Technically known as Augmentation Mammaplasty, this is one of the most popular cosmetic procedures in the US and the United Kingdom.  An implant is inserted through a small incision and positioned either behind the pectoralis major muscle or beneath the actual tissue of the breast. When the implant is beneath the muscle, it may have a more natural appearance.

An implant may look unnatural in front of the muscle if you have a small
amount of breast tissue and not much subcutaneous fat. Wrinkling in the
implant is also more visible when the implant is placed in front of the muscle.

The Procedure

Breast enlargement takes approximately one hour. In the United Kingdom,
the surgery is carried out at a private hospital. You will usually stay in the
hospital for one night. In the United States, surgery is usually performed at
our Accredited Surgical Center in Norwalk, Connecticut. For patients who
request or require a hospital setting, cosmetic surgery is performed at the
Greenwich Hospital in Greenwich Connecticut or the New York Eye and Ear
Infirmary in Manhattan, New York.

The Recovery Period

Implants are either positioned in front of or behind the muscle. After surgery,
you will wear a "bandeau" (for 14 days, day and night and for 2 more weeks
during the day only) to position the breast implants. In most cases, no bra is
recommended for 6 weeks. Under-wire bras are usually to be avoided except
for social occasions. Some sutures may be removed 4 days after surgery.
Most sutures do not need to be removed. The remaining sutures will absorb
spontaneously and help to give you a narrow scar that is barely visible.

Although you will be out of bed on the same day as your surgery, you will be
advised when you can resume your daily routine. Light exercise, such as
gentle walking, is permitted at one week, more vigorous exercise at two
weeks. You may return to a regular exercise schedule at three weeks. To
permit proper healing, you should avoid lifting weights for three weeks. The
decision regarding when you should return to work and fully resume normal
activities depends on how fast you heal and how you feel. Most patients
return to work within seven days. Air travel is permitted after 5 days. No
heavy lifting (greater than 5 pounds) is recommended for 10 days. You may
drive after 7-10 days. Automatic transmission is easier than a manual
transmission or "stick shift."

How will I look?

You will discuss the eventual size of the breasts with Prof. Kirwan during the
initial consultation. Your new breasts should look and feel natural. After the
procedure, most women adapt quickly to their new shape and rarely give a
second thought to their implants. They will not affect fertility, pregnancy or
your ability to breastfeed.

Since the purpose of the procedure is to make, your breasts look attractive;
scars are kept as small as possible and usually made either under the nipple
or under the crease of the breast.

Type of implant

Breast implants are made with either a smooth or a textured surface. There
are some theoretical advantages to a textured implant in that it may be
associated with a decreased rate of capsular contracture.

The disadvantage of a textured implant is that it remains immobile on the
chest wall and has a harder feel and more unnatural look. For this reason,
Prof. Kirwan prefers silicone gel implants with a smooth envelope. The
following implants are available:

Anatomically Shaped Cohesive Silicone Gel

This unique shape-retaining cohesive silicone gel implant maintains its
original shape. The disadvantages of the anatomical or tear-drop shape is
that it keeps the same shape in the standing and the lying position whereas
a normal breast is round in the lying position and tear-drop shaped in the
standing position. Studies have shown that the round implant is teardrop
shaped in the standing position. Anatomical implants generally have a
greater forward projection than the same volume round implant.

Silicone Gel Implants

Silicone implants have been successfully used since 1962. Silicone gel has
an excellent texture as a filling material because it is soft and pliable and
allows for natural movement. Silicone gel feels like natural breast tissue.  The
possibility of silicone interfering with the standard mammography can be
overcome easily by informing your radiologist about the presence of the
implant; he or she can alter the technique to obtain the optimum result
(Eklund Technique). Radiologists, who perform this procedure as well as
other diagnostic studies for breast tissue and implants, will be recommended
in the USA and the UK. There has been no evidence that silicone gel is
related to connective tissue disease. In fact, silicone appears to be one of
the most inert materials known.

Capsular contracture

This is less common when the implant is beneath the muscle. The implant
may have a more natural appearance when positioned behind the muscle,
especially in someone with a small breast and not much fat.

Safety

Breast enlargement is a relatively safe procedure. However, as with any other
surgical procedure, there are certain risks and specific complications that
you should discuss with your surgeon.

In the United Kingdom, all implants are numbered and have a CE mark. You
will be given a record of this to keep, as it is an important means of being
able to identify your chosen implant and its origin years after it has been
inserted.

More Information

Institute of Medicine booklet for women on breast implants: Information for
Women About the Safety of Silicone Breast Implants, published by the
prestigious Institute of Medicine (IOM).

This consumer booklet is derived from the large government-funded IOM
study -- Safety of Silicone Breast Implants -- released last year. The study
evaluates the evidence for associations of breast implants with human health
conditions, provides a comprehensive list of references, and makes
recommendations for further research. The enclosed consumer publication is
a step toward meeting one of the IOM study recommendations -- that is,
making the information contained in the original report available to women
who have or who are considering breast implants. In this publication, the
Institute of Medicine seeks to provide a short, easily understood version of
that information to women.

You may wish to consider ordering a copy of this booklet if you are
considering breast implants. To order contact the National Academy Press
at 800-624-6242 or online at www.nap.edu. The price for booklets ordered
online is $4 per copy. The full 560-page IOM report -Safety of Silicone Breast
Implants -- may be ordered online for $39.20.

In the USA: 605 West Avenue Norwalk, CT USA 06850 Ph: (203) 838-8844 Fax:(203) 853-1862 Efax:(203) 286-1046 Email Prof. Kirwan Also in the USA at: 800-A Fifth Avenue, #202 (corner of 61st St.) New York, NY 10065 Ph: (212) 838 8844 Fax:(203) 853-1862 Efax:(203) 286-1046 Email Prof. Kirwan In the UK: 56 Harley Street London W1G 9QA Tel:+44 (0) 20 7637 4455 (after 2:00 p.m. GMT from UK) Fax: +1 203 853-1862 Efax: +44 (0) 20 7504 8143 Email Prof. Kirwan