Breast enlargement. Breast implants

1. Background and history

Many women feel that their breasts are too small, and that they do not match the rest of the body. Finding clothes that fit may be difficult. For some, the sexual self-esteem is linked to the size and shape of the breasts. Having implants or prostheses placed inside the breast(s) is an option for some of these women. Prostheses will make the breasts larger, rounder and firmer.

The reasons why the breasts are small or saggy can be several:

• Some women develop small breast glands.
• Others develop saggy, ”empty” breasts after nursing.
• A part of the breast gland may have been removed due to illness.
• Some have different sized breasts, where only one breast has developed normally.

It was in 1962 that the first breast implants or prostheses were taken into use: They consisted of a smooth shell of silicone rubber filled with silicone gel. This type of prosthesis has undergone many changes since then, and exists in many different varieties today: Most are filled with silicone gel, while some are filled with saline or hydro gel. They all have an outer shell made of silicone rubber or some other tissue-friendly material.

Earlier, there were some problems related to the smooth prostheses. They would sometimes leek, and the tissue around the prosthesis had a tendency to harden. Over the last few years, newer and improved types of implants have entered the market. Many of the problems we used to see are now history.

After the shell of the prostheses was made thicker and stronger in the beginning of the 90’s, the problem of leakage is completely gone. With the new, rough surfaced prostheses, it is also seldom that the breasts harden. International scientific research is also unambiguous: Breast enlargement with prostheses has become a safe operation with predominantly good results and satisfied women. This is in agreement with our experiences in Norway.

2. Different types of implants

Implants made from other materials may have some advantages, but few supporters. For instance, saline prostheses may leek. They also have a tendency to fold. In addition, it is often possible to feel that they are filled with water – they simply do not feel natural. Until the saline-filled prostheses have undergone major improvements, we do not recommend these as a first alternative. Smooth prostheses are practically not in use any longer.

Prostheses filled with hydro gel, or sugar gel, are also available – but rarely used. They are no safer or more secure than other types. Actually, we do not yet know (2004) all that much about the long-term effect of prostheses with water or sugar gel. They are more expensive because they are low in demand.

The different prostheses come in different sizes. Which size to use, depends on the woman’s wishes and on the shape of the breast before the operation. If the breasts look different, using different sized prostheses may decrease the difference. Sometimes only one of the breasts needs prosthesis. Saggy breasts with a lot of excess skin require larger prostheses.

The size of the prosthesis is measured in milliliters (ml). The more common sizes span from 200 to 500 ml. We usually use implants of 240-350 ml. In a medium slim woman, a 200 ml implant will equal an increase in size of about one cup-size. This, however, depends on the type of bra used.

Most implants are round in shape, and they will adapt to the shape of the breast and the surrounding tissue. Other implants are drop-shaped (”anatomical”). They can be used when round implants do not produce a satisfying shape of the breasts. Drop-shaped implants are seldom needed. We take your wishes in consideration when deciding on the size and shape of the implants. After an individual evaluation, FORNEBUKLINIKKEN will use the type of prosthesis that is best for you! In most cases, this will be a round prosthesis of silicone.

3. The different methods

• Where will the scar be?
  The incision will be a few centimeters long, and is normally placed in the fold underneath the breast (inframammary or crease incision). It will then be least visible while standing up. It can also be placed on the edge of the pigmented area (nipple incision), but is then likely to become more visible. If the prosthesis is placed under the muscle, the incision can be made in the armpit (transax or armpit incision). It will then be slightly longer, and show when you swing your arms. The incision is closed with internal stitches (which will dissolve by themselves) once the prosthesis have been inserted.
  
• Over or under the muscle?
  Both methods have its advantages and disadvantages. We usually place the prosthesis under the gland – on top of the muscle. This is the more “gentle” method – there will be less bleeding and less pain afterwards. Sometimes we need to place the prosthesis under the muscle. We do so when the woman is skinny and have little breast tissue – in order to get a better-looking result. The risk of a capsulation is somewhat lower when the implant is placed under the muscle, but the implants may move – usually upwards – when the breast muscle is used. If you have a great deal of loose skin, an implant under the muscle will often give the breast an unnatural shape of the breast. If you are into sports that require a strong breast muscle, such as weight lifting, handball, gymnastics, and so on, an implant under the muscle can make the muscle weaker.

FORNEBUKLINIKKEN will choose the method that is best for you, after an individual evaluation. In most cases, the best method will be to place an implant over the muscle through an incision underneath the breast.

4. Who will benefit from a breast enlargement

Prior to the operation, your breasts need to be clean, and without sores or acne. Medications that contain acetylsalicylic acid (Dispril, Albyl, etc.) delay wound heeling. They must not be used during the last two weeks before to the operation and during the first week after the operation. In addition, the procedure will not be performed if the patient has the flu with a fever, a cough or any type of infection. You will need to rest for at least one week after surgery. Thus, mothers of young children are in need of assistance during the first week after surgery. Breast-feeding must be ended three months prior to the operation. We do not operate on women who are mentally unstable, abuse alcohol or drugs, or suffer from a severe eating disorder. Minors must be accompanied by one of their parents for a consultation before surgery.

5. Before the operation

It is important that you think about which size you want beforehand. Some women want large breasts, others only want a little ”refill”. The requests are often expressed as ”a little bigger”, ”natural”, ”large”, or ”as large as possible”. Bra cups are also often used to describe the desired size (B, C, D, and so on). Bras often differ a great deal in cup sizes. Thus, it is impossible to guarantee a certain bra size, but it does give the surgeon a fairly good idea about what you want.

You can also try the following at home: Fill a thin plastic bag with rice - vary the amount of rice. Put the bag inside your bra and look in a mirror. When you find the size you are comfortable with, weigh the bag of rice. The weight of rice in grams is about equal to the volume of the implants measured in milliliters. This will give you an idea about the size, but not the shape. You can bring the bag of rice with you to the clinic on the day of surgery. Showing the surgeon a photo of the breasts of other women will also give us an idea of what you want. That said, it is often impossible to achieve exactly what the photo show. We also have special test-prostheses that we use during the consultation or right before surgery.

If you live far from the clinic, you may submit photographs of your upper body (without a bra), taken from the front and side. It is best to have someone else take the photos, but it is possible to take them on your own by using a mirror. If you are reluctant to have the film developed, you can send us the entire film spool without having it developed first. If you do this, remember to take a picture with your name on it at the end of the roll. If you have a digital camera, it is more practical that you send us the pictures (max 2) by email along with the health information. After we have reviewed the photos, we can do the consultation by email or over the phone.

Occasionally, we can do without pictures or a consultation. You must then have read all the information we provide and be completely sure that you want to undergo the breast enlargement procedure. There must be no doubt that you qualify for the procedure – your breasts cannot have an unusual shape or too much excess skin (”saggy breasts”). The entire consultation will then take place on the phone with the clinic’s surgeon and the receptionist.

Whether you meet for a consultation, send pictures or you just call us, we need information about your health in writing. In this form, you fill in information about former illnesses, allergies and medications you use.

When you decide to go ahead with surgery and the day is scheduled, you will be asked to pay a deposit. It is usually 10% of the total price. The rest is paid on the day of surgery, at the latest.

6. The day of the operation

You arrive fasting, and should have arranged to have someone pick you up or have ordered a taxi beforehand. You cannot drive or go home by train or by bus. In addition, you must spend the first night after surgery somewhere that takes no longer than one hour by car to get to from our clinic.

On arrival, you will be given a sedative that relaxes you, then a sedative that makes you sleep. In addition, local anesthesia is injected into the breast. See Pain Management. The operation, which takes about one hour, usually takes place without pain or discomfort. Then, you are placed in one of our resting rooms where you rest until you are fit to leave our clinic. You will be ready to go home after about 4-6 hours.

7. After the operation

You will feel sore and tender for the first few days, and also a bit of ”pressure” in your breasts. This will diminish within the first week. Spend the first two days doing nothing but resting, lying or sitting still with your upper body higher than the rest of your body. A ”stressless” recliner is perfect for this. Then, the next five days you can start moving about carefully, but avoid any blows to your chest! Housecleaning and gardening are typical activities that need to be avoided for the next two or three weeks. Also, no massage, and make sure that the support-bra covers the breasts completely and that the edge don’t rub against the skin causing sore skin or grooves. The support-bra must be worn 24 hours a day for the first month. We will provide you with the right bra in our clinic after the operation. The bandage (compresses) can be removed 4-6 days after surgery. After that, the wounds need to be taped.

3-4 days after the operation, you can take a shower, but very carefully. Cover the bra with plastic or something waterproof. If the bandages get wet, they must be changed.

We recommend that anyone with breast implants, use a bra as often as possible. This will preserve the shape of the breasts and prevent stretching of the skin.

One week of absence from work must be expected. Physical training and hard labor should wait for one month.

We offer check-ups during the first week and after one year, then yearly check-ups after that. The check-ups are voluntary and free of costs.

8. . What kind of results can I expect?

The pictures on our site are only meant to illustrate what to expect. You cannot pick the wanted size from a picture or compare yourself with a friend. However, a picture of another woman’s breasts that you like will help us get an idea of what you want.

We have different aids to help us find the right size before surgery. In addition, we place test prostheses inside the breasts during the operation to help us consider the size beforehand. Thus, it is extremely rare that anyone is dissatisfied with the size and shape of the breasts afterwards. Sometimes it is not possible to achieve the desired size because there is simply too little room inside the breast. For instance, you may have tried prosthesis or a plastic bag filled with rice that equals a 370-milliliter prosthesis and results in a D-cup. In reality, you may not have room for more than 320 milliliter, which results in a C-cup. In such cases, with a smaller implant than desired, your breast tissue will adapt so that you can have the implant of the larger and desired size in a year or two. On rare occasions, the size we planned to use turns out to be too small. When it happens, it is because the patient’s breasts have too much and too elastic skin.

A few patients form scars that are easy to see. By taping the scars for a few months after the operation and using a quite tight support bra, visible scars can be prevented.

9. Possible complications

The reason why some scar capsules shrink is unknown. We know that circumstances around the operation (sterility, experience of the surgeon, etc.) matter. Bleeding after surgery can also contribute to the capsulation. Thus, to prevent bleeding after the procedure, it is very important to stay calm for the first week after surgery.

Capsulation happens more often after breast-feeding. Usually the hard capsule is only experienced in one breast. Capsulation can occur several years after the surgery. Less than 10% of women with modern, rough surfaced silicone prostheses form a small hard capsule within the first ten years. The capsule is only noticeable because the breast feels slightly harder than before the operation. Many do not even notice it themselves. In cases where the capsulation is a bit more severe, the breast will be hard enough for the patient to be able to feel it herself.

Earlier, the use of smooth prostheses often resulted in capsulations. Nowadays, with the new and rough-surfaced prostheses, our experience is that capsulation occurs only in 1-2 % of the cases within ten years after surgery. Only on rare occasions, the breast becomes so hard that a new operation is necessary.

The hard scar capsule can be removed with another operation during which the prosthesis is also replaced. However, there are no guarantees that the breast remains soft in the future. Most surgeons agree that hard capsules should only be removed if they ruin the shape of the breast or cause discomfort. Placing the implant under the breast muscle is an alternative for the patients who experience capsulation when the implant is placed under the breast gland.

After an operation, one may experience complications in the form of bleeding. This is not dangerous, but may call for a new operation. We have effective methods to treat such complications – without ruining the result.

Infections hardly ever occur in private clinics.

A severe blow to the breast (for instance in a car accident), can cause the implant to tear. Should you experience something like this, the breasts ought to be examined with x-ray and ultrasound in order to rule out any leakage. Leakage is not dangerous, but requires a new operation during which the prosthesis is replaced. Other than that, the prostheses can take quite a bit of rough treatment and normal physical activities. In fact, they are very difficult to break.

Reports of women who have become sick due to silicone prostheses, have proven to be wrong. Newer research shows no connection between silicone and disease.

Reduced sensation of the skin above the scar or of the nipple sometimes occurs. In most cases, the sensation comes back within about a year. In a few cases, the woman experiences an increased amount of sensation of the nipples. This also usually goes back to normal after a while.

In women who are very slim with a very thin layer of fat tissue below the skin, the prostheses may develop small folds. These can be felt with the fingertips, but are usually not visible. A few experience some unpleasantness when lying on the stomach, and some experience that their breasts more easily get cold after the operation. If you have visible blood vessels under the skin, this can become more visible after the operation.

Should you experience unpleasantness or other problems that make you want to remove the prostheses, this can be done by a small procedure. However, our experience is that very few of our patients decide to have their implants removed.

There is no increased occurrence of cancer in women with silicone implants. Any skilled doctor can perform mammography and ultrasonic testing without problems.

10. Replacing implants

If you want very large prostheses, it often needs to be done with more than one operation. A new operation will then be necessary after 1-2 years. By then, the smaller prostheses will caused the skin and the surrounding tissue to stretch enough for larger implants to fit.

For those who had smooth surfaced and thin-walled prostheses implanted before 1990, as well as those who mistakenly have practiced massaging their breasts in order to keep them soft, we recommend that they have their prostheses replaced because of the risk of leakage. The same goes for those who have undergone a so-called ”closed capsulotomy” – a method that was abandoned 20 years ago.

The prostheses are designed to remain inside the body for the rest of the patients’ lives, and most of the producers of prostheses deliver them with a 10 years guarantee. There is no reason to replace them as long as you do not feel any discomfort or experience any problems with your prostheses.

11. Breast-feeding

There has been some concern that compounds from the breast implants can pass into the milk. Silicone or other compounds from the implants have never been detected in mother’s milk. We also know that silicone is harmless for both children and adults.

Neither is there any proof that children, who have been breast-fed by mothers with breast implants, have an increased sickliness compared to those with mothers without breast implants. Thus, it is safe for you to feed your child from breasts with silicone gel- or saline-filled implants. Other and newer prostheses filled with other substances, we still know little about, but there is reason to believe that these too are harmless to infants.

12. Enlargement and lift

An alternative can be a large prosthesis that fills out all of the loose skin. However, even with large implants, it is likely that the breasts will continue to be loose if there was a considerable amount if sagginess before the operation.

13. Guarantee of safety

 Valid from August 1, 2007 the Fornebu Clinic offers the following guaranties to its patients:

1. The implant will be replaced free of charge if any damage to the implant occurs. Lifelong guaranty.
2. Any unexpected complication or problem that occurs which demand a new operation will be performed at the clinic without charge. Lifelong.
3. With patients who want to have the implants removed due to personal reasons (very rare), the Fornebu Clinic offers to perform the removal without any costs for the patient. Lifelong.
4.  Patients, who are diagnosed with a so-called hard capsule (capsular contracture) within five years of the operation, will be given a new operation by the Fornebu Clinic free of charge. It will be no extension of the guaranty further on more than the 5 years if a secondary  operation is taking place for any reason within the guaranty period of the 5 years. 
5. The guaranties concern all kinds of implants.
6. The guaranty is valid for all patients who have been to a consultation (personally or electronically) after July 1t, 2007 and are undergoing an operation after that day. 

The guaranty does not include:   

1. Recontruction after cancer   
2. The guaranty does not include patients operatated at another clinic.  
3. If the woman later desires another size of the implants, she will pay only for the operation - not for the implants.

Requirements to the woman for mantaining a valid guaranty: 

• Follow the postoperative instructions given by the Fornebu Clinic. 
• Undergo a check up (free) once a year or respond to a simple questionaire.
• The woman is required to take imediate contact with the Fornebu Clinic if problems or discomfort is experienced, and she is obligated - if her surgeon eventually requires so - to undergo necessary examination - such as x-ray or ultrasound. 
• An eventually new operation is to be performed at the Fornebu Clinic.