Breast augmentation (breast enlargement)

The aim of this breast augmentation information is to help you as a patient at Art Clinic to reach a well-founded decision regarding your breast augmentation surgery. The information is compiled in order to provide you with general information about breast augmentation and the implants we use at the clinic. It is to your advantage if you are prepared with any questions you may have prior to the consultation with one of our plastic surgeon specialists.

Breasts have always been a symbol of femininity and each culture has its own ideal image of the female body. A heavy breast can be physically troublesome and a small or loose breast can also feel like a problem.

Today, breast augmentation with breast implants is one of the most popular plastic surgery procedures which we perform at Art Clinic. The breasts can be naturally small or have become ”empty” after pregnancy. The number of patients that undergo breast enlargements increases each year and at Art Clinic we work continuously to improve and refine our technique in order to achieve the best, natural result that is possible.

The breasts shape:

Breasts contain milk canals and mammary glands surrounded by fatty tissue, which gives them their shape and decides how they feel to ones touch. The breast sits on the pectoralis major, the pectoral muscle. Factors such as pregnancy (when the mammary glands temporarily enlarge), rapid weight loss and gravitation all contribute to the skin stretching, which can cause the breasts to sag or become loose.

Breast implants:

Today breast implants are placed into three main groups.

  • Implants filled with silicone gel
  • Expandable implants filled with a combination of silicone gel and salt water solution.

All of these implants have a coating of silicone elastomer (silicone rubber). The coating can be either textured or smooth.

What is silicone?

Silicone is polymers composited of silicon, oxygen, carbon and hydrogen. Silicone can be fluid, gel like or firm. Silicone has many areas of application as a medical implant, such as intraocular lenses, pacemakers for the heart and tissue expanders. Silicone also exists in many of our daily household items such as, polish, sun lotion, hand cream, deodorants, soap, processed food, water protectant and in chewing gum.

Silicon, which is the principle ingredient of silicone is a common element in nature and exists amongst others in sand, stone and glass.

Who is suited for a breast augmentation?

The procedure is performed in order to increase size and to improve body proportions. Art Clinic recommends that only women over the age of 18 should be given implants since growth is in general finished.

For many women, psychological well-being is associated with being content with one’s body. Although not all women feel a breast augmentation is necessary, this procedure has resulted in great personal satisfaction for thousands of women.

A breast augmentation can also be considered by women for personal reasons such as:

  • Breast augmentation can create a more proportionate body
  • Reconstruct and enlarge breasts which have lost their shape due to breast feeding
  • Create a balance between breasts which are of different shape or size

Your reasons are very personal and your choices surrounding a breast augmentation should be decided by you and your surgeon based on your personal needs, wishes and expectations. Today there are many options for women who feel breast augmentation is right for them. This information is compiled in order to help you fully understand your breast augmentation and all the options you have, but it is not meant to replace discussions between you and your surgeon. It may be good to discuss with family and friends for them to help you reach a decision. We advise you not to take any rash decisions, read the information carefully and prepare yourself for the consultation with the surgeon. Feel free to write down your questions to the doctor and bring them to the consultation. (It is important that you have read through and considered this information before deciding on breast augmentation surgery.).

Reasons for not being suitable for breast augmentation surgery

Contraindications for breast implants:

  • Women with existing breast cancer without adequate treatment
  • Women with an active infection somewhere in the body
  • Women who are pregnant or breast feeding

Things to consider surrounding breast implants

Living with breast implants
Whether you undergo an enlargement or a reconstruction you need to be aware that an enlargement may not be a one-time procedure. Additional visits to the physician will most likely be needed, and it may be necessary to undergo further surgeries during the patient’s lifetime. Many of the changes that patient’s breasts undergo after implantations are irrevocable (cannot be undone). If a patient at a later date decides to remove the implant(s), ones breasts may be left bumpy, wrinkled or various other cosmetic changes. Breast implants can affect the patients capacity to produce enough milk when breast feeding, which however is extremely rare. Breast implants do not stop the breast from sagging after a pregnancy. Routine mammography’s can be more difficult to carry out with breast implants, and a patient may need further examinations.

Implant size

Generally, the larger the cup size, the larger the implants (measured by cubic centimetres or millimetres) considered by the surgeon. The surgeon will also examine the existing tissue in order to assess if there is enough to cover the implants in a natural way. If one chooses an implant which is too large for the existing tissue, the surgeon may caution the fact that the edges of the implant may be visible and felt after surgery. It can even cause complications during surgery. Furthermore, implants which are too large can hasten the effects of gravitation and result in the breast sagging and becoming loose much sooner.
Surface structure
There are round and anatomical implants with a textured or smooth surface. The textured surface was created to provide the implant with a porous and rough interface against the body’s collagen.
The following implants can be more noticeable (easier to detect) to the touch: implants with a textured surface, larger implants, placing in front of the pectoral muscle and the lack of enough skin/tissue to cover the implants.

Implant placement
The implants can be placed either partially under the pectoralis major (sub muscular) or in front of the muscle and under the mammary glands (sub glandular). The advantages vs. disadvantages of the different implant placements should be discussed with the surgeon. A sub muscular placement can minimise the risk of the implants being felt through the skin and also the risk of hardening of scar tissue around the implants. Furthermore a sub muscular placement can also minimise the risk of sagging by carrying the weight of the implants. It also makes it easier to examine your breast during a mammography. The disadvantages of this placement are the longer surgery and recovery time. Sub glandular placement on the other hand can shorten the length of the enlargement surgery procedure as well as recovery time. A possible disadvantage of this placement is that the implants edge can be visible through the skin. A mammography examination can also be more problematic when the implants are placed sub glandular. At your surgeon consultation you will discuss the various placement alternatives in relation to your individual needs in order to make a choice suitable to you.

Incision placement
The advantages and disadvantages of the various incision placements are discussed with the surgeon before your surgery. The three most common areas to place the incision in are:
1) The crease under the breast (inframammary).
2) Areola (peri-areola)
3) Armpit (transaxillary)
If the incision is placed in the armpit the surgeon can use a probe camera in combination with other less invasive instruments in order to create a pocket for the implant. A forth incision placement, via the navel (transumbilical) using endoscopy technique has not been studied and is therefore not recommended.
Inframammary: this incision is less hidden than the one around the areola,
Peri-areola: this incision is the least visible, but is associated with greater breast feeding difficulties compared to other incisions.
Transaxillary: this incision is less hidden than the one around the areola, but is associated with less breast feeding problems than the incision around the areola.
Take into special consideration when contemplating breast enlargement.
Which alternatives are there to breast augmentation?
• Accept your breasts for what they are
• Obtain a padded bra or external prosthetics
Surgery and narcosis
Breast augmentations are generally performed under day surgery; this implies arriving to the clinic in the morning and then leaving the clinic in the afternoon/evening. Narcosis is generally used, but it is also possible to perform the surgery under local anaesthesia together with relaxant medication. In general the procedure takes between approx. 35-60 minutes. The surgeon places an incision and makes a pocket for the implant. The implant is placed in the pocket and put in place. Finally the incision is closed, usually with sutures.
You will then rest in our post operative ward under the surveillance of trained intensive care nurses and later travel home after a few hours rest in this ward.
The scarring following a breast enlargement troubles many patients. It can be said, that in general these heal very well and in most cases become very discrete which ever method one chooses. With modern technique it is possible to calculate how the breasts will change post surgery and therefore place the incision as discretely as possible.
Post-operative care
You will probably feel tired and tender for a couple of days post surgery also the breasts can become swollen and sensitive to touch for some time after your surgery. The skin over your breasts may also feel tight while it adjusts to the new breast size. You will use a specific post-operative bra, pressure bandage or sports bra in order to provide special support and positioning during the healing process, the clinic will provide you with a suitable bra that you will leave with on the day of surgery. If you desire an additional support bra they are available to purchase at the clinic. Based on what your surgeon has recommended you will be able to return to work within a few days after your surgery. Strenuous activity which can heighten your pulse and blood pressure should be avoided for a few weeks. N.B: Contact your surgeon immediately if you contract a fever or extreme swelling and/or redness around the newly operated breast.
Choosing your surgeon – also take a look at the section, general information/prior to your consultation, on our web page.
Most importantly the surgeon should frequently and successfully perform the procedure you are interested in and have relevant education within their speciality, such as a plastic surgery specialist.
Feel free to contact the National Board of Health and Welfare (socialstyrelsen) on the number: +46 (0) 8 7869930 between 13.00-15.00 to check the surgeon’s education.
A surgeon’s skill can depend on education, interest, experience, sense and dexterity for that type of procedure. A surgeon is not always as good at all procedures, just like in everyday life one cannot be the best at everything. A surgeon is like us, good at somethings and less at others. Surgeons also excel in the procedure they perform most frequently.
When deciding on an experienced plastic surgeon the following questions should be asked:
• How many breast augmentations does the surgeon perform every year?
• For how many years has the surgeon been performing breast augmentations?
• Which is the most common complication the surgeon encounters during breast surgery?
• How many of the surgeons breast augmentations need to be redone and which is the most common reason for this?
• Hur stor andel av kirurgens bröstoperationer måste göras om och vilken är den vanligaste typen av om operation som denne måste utföra?
What questions should you ask your surgeon prior to a breast augmentation?
Below is a list of questions which are worth asking when meeting with your surgeon.
• Which are the risks and complications associated with breast enlargements?
• How many further surgeries to my implanted breasts can I expect during my lifetime?
• How will my breasts look if I choose to take out the implants without replacing them?
• Which shape, size, surface texture, incision placement and placement of the implants would you recommend to me?
• How will my breast feeding capabilities be affected?
• What can I expect my breasts to look like after a couple of years?
• What I can expect my breasts to look like after pregnancy? After breast feeding?
• Which other procedures or products are available if I do not choose to have breast implants?
• Are there before and after photos for each type of procedure that I can take a look at and what expectations can I have?
What precautionary measure should I take into consideration?
For patients with the following diseases and medical conditions it has not been possible to establish the procedure as safe:
• Autoimmune diseases such as lupus och scleroderma
• Diseases that affect the healing process and the bloods coagulation ability.
• A weakened immune system i.e. immunosuppressive treatment in progress
• Reduced blood supply to the breast tissue.
Mammography
You may need to undergo a mammography before surgery and another on six to twelve months after your surgery, your surgeon will inform you prior to your surgery
Continuous examination
You should personally examine your implanted breasts every month. In order to do this successfully you should ask your surgeon for help to feel the difference between implant and breast tissue. New knots and suspicious swellings (tenderness) should be examined with a biopsy. If a biopsy is performed caution must be taken so that the implant is not punctured.
What complications can arise from implants?
All surgical procedures can involve complications such as effects related to narcosis, infections, swellings, redness, bleedings and pain. There are also specific complications related to breast implants, such as:
Rupture
An implant rupture (i.e. the silicon covering on the implant cracks) can occur within the first months of implantation or after several years. The reason for a rupture can be due to surgical instruments causing damage to the implant during surgery, filling too much or not enough in the saline solution implants (i.e. if one has chosen saline implants) capsule contracture, closed capsulotomy, external influences such as trauma or intensive physical effects, extreme pressure during mammography, navel insertion or other known/unknown influences. You should also be aware that breast implants can wear out over time and then rupture. It may be necessary to undergo additional surgery in order to remove or possibly replace ruptured implants, this is however most uncommon.
Capsule contracture
Scar tissue or the capsule which normally forms around an implant can tighten around or squeeze the implant, this is known as capsule contraction. Capsule contracture is common after an infection, bleeding or after fluid accumulation.
It is necessary to understand that there is a certain risk of undergoing additional surgery in order to replace or remove the implants. Rupture problems, capsule contraction, infections, that the implants move and calcium deposits can result in the implants being removed. Many women choose to replace the implants, although some women refrain.
Dissatisfied cosmetic results
Dissatisfied cosmetic results such as wrinkles, asymmetry, that the implants move, wrong size, unforeseen shape, perceptible implants, deforming scar tissue, hypertrophic (uneven, elevated) scarring, and or looseness (saline implants) can occur. Accurate surgical placing and techniques can prevent undesired results
Infection
Infections can occur after all types of surgery. Most infections in connection with surgery occur within a few days to weeks after surgery. Infections with an implant are more difficult to treat than infections in normal bodily tissue. If the infection does not respond to antibiotics it may be necessary to remove the implant and insert new ones once the infection is gone. Contact the clinic or your surgeon immediately if signs of fever occur, or if there is something you are concerned with, we are here for your sake!
Haematoma /Seroma
A haematoma is an accumulation of blood in a bodily cavity and a seroma is an accumulation of blood serum (in this care around the implant or incision). Haematoma and seroma which occur after surgery can contribute to infection and capsule contracture. Swelling, pain and bruising can occur. If a haematoma occurs it is usually soon after surgery, but can also occur at any time after trauma to the breast. While the body absorbs small amounts of haematoma and seroma, larger amounts will need drainage in order to heal correctly or the incision is opened and the haematoma removed. Implant rupture can occur during drainage of the implant
Sensitivity to the nipple and breast
Sensitivity to the nipple and breast can increase or decrease after a breast augmentation. The changes after surgery can range from intense sensitivity to insensitiveness of the nipple or breast. These changes can be temporary or permanent but are rare.
Breast feeding
After breast surgery with implants it is generally possible to breast feed as normal.
Deformed chest wall
The pressure of the implants can cause the breast tissue to thin and shrink. This can occur when the implants are still in place or after they have been removed without being replaced.
Connective tissue disease
The fear of a connection between breast implants and developing auto-immune diseases or connective tissue diseases, such as lupus, scleroderma or rheumatic arthritis was voiced in reports of such cases within a few women with implants. A survey of several epidemiological studies of women with and without implants shows that such diseases are not more common in women with implants than women without. However, there are women who believe that their implants have given them connective tissue disease.
Cancer
Published studies show that breast cancer is not more common in women with implants than women without.
Effects on the second generation
The fear of possible damaging effects on children from mothers with implants has been voiced. The Institute of Medicine’s report established that there are no effects to children from mothers with implants.
Silicone gel
The gel in an implant is composed of large three dimensional tissues like molecules that constitute 20% of the total gel weight. The spaces are filled with a mixture of medical silicone oils. These oils are similar to the materials found in many products, including medication against stomach gas, which are available without a prescription for both adults and children. A microscopic amount of these oils can leak through the implants coating, but most of the oil stays on the wall of the implant.
General questions about breast implants,
What is the length of life for an implant?
Art Clinic only uses the highest quality implants from leading suppliers, our breast implant suppliers leave a written guarantee for the implants. However, it is important to know that you are likely going to have to replace your implants during your lifetime. The time period varies between women. Some women need to undergo replacement surgery within just a few years, whereas for others the implants can last for 30 years or more. There are a few reasons why a woman will need replacement surgery. Sometimes it’s a question of choice, such as a change of size of implant model, and sometimes removal or replacement is necessary because of complications.
What about exercise?
Your surgeon will be your best advisor regarding how long you need to be away from work and will discuss with you how and when you can resume your activities. The recovery period varies between women. Generally the first days are the most trying. The average time for resuming normal activity is between four to six weeks. It is important that sweat does not enter the wound while it is healing. Avoid exercise and sun tanning until the wounds have healed. Do not perform any strenuous activities, especially not on your upper body , too soon. Let your body heal and rest. You should aim to minimise the swelling around the implants. Taking a bath is usually possible after one month, also in a Jacuzzi. During early stages, one to two weeks after surgery, you should not submerge the wound under water.
Some expansion and contraction of the implants shell can occur during pressure changes. This can temporarily result in a small amount of air bubbles in the implants which disappear by themselves after 1-2 days. With silicone implants as well as saline implants it is possible that fluid sounds (bubbling) can occur. The larger the implants the heavier they will be. You should use a support bra when jogging in order to minimise pressure to the skin and ptosis (sagging) of the breast.
Remember to ask your surgeon for advice before returning to exercise. A patient’s recovery time strongly varies. Walks are however generally recommended in order to promote circulation.
Can I sunbathe is I have implants?
To use tanning beds or sunbathe will not harm the implants but can make the scars worse. You should therefore avoid exposing the surgical wound to sun and solar radiation for at least a year after surgery, since sun and solar radiation will permanently give the wound a darker colour.
Will my breast still move as normal?
This depends on several factors such as which implant model you choose, the pocket dissection, the way your body carries the implant and whether there is any capsule enclosure at all. It is possible that many women can receive breast implants that are soft and move nicely, whereas others may obtain a harder result with implants that are in a more fixed position.
When can I use an underwired bra again?
Most surgeons recommend women to wait at least 3 months before using an underwired bra after breast surgery. Your body will form scar tissue around the implant during 3-6 months. During this period the pressure from an underwire bra can influence the formation of scar tissue in a way that makes the indentation of the wire permanent. After this initial healing period it is possible to alternate between underwired bras and other bras in order to avoid permanent indentation.
To conclude:
We are all created differently and therefore have different prerequisites for breast enlarging surgery, we have also different opinions and taste about shape and size (volume) etc. Art Clinic is today one of Sweden’s leading specialist clinics within esthetical and reconstructive plastic surgery. Our experiences plastic surgeons have extensive and genuine experience, we take our time and listen and advise you in your choices surrounding implant, size and surgical procedure and tailor the surgery to your desires.
For more information or to book a first free of charge consultation with one of our authorised nurses contact Art Clinic in your area.
We offer you a warm hearted welcome!

A breast augmentation is a plastic surgery procedure which is performed in order to chnange the shape and size of the breasts.

Breasts have always been a symbol of womanhood and each culture has its own ideal image of the female body. A heavy breast can be physically troubling, whereas a small or loose breast can be experienced as a psychologically troubling issue.

Breast augmentation with breast implants is today one of the most popular plastic surgery procedures that we perform at Art Clinic. The breasts can be naturally small or become “empty” after pregnancy. The number of patients that undergo breast augmentations increases each year and at Art Clinic we work to continuously improve and refine our techniques in order to achieve as good and natural result as possible.

Breast augmentation can also be done in connection with a breast lift which is another procedure with increased popularity.

Surgical procedure – breast augmentation

A breast reduction is performed under general anaesthetic or in some cases local anaesthetic in combination with relaxative substances. The surgery usually takes between 35-60 minutes and one can go home the same day. The implants do not need to be exchanged and can be inserted in three different ways. Usually they are inserted in the fold of the breast (inframammary fold). The advantage of placing the incision here is that it provides the best view and precision as well as being able to choose freely between placing the implant over or under the muscle. It is also possible to insert the implant via the areola (periareolar), meaning the incision is placed at the edge of the lower half of the areola and the skin of the breast. This technique is suitable for implants placed under the breast tissue. Disadvantages of this technique includes the limitations dictated by the size of the areola and that it is difficult to access.

Breast augmentation via the armpit (transaxillary incision) is the most rare. The implant is usually placed under the muscle. The disadvantages of this technique includes a slightly increased risk for complications and the difficulty of over viewing the area of surgery. The scars after breast augmentation worry many patients. Generally they heal very well and in most cases become very discreet which ever method you choose. With modern technology one can calculate how the breasts will change after an enlargement and therefore place the incision as discreetly as possible. When the surgery is completed a support bandage is worn for 6-8 days until the follow-up.

Post surgery

Pain is a frequent occurrence during the first days after surgery. You will receive a prescription for pain relief medication which you can take when necessary after your surgery. After a well deserved rest most patients can leave the clinic the same say.

Massage is only recommended if one has inserted breast implants with a smooth surface, if one has inserted implants with a textured (sandpaper like) surface we do not recommend massage.

After a breast augmentation one should avoid heavy lifting and extreme exercise for the first 4 weeks. Walks and lighter exercise is allowed.

Absence from work is necessarily needed for a few days. Sometime after your surgery the breast will feel taut and swollen and it can take up to several months before the breasts have settled into the definitive shape.

After breast surgery with breast implants it is generally possible to breast feed.

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