Project Description

Breast Surgery

Breast Augmentation

Breast enlargement is one the most popular cosmetic surgeries the world. For many women, the way they feel about their bodies and their femininity is directly linked to the size and shape of their breasts, and their personal body image can be dramatically altered following breast lift enhancement surgery – be it in the form of augmentation, lift or reduction. If you are requiring an extremely natural augmented result then structural fat grafting should be considered.

In South Africa, breast augmentation and enlargement procedures are just as popular as anywhere in the world and they are certainly the most common surgeries in my practice.In my practice, most patients are looking for a very natural breast enhancement. It is not really about the size, but more importantly about improving the shape of the breasts.

The actual procedure is usually very straightforward, but obtaining information on the details of the operation is often a daunting process for patients. The primary reasons for the confusion is because many different approaches and placements are offered by different surgeons, and that there are a large variety of implant shapes available.

If you feel as though your bust line is too small, it’s lost volume after pregnancy, or simply disappeared after significant weight loss, you’re an ideal candidate for breast implants. Breast augmentations can also rectify the shape should they have a  lack of symmetry.

Often, those who undergo this procedure are those who’ve struggled with smaller breasts for most of their life. So the relief these patients report feeling is immeasurable.

You can expect to feel a definitive boost in self confidence, which will be reflected in your overall posture.

After a successful procedure, you can expect to have these ideal results for approximately 15 years. Due to maturing and gravity taking their toll, the results do fade after a prolonged period of time.

“A  beautiful breast is a feminine weapon that men just don’t have.”

As with any surgical procedures, there is a risk involved in breast augmentation. But, the procedure itself is extremely routine, so mishaps are few and far between.

However, it’s important for you to be aware of any and all the risks that you can incur. Some of what can go awry after your surgery includes:

  • Capsular contracture – This occurs if the scar or capsule around the implant begins to tighten,  causing the breast to feel hard. This can occur within a few months of the breast augmentation procedure, or many years after the surgery. Capsular contracture can be treated in several ways, and sometimes requires either removal of the scar tissue, or removal and replacement of the implant.
  • Excessive bleeding –  This can follow the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood..
  • Infection – A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted. This is one of the main reasons why I choose to operate in a dedicated cosmetic surgery hospital where dreaded hospital acquired bugs are absent.
  • Nipple sensitivity – Some patients have reported that after a breast augmentation, their nipples have become over or under sensitive, and in some cases, even numb. These symptoms may disappear with time, but may be permanent.
  • Leaking implants – If you injure yourself by impacting your chest or surrounding area your implants can rupture and leak into your breasts. This can also occur from normal compression and movement of the breasts.

If a saline-filled implant breaks, it deflates in a few hours and the body absorbs the salt water, which incurs no bodily harm. But,  if there’s a break in a gel filled implant, but the scar capsule around it doesn’t tear, you may not notice any change.

However, if the scar also breaks or tears, the silicone gel may move into surrounding tissue.

The gel may collect in the breast and cause a new scar to form around it, or it may move to another area of the body. There may also be a difference in the shape or firmness of the breast. Both saline and gel implant breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.

A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as “connective-tissue disorders”, but the FDA has requested further study into the matter.

While there is no evidence that breast implants cause breast cancer, It’s important to remember that having breast augmentation may alter the way a mammogram is conducted as ultrasonic methods will be used, rather than traditional ones.

Breast Augmentation

The Procedure

It’s important to conduct your own research prior to your consultation. This way, you’ll know what to expect and be able to ask any important questions you may have.

It’s important for you to be honest with me as far as your medical history, chronic medications and expectations of the procedure are concerned.

I  will do a physical examination, take measurements, and if necessary photographs to assess your breasts for surgery. I will take into account the size and shape of your breasts, skin quality, and the placement of the nipple and areola. In addition, I will need to be told of your plans (if applicable) to lose a significant amount of weight in the future. Many women find their breasts sag or shrink with weight loss. In this instance, I may recommend that you schedule surgery for once your target weight has been achieved.

Using breast sizers, we will make a decision on the correct size and shape implant for your body. Depending on your breasts and skin tone, I may also recommend a breast lift in conjunction with an augmentation. Be sure to discuss your expectations frankly so you and I are both on the same page.

What Types of Implants Can I Choose From?

There are many choices and I am now able to advise on the correct “designer implant” shape that will fit perfectly with your specific breast and chest wall shape.

The choices range from silicone to saline and from rough to smooth textures. Round and anatomically (tear drop) shaped implants are also an option. I have experience in inserting all the type of implants, and will take your body type into account before assisting you in the final implant decision.

Is the Implant Placed Under or Above the Muscle?

My aim in most patients is to give them the most natural result. Small-breasted women who are very thin are usually advised to have the implant inserted under the muscle to cover the implant. In my view, the advantage of a prepectoral implant (in front of the muscle) is to give the breast tissue a mild lift and is therefore the procedure of choice in patients with more sagging breasts. Medical evidence does however show that by placing the implants behind the muscle, the potential for development of capsular contracture is reduced. It is also easier to perform a breast examination and mammography in patients with implants placed behind the muscle. The disadvantage of lifting the chest wall muscle, however is a longer recovery period. It is therefore of extreme importance that you discuss these pros and cons with me before the procedure.

Once a shape and size has been decided, you’ll book in a surgery date.

The procedure will be performed at the Renaissance Surgical Clinic. Depending on your procedure, you’ll either be admitted as a day patient an inpatient, in which case you’ll be monitored at the Renaissance facilities.

The surgery lasts approximately 2 hours and is performed while you’re under conscious sedation. which will make you feel drowsy and relaxed, however you’ll sleep through the entire operation and not be aware of the procedure. Occasionally, I may use a general anesthesia, but in all cases, a certified anesthetist will be responsible for your well being.

The breast augmentation procedure involves:

  • Incisions – The most common site for scars is in the crease under the breast. Other, less common incisions are in the armpit and around the the areola. Scars will vary depending on the severity of the natural droop and if any breast tissue needs to be removed. The look of the scars will improve over the course of two years following surgery. As far as the placement of the nipple is concerned, It is usually not necessary that the nipple be transposed higher on the breast. However, in patients where there is sagging of the nipple, a simultaneous breast lift ensures a natural look, while the sensation and functions of the nipple are maintained.
  • Insertion – The placement of the implant will depend on your anatomy and our preoperative discussion. I will create a pocket by lifting the breast tissue, either in front or behind the pectoral muscle, and insert the desired implant.
  • Finishing touches – Once the implants are in position, I close the incisions with sutures and reinforced with tape and a gauze dressing to help with healing. The area is then cleaned and you’re placed in the care of our recovery team. Drainage tubes may also be used for several days following surgery.
Once the breast augmentation surgery has been completed, you can expect to be in some pain for up to 3 days, but you’re encouraged to get out of bed for short periods of time after surgery. It’s also imperative that for two weeks post op, you don’t raise your arms above your waist, drive or partake in any strenuous activities. If you’ve had drains inserted after your procedure, they’ll be removed in a few days and your dressings will be checked and changed, or removed entirely.  You’re also advised to handle the breasts gently for the following weeks of your recovery.

To keep pressure off of your breasts, you should sleep on your back. It’s also advisable for you to wear a support bra for a few weeks post surgery until all swelling and bruising has subsided.

You can expect your stitches to be removed on the 10th day of your recovery and should not be alarmed if your breasts take some time to assume a natural shape and for scarring to fade.

A  complete recovery can take anywhere up to 12 months. If you are at all concerned about anything during the post-op period, always contact me for advice and reassurance.

In most cases it is possible for patients to resume work within a week of a breast augmentation surgery unless the nature of the work is excessively strenuous. You can also resume exercise, starting slowly, within a few weeks.

It’s normal for you to experience mild discomfort periodically but severe pain must be reported immediately. Sexual activity may also be resumed after around 2 weeks.

For information on how best you can recuperate, consult my General Recovery page.

Allowing me to perform your breast augmentation places you in the capable hands of a surgeon who has been practising for over 18 years.

Contact my practice today to find out how breast augmentation can change your life and perception of yourself.

“Hi Nerina, just wanted to say thank you! I could not have expected or wished for more, I have not stopped getting comments of admiration for your handy work. Really huge THANK YOU!”
K Miller, Breast Augmentation
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