BREAST AUGMENTATION

An expert in the field of dermatologic and aesthetic surgery, Dr James Roy Kanjoor has done his MCh from Madras Medical College in 1990, FRCS (Edinburgh) in 1999, and Keratinocyte Culture Training at the University of Freiburg, Germany. He is known for doing one of the first BRAVA Breast expansion and fat augmentations in India. A board-certified plastic surgeon, he has published about eight articles in indexed journals. He has worked at Kuwait MOH for eight years and another four years as a consultant at private practice. He also established the Department of Plastic and Cosmetic Surgery at Belhoul Hospital Dubai, UAE.

Know more about breast augmentation from Dr Kanjoor:

Who is a good candidate for a breast augmentation surgery? What is the type of patient you typically see for this procedure?

Both women and transwomen can opt for breast augmentation. Biological females usually in the age group of 30-40-yearolds come after child birth due to deflated breasts. Another group of women who opt for this procedure – in their early 30s – are post weight loss patients who have both deflation as well as sagging. They need a lift as well as volume with implant or autologous fat. This procedure is called Mastopexy with concomitant augmentation.

The ideal or good candidate for a breast augmentation procedure is a young person with good quality skin with elasticity, less stretch marks and above all no sagging. The skin envelope should have sufficient fat pinch to cover the implant.

As in the case of transwomen, they opt for breast augmentation between early 20-30 years. For them, breasts are the sign of feeling most feminine, and to achieve the same, they opt for this procedure.

How can best results be derived from this treatment? Tell us about the surgical technique adopted by you?

Best results are in the eyes and minds of the person who seek this augmentation. As a doctor, we should spend quality time with them before the surgery and try to understand and register what they perceive and the type of breasts that will satisfy them. While some would want a normal appearance, some prefer a transformation that is noticeable. Most of them prefer a slightly larger size.

Secondly, but most important is the clinical observation of the “sagging or ptosis” as sagging is difficult to correct with just an implant. Also, the skin envelope around the breast should have a good pinch – more than 2-3 cm – to give a good envelope around the implant so that the margins are not visible.

There are different surgical techniques: subglandular, subfascial, and submuscular dual plane pockets. The most common approach is submammary. In the transaxillary approach, the scar is least noticeable, and hence this is commonly sought after.Transareolar is a good approach with least visible scars and is practiced when the areola is wide. Transumbilical endoscopic breast augmentation are also possible.

My preferred technique is the subfascial pocket through the submammary approach, which is a good technique with the least pain and offers a good outcome. Also, when the skin envelope is insufficient, immediate fat grafting can be combined with the  composite augmentation technique.

What is the recovery time for a breast augmentation surgery and what is the post-treatment care involved?

We do breast augmentation as a day care ambulatory surgery under total IV sedation with local anesthesia, or LMA or sometimes general anesthesia. The patient goes home the same day.A surgical bra is applied on the operation table. If the bra is not available, surgical plasters are taped all around the breast for seven days. The patient is advised less movement of both shoulders for three to seven days. A three-week period of less work and care is ideal. While no other special care is needed, direct injury to the breasts should be avoided.

Breast augmentation is not a lifetime surgery. In the earlier times, exchange of implant was recommended after 7-10 years. At present, due to the availability of advanced quality of medical grade silicone, the need to exchange can be avoided unless some complications like capsular contracture or malposition occurs. Capsular contracture presents a hard consistency over the implant area. There are trouble-free patients even after 20-25 years. Recently, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has been reported in few patients after several years. For legal reasons, it is better to seek counselling about the same.

Any contraindications involved that one should be aware off? Also, is there anything the patient must not do after the procedure?

For a healthy person – female or male – with suitable local factors such as ideal tissue factor, no asymmetry and no sagging, there are no contraindications. Probably over my years of practice, what I have considered as a contraindication is the patient’s unwillingness for the procedure, yet agreeing for the same out of pressure from her husband, mother or close friends. She is not mentally prepared for this change. I have also had occasions where patients have returned after three to four years requesting for the implants to be removed. Hence, I make sure that I reconfirm her state of acceptance before the procedure, especially when she is alone.

This is a deceptively safe procedure with less complications if the patient, implant and procedure selection are all ideal.

Which do you consider as your most challenging as well as successful case study for this treatment, and why?

A challenging case would be a concomitant breast augmentation for a small sagging breast. It is a situation where two paradoxical principles are working at the same time. Mastopexy aims at a tight lifted envelope, and breast augmentation aims at an expanded aesthetic breasts. This approach requires meticulous planning.

The successful case was that of a mother of two children who had a silicone implant through axilla, which was so gratifying to her when she said her husband failed to notice the scars of the augmented breast but appreciated how she maintained herself even after childbirth.

The ideal candidate is a young person with good quality skin with elasticity, less stretch marks and above all no sagging.