Breast enlargement is a very common desire for many women. A smaller breast size often leads to low self-esteem. Since this is a personal issue, many shy away from getting professional help and suffer in silence. There are a lot of myths assosciated with getting breast implants and as usual, the truth lies somewhere in between. But if you are interested in getting surgical help, here is also the information you need to know. Read up on all the possible risks and complications involved as well as the benefits that this surgery comes with. This will then help you make an informed and wise decision.

Facts and fabrications
Implants — the pros and cons go further than filling your favourite dress out better. The desire for bigger boobs can start as early as school — who was the first in class to wear a bra? Media, peers etc. can all contribute to a smaller-breasted woman’s low self esteem and it’s very rarely discussed. Any apprehensions of implants causing auto immune diseases or breast cancer have no scientific basis.
The myths surrounding the procedure abound — some extoll its confidence building virtues, some condemn its potentially dangerous vanity. The truth lies somewhere in between. An objective, comprehensive analysis of risks, benefits and possible complications can help one make an informed decision.

Implants — are they for you?
Women younger than 17 and in their late 40s onwards will not really benefit from implant procedures. With the exception of patients who need breast reconstruction (following breast removal — for cancer), this is purely a cosmetic procedure so personal choice is key. Implants can ‘fix’ underdevelopment (of either one or both breasts) or mild sagging with less scarring than a breast lift. It’s what’s on the inside that counts.

Types of implants:
Implants have two components — an outer shell and inner content. The outer shell is made of silicone and the inner filling can be either sa-line or silicone gel. The shape of the implant, imitating nature, varies widely — circular, anatomic, high profile, low profile and the outer shell surface can be texturised or smooth. Some implants have a fixation patch to help them stay in place. Manufacturers cater to several permutations and combinations to match each patient’s unique requirements.

Saline or gel: Which is better?
You will have heard the argument in favour of saline implants — if the contents leak, the body absorbs the saline, no harm done, except loss of implant volume. Another advantage is that the implant comes as an empty shell and is filled with saline during the operation which translates into a smaller incision at the time of insertion — ergo, a smaller scar.
Gel implants though in consistency ‘feel’ much more ‘natural’. In a skilled surgeon’s hands, they can be inserted with as small an incision, leaving a scar of similar length. And they are the implant of choice by most plastic surgeons worldwide.

Making the cut — implant positioning
The incision (to insert the implant) is most commonly made in the fold under the breast. Doctors may also insert around the nipple or in the armpit, but while these approaches produce less noticeable scars, implant positioning is more difficult.
Implants can be positioned under the breast and above the chest muscles or under the chest muscles.
Above the muscles produces better volume and shape as compression by the muscle is avoided. For combination procedures though (breast lift plus implant) or breast reconstruction (following cancer surgery) under the muscles is a better location.
Time? Money? Recovery?
Routine breast implant surgery is done in a day while combination procedures and reconstructions require approximately two days hospital stay. It can cost between Rs 1,00,000 to 2,00,000 depending upon the procedure. Very minimal post-op care is needed. Avoid straining the area; so for at least three weeks, limit shoulder movement, don’t lift heavy objects and wear a support bra.

Measuring the risk
Implants entail a surgical procedure and have inherent risks — bleeding, pain, infection, displacement, capsular contracture. Though uncommon, a detailed discussion with your plastic surgeon will help you make an in-formed decision. And while I have seen patients who have lived problem free after getting implants more than 20 years ago, the new generation of implants (textured surfaces, cohesive gel) and proper surgical procedures have further reduced such untoward incidents.

Combination surgeries
The breast lift and implant is a common combination. A simple breast lift cannot produce the upper fullness many women desire, so the addition of a small implant perfects the results.
Breast removal for cancer and reconstruction immediately after is very common. Whether to do so immediately or later is usually decided by the disease process and consultation between the onco surgeon and the plastic surgeon.
The measures taken to enhance one’s appearance remains a personal decision usually unaffected by what is in or passé. The fact is breast implant surgery remains one of the most satisfying procedures in the field of cosmetic surgery — both for the patient and the surgeon.
The writer is a senior
consultant cosmetic surgeon, Apollo Hospitals