Breast augmentation surgery/ breast implant surgery- Bangkok, Thailand

Breast enlargement surgery or breast implant surgery, technically called Augmentation Mammoplasty (AM) is a surgical procedure to enlarge small breasts or breasts that have lost their fullness.

For patients with mild to moderate breast sagging, it will also improve the shape of breasts and also position of the nipples.

Among the gender reassignment surgery, the breast enlargement surgery is one of the most popular cosmetic procedures for transsexuals. It is not unusual to combine this procedure with sex change surgery in one setting.

Types of implants

All breast implants utilize a silicone shell but the fillings differ, either gel-filled or saline-filled.

The outer silicone shell, which give the prosthesis its elasticity and integrity, may be smooth (shiny polished) or textured (finely rough) surface.

There is no doubt that the breasts, augmented with textured implant, providing a disruptive surface for collagen interface, have a lower tendency to develop contracting capsules than the breasts augmented with the smooth implants.

Breast implants may not last a lifetime and the rates of rupture in saline filled implant is higher than the gel filled one.

The gel filled implants I always recommend to my patients contain high cohesive gel, which is more crosslinked than a standard silicone gel and provides a higer resistance to flow. If the implant shell is ruptured, the inside gel will rarely escape (not leak).

The shape of the implants I prefer to use is round shape, low to moderate profile (projection), providing natural upper fullness as well as nice clevages of your new breasts.

My favorite choice of breast implant is Siltex Textured Surface Breast Implants from Mentor corporation. (click to get more info. on Mentor's website)

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About the Breast implant & my surgical technique

Sizing of breast implants

The implant should not be too small or too large in comparision to the patient's chest wall dimensions. Our goal is to augment your breasts to a size that is in better proportion to your physique and to maintain a very natural look.

There are many factors effect the such as your original cup, your expected cup and your physique including the chest muscle.

If you have board chest, especially the position of your nipple is far apart, the selected size of implants should be rather big with low to moderate profile (wide base dimension) to get a closer nice cleavage.

If you have some degree of breast sagging, the selected size should be quite big with moderate to high profile, providing upper breast fullness and also improving the nipple position.

If you have little breast tissue and/or very thin skin, the proper size should be choosen carefully (for example: not more than 280cc.). Too big implant may cause abnormal thinness of skin (translucency) or visible and/or palpable wrinkling (rippling) in an implant.

Placement of the implants

There are 2 surgical techniques of placing the implants, which should be thoroughly discussed between the patient and the surgeon.

1. The implant is placed under the breast tissue and over the chest muscle (subglandular placement).

2. The implant is placed under the chest muscle and breast tissue. (submuscular or subpectoral placement)

I prefer to place the implants submuscularly as it can help reduce the chance to get capsular contracture and also visible/palpable wrinkles in an implant, which are related to the thinness of the overlying tissue cover (skin and breast tissue).

Surgical technique

The procedure is usually done under general anesthesia.

I prefer to insert the implant via the incision in the crease of armpit (transaxillarly), since in most cases the scar is almost invisible.

The dissection is carried out transaxillary with a special instrument to develop an appropriate space for the implant.

I routinely create the space under the chest muscle (subpectoral plane).

A well-defined pocket of adequate size and symmetry will be created to allow the implant to be placed flat on a smooth surface.

The implant will be inserted via the armpit incision and placed at the proper level in the created pocket.

Small surgical tubes will be routinely used to drain the fluid collection and also prevent hamatoma (blood clot formation in the pocket).

The surgery takes 1 to 1.5 hour and a bandage will be applied over your new breasts to help with healing for two days postoperatively.

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Postoperative Breast implant surgery information

Recovery and after care

The surgical tubes and bandages are removed on postoperative second and third day respectively, and then you are allowed to bathe as usual.

The patient is requested to have early breast excercise (gently move and/or expand the implants around the created space) to prevent the breast firmness (capsular contracture)

There are two main technique for excercising, which are pressing and sqeezing technique. The aim is to maintain the space around the implant as well as prevent the thickness of surrounding capsule (capsular contracture)

Only gentle manipulation of the implants is recommended, the proper time should be between 15-20 minutes 2 or 3 times a day. You may adjust your own schedule later if your breast contour improves satisfactorily and there is no resistance while exercising.

You will be taken care of by my nurse team everyday during your recovery at the nearby recommended hotel. This is the important time you will learn everything about the after care, especially breast massage technique. I recommend you plan to recuperate with us for not less than one week.

Technique of Breast Implant Massage after Breast Augmentation

Whenever any foreign material is inserted into the body, the body will respond with a non-specific reaction of scar formation to try to wall off the foreign material with a scar covering.

Ordinarily the body will try to limit the size of this scar into the smallest possible space, but there are ways to limit the scar response by appropriate techniques after breast implant surgery.

There are two techniques that I recommend you to exercise the implants (breast massage)to prevent Capsule Contracture (development of a foreign body scar).

1. The compression technique (for making the surrounding capsule very thin and getting soft breasts)

Compressing force against the implant can make the capsule around the implant to be so thin and elastic.

Place your lower palms at the center of your new breast (at the nipple area or just above it), and then, gradually apply pressure vertically against the chest wall to expand the implant.

While effective pressing the implant, the force must be applied constantly on breasts 2-3 minute each time and then switch to the other side.

This should be done 2-3 times per day, around 20-30 minutes each.

2. The squeezing technique (for checking the space around the implants)

Spread your thumb apart from the other fingers at the lowermost area (infra-mammary fold) of your new breast).

Forcing the thumb toward other fingers to push the implant up to the upper border of the space.

You must hold the squeezing force for a minute before releasing, this should be done 1-2 time before and after doing compression technique.

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Breast implant surgery information

Risks of the procedure

All surgical procedures have a small risk of complication inherent to the surgical itself and to anesthesia. These risks include:

Infection, as manifested by swelling, tenderness, redness and fever, is an uncommon risk . However, if an implant becomes infected, it must be removed immediately. You need to wait for several months before we can reschedule another operation.

Hematoma formation (large blood clot in the wound), which is manifested by enlargement and discoloration of tissue, may, if happened, need to be removed. Meticulously stop bleeding, surgical tube drainage and postoperative pressure bandage are important to prevent this sort of complication.

Risks specific to breast implant surgery

Capsular contracture

Capsular contracture is the most common side effect of breast implant surgery.

To accept the implant, a surgical pocket behind the breast is made somewhat larger than the implant itself.

Normally a healing scar forms a very thin envelope (capsule) around the implant, which, on occasion, will shrink sufficiently to squeeze the implant, producing varying degree of firmness.

At its worst, the implant can feel hard, be painful and /or distorted. This can occur soon after surgery or years later and may be unilateral, bilateral or asymmetric.

Surgical release of the scar (via the peri-areolar incision) is ofter successful but recurrence is not uncommon. Removal or replacement of the implant may sometimes be required.

The cause of this contracture phenomenon is poorly understood but appropriate breast excercise against the capsule can significantly reduce the rates of this undersirable complication.

Rupture of the implant

Breast implant may not last a lifetime.

For saline filled implant, if the implatn shell is ruptured, there is a rapid change in shape of the implant and you absolutely need to change the new one.

For standard silicone gel, if the implant shell is ruptured, the escaping gel is usually contained by the scar envelope in the surgical pocket and may be undetectable except by Magnetic Resonance Imaging (Silent rupture). Most of the reported case occured in the more fragile, thinner shell devices implanted in the late 1970's.

For the high cohesive gel, if the implant shell is ruptured, the gel will normally not escape or migrate from its shell due to a higher resistance to flow.

Changes in Nipple and Breast sensation

Any surger of the breast can result in undersensitive or oversensitive nipple-areolar complex and/or underminded area of breast skin.

These changes are believed to be a result of nerve damage from the surgery.

These changes can be vary in degree and may be temporary or permanent.

Interference with Mammography in Detection of Cancer

As silicone is opaque to x-ray, an implant may theoritically interfere with the early detection of cancer by mammography as it may obscure part of the breast.

Newer techniques of breast compression improve the amount of breast tht can be visualized.

Alternatively, most surgeons feel that the implant may improve the detection of tumors by palpation.