPLANT WORK?

Fat is removed from a part of your body that has abundant unwanted fat deposits. This fat is then purified through a specific technique and then injected back into the face or body that needs improved contouring.

Fat injections by creating fullness; give some lifting to the general structure. The goal is therefore to give fullness to the breasts achieving a more youthful state.

In addition to adding volume, fat is extremely rich in stem cells, which are re-injected with the fat. Stem cells are known as “ the fountain of youth” and helps to stimulate many other cells in the body to improve their functions.

 

HOW IS THE PROCEDURE PERFORMED?

The fat is harvested in theatre under local anesthetic or sedation.

The harvesting area is chosen (usually the knee or inner thigh). When larger volumes are required for breast and buttock augmentation then the abdomen and flanks are good donor areas. The procedure is a form of liposculpting where the shape of the body is changed by removing fat from one area and sculpting/ augmenting another area.

The fat is harvested using a small blunt cannula. The fat is then cleaned and centrifuged.

The breasts are anaesthetized and the fat is precisely injected into the area. The amount injected into each area is always more than required, as the body will reabsorb 40-50%. The procedure can take from 1-6 hours depending on the areas requiring grafting.

 

HOW LONG IS THE HEALING PROCESS?

Patients are discharged on the same day as the surgery on painkillers and antibiotics. A compression bandage is worn on the harvested area for a week to decrease swelling and bruising. Results will be visible immediately however extensive swelling and bruising can be expected for 1-2 weeks. The final results after some of the fat has been reabsorbed will be apparent by 6-12 weeks.

Costs:

This procedure is more costly than an conventional breast augemtnation due to the lenghly surgical time to harvest and prepare the fat for injection. The procedure may also need to be repeated for optimal volume results after 12 months. Cost +/- R 70000 per session.

 

SURGICAL BREAST IMPLANTS:

Conventional breast augmentation using silicone implants still remains the best method for improving size and shape of the breasts. Implants may not be perfect, however they have been used for more than years and the results are consistent and is probably the only technique to increase breasts by more than one cup size.

Costs : This would depend on the type of implant used ie the more natural anatomically shaped or round implants. R 55000 – 65000.