During a breast augmentation, implants are inserted through an incision - usually made in or just above the breast crease, around the areola (pigmented skin surrounding the nipple) or in the armpit and placed into a 'pocket' created either below the breast tissue or below the chest muscle (pectoralis major) to add volume and enhance shape. In general I would consider the inframammary incision suitable for most breast augmentations. Where the areola diameter is sufficiently large or where an areolar reduction may enhance the breast proportions this may be a suitable alternative.

The 'pocket' position is largely determined by the adequacy of skin cover (thickness/laxity) in the region of the anticipated margins of the new breast implant. In thin patients I would generally use the sub-muscle plane. For all other cases a subglandular or subfascial plane is used.

To reduce the likelihood of infection, antibiotics are given intravenously during the operation, shields are applied over the nipples to prevent bacteria in the nipple ducts contaminating the wound and the implants and cavity soaked in antibiotics prior to placement.

Inpatient/Outpatient

The operation is generally performed as a day case procedure at the Renaissance Surgical Clinic (i.e. you will go home the same day).

It is possible however to perform the procedure as an 'in-patient', admitted overnight at the Cape Town Medi-Clinic.

Length of procedure

Between 1 and 2 hours

Anaesthetic

A certified anaesthetist will be responsible for your well-being.

The procedure is usually performed under deep intravenous sedation with local anaesthesia. This ensures complete comfort without awareness during the procedure, rapid recovery and good post-operative analgesia. Alternatively,general anaesthesia may be employed.

Implants

I generally use textured silicone gel implants. From the late 80's, 3rd generation implants became available characterized by significant technological advances greatly improving in their safety profile.

Breast implants come in a variety of sizes, shapes and forms.

Common to all implants is an outer shell made of silicone and a filling, usually saline (salt water) or silicone gel ('gummy bears'). In South Africa most augmentations are performed using gel implants for their superior, natural feel.

Implant shapes are either round or anatomical (teardrop). Round implants are used almost exclusively in South Africa. It is interesting to note that in Western Europe the majority of breast augmentations are now performed using anatomic shaped implants. Anatomic shaped implants were created in an attempt to achieve a more natural appearance, particularly the avoidance of the unnatural, rounded upper pole to the breast (i.e. fuller in the lower half and flatter in the upper half.) To date there is controversy amongst plastic surgeons as to the potential benefits and indications for the use of anatomic shaped implants. In this respect, patients requesting a 'natural look', will benefit using these implants - albeit at a slightly higher price!

Breast implants also come in a variety of sizes. The width of the base of the implant, its projection and volume can be selected to create the optimal implant to suit your individual proportions and requirements.