The First Consultation

During the first consultation the patient will discuss the goals and expectations of the surgery together with the operating surgeon. The surgeon will assess the nature of the breasts, decide on the size and position of the implants considering the patient's expectations and the breast to hip ratio and explain the risks involved in the procedure. At our hospital different size implants can be ordered for the patient. The smallest breast implants are around 100 cc in volume and the bigger ones can be over 500 cc. The size difference between the implants is 30 cc.

After the breast augmentation the patient stays overnight at the hospital.

Breast Augmentation

For many women, breast size is an important part of feeling good and desirable. Having a breast augmentation can greatly improve self-esteem for many women.

Breast augmentation can dramatically enhance the appearance of a woman's breasts. It can also improve the breast to hip ratio important for a balanced body image. For example, hips will look narrower after the breast enlargement making the figure look more graceful and balancing the body contour.

Before the breast augmentation	After the breast augmentation

Having children, the loss of a significant amount of weight and ageing all contribute to the loss of volume and tone in the breasts. Breast size and shape depends upon various factors such as breast gland size, skin tone and heredity. Implants are used to enlarge small breasts. They can also be used to reconstruct breasts after cancer, to correct underdeveloped or asymmetrical breasts. There are several surgical approaches to reconstructing a totally or partially missing breast, e.g. tissue expansion, implants, and TRAM method. In some cases, for instance, it may be necessary to replace local tissue from elsewhere in the body.

Before the operation it is extremely important to try different size implants to get an idea as to the look you desire and to carefully go through all the information about the surgery. The operation lasts about an hour and is done in general anesthesia. Before the operation the position of the implants is carefully marked. The implant is placed either above or below the muscle. The incision can be placed along the crease underneath the breast; around the areola; or in the armpit.

Silicone gel filled implants

Breast Reduction, Breast Lift

Large, sagging breasts often cause back pain, tense muscles, postural problems and skin rashes. Too big breasts can also interfere with normal physical activities. The breast size depends upon various factors such as heredity, amount of pregnancies, age of the patient, amount of fat and overall weight of the patient.

Breast reduction can be done at any age but on the very young patients should be performed only after careful consideration.

During the consultation the breast size and shape are discussed. The operation is done in general anesthesia and lasts 2-3 hours. During the operation, over one kilo of excess breast tissue can be removed, the excess skin is excised, the nipples are relocated to a higher position and the remaining breast tissue is reshaped.

Before the breast reduction and lift	After the breast reduction and lift

Breast reduction uses incisions that encircle the areola and then extend vertically down the breast and horizontally along the crease underneath the breast. In some cases, the incision is placed just around the areola. There are other breast reduction techniques using a different pattern of incisions. Breast reduction does not usually prevent lactation and breast feeding but the nipples sensitivity might temporarily decrease following the operation.

Implant fillings

A silicone implant consists of an outer silicone shell filled with a silicone gel. Some implants are filled with gel so hard that when cut in two they do not leak a drop of gel. Textured implants are more tissue friendly than smooth implants minimizing capsule contraction or scarring around the implant to a few percents. At our hospital we also use saline-filled implants.

Before the breast reduction and lift	After the breast reduction and lift

Silicone and Breast Cancer

Lately the safety issues of silicone breast implants have been extensively discussed in the mass media. There is a great deal of scientific evidence supporting the long-term safety of silicone breast implants. According to the multiple clinical trials, the incidence of breast cancer in patients with silicone breast implants is even smaller than in patients without implants. This could be due to the fact that the patients who have undergone breast enlargement often have less breast gland tissue and are therefore at at lower risk to develop breast cancer.

Recent studies conducted in the USA, e.g., the study carried out at the University of Los Angeles supported the safety of silicone breast implants. The study performed on the patients operated 27 years ago had shown that the risk of breast cancer in the patients with silicone implants is smaller than in the patients without the implants.

Silicone Gel and Autoimmune Diseases

In medicine silicone gel is considered to be a suitable filling substance for use in the breast implants as it does not get rejected by the body. Despite that, there is an opinion suggesting an association between silicone gel and autoimmune diseases such as rheumatoid arthritis and progressive systemic sclerosis or scleroderma. One symptom of connective tissue disorder is a disturbance of the autoimmune system. In autoimmune diseases the autoimmune system turns against itself causing tissue damage. Heredity is a frequent cause of connective tissue diseases and women are affected much more frequently than men. The fact that among them are also women with silicone-filled implants does not prove that silicone causes autoimmune diseases. There are no clinical data proving an increased incidence of connective tissue disorders in patients with silicone gel breast implants. Statistically, connective tissue diseases are as frequent in women with silicone-filled gel implants as in the rest of the population.

In most European countries silicone gel is approved as a filling substance for use in breast implants. In the USA the use of silicone gel breast implants is prohibited till the manufactures of these devices present the FDA (The Food and Drug Administration) clear proofs that there is no connection between silicone-filled breast implants and autoimmune diseases.

Control in the EU Countries

Silicone-filled implants are approved for breast augmentation in all the Nordic countries and all the EU countries except for France and Italy. In Finland silicone-filled implants have been used for breast augmentation since 1970s. Although the Medical Devices Unit of the National Agency for Medicines recommends a careful examination of the patients prior to breast augmentation, there are no limitations of the silicone gel implants use in Finland. The patients with silicone-filled implants are advised to be examined by a general physician every two years (the National Research and Development Center for Wealth Fare and Health, 1994).

According to the official opinion of the National Research and Development Canter for Wealth Fare and Health (Impact 4/98), silicone gel is a safe filling substance for use in breast implants and does not cause autoimmune diseases.