Q&A on breast surgery

Q: How would one find the right surgeon to do the job and know that a good job will be done?

A: An important question. Ask your GP for a recommendation or get a name from a friend who is happy with the outcome of her surgery. Be sure to feel comfortable with the surgeon, use your instincts and have a second consultation if necessary. Also make sure your surgeon is a member of the Association of Plastic and Reconstructive Surgeons of Southern Africa.

Q: I had breast implants about 20 years ago. They have become extremely hard (like tennis balls) and the underside of the left breast is painful - as though there is a small lump. How do I get this corrected or is it time for the implants to come out. I am 49.
A: capsular contractures (hardening of implants) is a common and sometimes troublesome problem that occurred especially with the older type of implants (but may still happen today). I will try and simplify by dividing the problem into early and late contractures.

Early contractures (usually within the first 3-4 months after surgery) happens where the body covers the new implant with a “membrane of scar tissue” (called a capsule) resulting in a firm, palpable and sometimes even visible implant. There are many theories why this happens, no definite answer yet. Fortunately the new generation of textured implants (the outer surface rough and instead of smooth) has made this much less of a problem than in the past.

Late hardening might be a sign of an implant rupture or leakage (assuming you had Silicone implants). The older generation (as in 29 years ago) implants were made with a much thinner outer wall than today and a disintegration of this wall would result in the leakage of silicone ... with the body “sealing it off” with a capsule. A replacement would be indicated.

Most important, do not see a painful augmented breast (especially when feeling a lump) as merely an implant problem. At the age of 49 could you could present with breast pathology other than implant related and a proper evaluation by your GP/Gynecologist /Surgeon/Plastic Surgeon is imperative.

Q: According to your knowledge, does breast enhancement pills work, for spesifically 'breast gain plus'?
A: I do not have any firsthand experience of these pills or other non-surgical methods which claim to give breast enhancement but there are little support for these measures in the academic literature.

Q: I am a 27 year old Quad a and due to my spinal injury have lost all the muscle tone in my breasts, would a breast operation be an option for me and would my recovery process be more involved.
A: A tricky one! Contrary to what is sometimes believed, breast shape is not determined by muscle strength or muscle tone. The myriad of muscle exercises to improve breast shape or breast volume is thus smiled upon by the plastic surgeon fraternity.

If a large size is causing functional problems (as might well be with a quadriplegic patient) a breast reduction is certainly an option. With proper pre-, intra- and post-operative care the recovery process should be fine but you will obviously have to discuss in detail with your surgeon.

Q: I have had a baby and my breasts had enlarged during pregnancy and did not go back to normal. If I have a reduction and then have a second child later on, what will happen to my breasts. Will it again enlarge and not go back to normal. What will be the best time to have a reduction? Should I wait to have my kids first and then consider it?
A: A wise and cost-effective decision for a woman planning another pregnancy in the near future would probably be to postpone the reduction until after her family is completed.

A surgically reduced breast will undergo the same changes of pregnancy … it will enlargement and afterwards show a possible decrease in size with loss of shape. Or they might show a long-term volume increase as you experienced.

Q: Are there any ops to lift your breasts just to firm them. I am happy with the size but they are hanging after I had my child.
A: The procedure to “lift” a breast without an obvious change in size is called a mastopexy. It’s a quite a popular procedure to provide a firm shape, the main disadvantage being a scar around the nipple, down the breast and as short as possible in the fold under the breast. Technically almost the same as a breast reduction but mostly skin to be removed … the bulk of breast tissue/volume left intact.

Q: I would also like to know what the recommended age for a reduction is, as I am only 21. My breasts are quite large, but the degree of permanent scarring is problematic for me. Is there any way to reduce the scars of the operation? Also, will the operation pose any problems when I decide to have children and wish to breastfeed?
A: It appears you need some encouragement! No, a breast reduction is not known as a painful operation. The first couple of days a burning feeling that can be well managed by oral medication. Usually one night in hospital, one week of behaving “sick” in bed at home and another week’s limited activities before a normal daily routine two weeks following surgery.

The cost for a reduction will cost around R40 000 (this includes the hospital, anesthetist and surgeon). Some medical aids will pay but a letter of motivation and clinical photo has to be subjected by your surgeon to state functional impairment caused by the physical weight of the breasts.

Regarding the timing of surgery one should make sure that your breast growth is completed before surgery, usually from around the age of 18. Breastfeeding after the operation is quite possible but may depend on the technique your surgeon uses.

Yes, residual scars (around the nipple, down and usually in the fold of the breast) are probably the main disadvantage of a breast reduction and should be carefully weighed against the functional/aesthetic advantages of having the procedure.

Q: I had a breast reduction 3 years ago, and I am now 20. I want to know about the scars, seeing that I can still see the marks quite clearly, I have tried many oils example, Bio-Oil and Clarins' SOS treatment oil. I also had silicon plasters, but only used them for a while, because it was irritating, and kept falling off. I was wondering if you have any suggestions on my problem, seeing that I realy want the scars to fade more. Maybe some other oils or cream I can try... Thank you very much.
A: The scars of a breast reduction are permanent … in my opinion the biggest factor to keep in mind when considering the procedure. Most scars will fortunately heal towards a thin line with the same color and contour as the surrounding skin. Sometimes you would however see the patient who who does not heal with a nice scar. These might be stretched or sometimes raised, itchy and red ... then called a keloid.

Treatment depends on the problem. Wide scars might improve with an excision of the most prominent areas and long-term support with a plaster (not silicone) to prevent stretching. Keloids may benefit from cortisone injections. I would prefer not be drawn into the controversy surrounding medication/oils/creams/special plasters to improve scar healing/appearance.

Q: I had a lift and implants done so 3yrs ago and am pregnant now. I would like to breastfeed again. Can I expect any problems?My nippels are not as sensitive as they were before the op and seems a bit bigger and the areola doesnt contract the way it did with my first born and before the op.
A: Breast implants are positioned behind the breast tissues (with both the “behind the muscle” and “in front of the muscle” techniques). This implies the milk ducts remain intact and, from a technical point of view, you should be able to breastfeed as normal.

From a safety point of view, extensive research has shown both Saline and Silicone implants to be perfectly safe in the context of breastfeeding.

Q: I want to enlarge my breasts, where should I go, how much does it cost and could I pay it off?
A: you could ask your GP to recommend a reputable plastic surgeon or get a name from a friend who is happy with the outcome of her surgery. You can also visit Association of Plastic and Reconstructive Surgeons of Southern Africa for a list of surgeons in your area.

You will find that the cost for an augmentation will be around R40 000 (hospital, surgeon, anaesthetist and implants included). This is a purely cosmetic procedure and payment is usually to be made at the time of operation.

Q: Hi, I would love to have only one cup size bigger breasts than what I have now. I'm 20, weigh 50kg and my breasts are +- 34b I would like to have a 34c. What are the costs and the best place to go. I would also like to know if you can breastfeed after such an operation, although I doubt it.
A: You could ask your GP to recommend a reputable plastic surgeon or get a name from a friend who is happy with the outcome of her surgery. You can also visit Association of Plastic and Reconstructive Surgeons of Southern Africa for a list of surgeons in your area.The cost is around R40 000 (hospital, surgeon, anaesthetist and implants included). Yes, the implant is inserted behind the breast tissue and breastfeeding will be as normal.

(Article reviewed by the Association of Plastic and Reconstructive Surgeons of Southern Africa, November 2012)

- (Health24, November 2012)

Read more:

Are you a breast surgery candidate?
Breast reduction: when less is more
All about breast augmentation

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