Procedures

Breast augmentation

Breast augmentation is a surgical procedure to enhance the size and shape of a woman’s breast for a number of reasons:

	To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
	To correct a reduction in breast volume after pregnancy.
	To balance a difference in breast size.
	As a reconstructive procedure following breast surgery.

Are you a good candidate for breast augmentation ?

Breast augmentation can enhance your appearance and your self confidence, but you should think carefully about your expectations and discuss them with me prior to yoursurgery.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in their appearance and who have realistic expectations.

Planning your surgery

During your initial consultation I will evaluate your general health and ask you whether you smoke or take any medications.  I will explain which surgical technique I think will be most appropriate for you, based on the condition of your breasts and skin.

You will have the opportunity to discuss your wishes and expectations with me.  We will discuss the type of anaesthetic to be used, the operation and your post-operative recovery.

Preparing for your operation

I will give you instructions to prepare you for your operation, including guidelines on eating and drinking, smoking and taking or avoiding certain medications.

Remember to arrange for someone to drive you home on the day after the operation and perhaps to help you out for a few days, especially if you have young children at home.

Your surgery will be performed in the Main Operating Theatres.  You will be anaesthetised by a Consultant Anaesthetist and cared for by fully trained theatre staff.

The operation

Inframammary crease incision

The method of positioning your implant will depend on your anatomy.  The incision will be placed in your inframammary crease ( the crease under your breast where your breast meets your chest).  Every effort is made to ensure that the incision is placed so the resulting scar will be as short and inconspicuous as possible. Once the incision is made in the skin, your breast tissue is lifted and a pocket is developed, either directly behind your breast tissue (subglandular) or underneath the pectoral muscle (submuscular).  The implants are then centered beneath your nipples.

Subglandular implant	Submuscular implant

Occasionally a drainage tube will need to be inserted into the breast pocket and this will normally be removed the day after surgery.

The incisions are closed with an absorbable suture and tapes are used to cover the wounds.  Adhesive tape is applied to the breasts to provide support.  The surgery usually takes between one and two hours to complete.

After your operation

You will wake up in the Recovery room and be transferred back to the ward shortly afterwards.  You will stay in hospital for one night and be discharged on the day after your operation, unless you have had drainage tubes inserted which may delay your discharge by a day or two.

You are likely to feel a bit tired and sore for a few days following your operation, but you will be up and about and any discomfort should be controlled by medication which we will provide for you before you are discharged.

I will ask you to wear a sports bra or crop top (there should be no underwiring) as soon as you feel comfortable to do so.  This will usually be on the morning after your operation.  You should wear this night and day for the first two weeks and then duringthe day for a further two weeks.  After four weeks you can wear any form of bra you wish.

You should leave your dressings alone until your first check up appointment back at the outpatients department, when a nurse will remove your adhesive tapes and replacethem with clean tapes.  A week later you will be seen again in the outpatient department and the suture knot will be painlessly snipped by the nurse.  Your next appointment will be to see me one month later.

The swelling in your breasts may last for three to five weeks.  For the first two weeks or so you may experience a burning sensation in your nipples, but this will subside as the bruising resolves.

Getting back to normal

You should be able to return to work after your first dressing change (one week), but this depends on the level of activity required for your job.

During this first week you should try to keep your elbows down by your sides, so you are not moving your shoulders around too much, and you should avoid lifting objects from above shoulder height.

Gentle exercise can be resumed after two weeks, such as swimming (breast stroke, notcrawl, backstroke or butterfly) and cycling.  You will be able to drive a car with power steering after three or four days but it may be longer before you can drive a car without power steering.

 Your breasts will probably be sensitive to direct stimulation for two or three weeks, soyou should avoid much physical contact.  After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.

Your scars will remain firm and pink for at least six weeks.  Then they may remain the same size for several months, or even appear to widen, but after several months your scars will begin to fade, although they will never completely disappear.

Routine mammograms should be continued after breast augmentation for women whoare in the appropriate age group.  The mammographic technician should be made aware that you have breast implants as a special technique will be employed to assure that you get a reliable reading.

All surgery carries some uncertainties and risk

Breast augmentation is relatively straightforward, but as with any operation, there are risks associated with surgery and specific complications associated with the procedure.

The most common problem, capsular contracture, occurs when the scar, or capsule around the implant begins to tighten.  Most capsules are soft (grade 1) and require no treatment, but some capsules squeeze the soft implant (grade 3 or 4) and can cause thebreast to feel hard.  Capsular contracture can be treated in several ways, and sometimes requires either removal or  “scoring” of the scar tissue, or perhaps replacement of the implant.

 As with any surgical procedure, excessive bleeding following the operation may causeswelling and pain in the breast.  This usually occurs in the first day or two after the operation, and if bleeding continues another operation may be needed to control the bleeding and remove the accumulated blood.

A small percentage of women develop an infection around the implant.  This may occur at any time, but is most often seen within a week of surgery.  In some cases the implant may need to be removed for a few months until the infection clears.  A new implant can then be inserted.

Some women report that their nipples become oversensitive, undersensitive, or even numb.  You may also notice a small area of numbness around your incision.  These symptoms usually disappear with time, but may be permanent in some patients.

There is no evidence to suggest that breast implants will affect your fertility, pregnancy or your ability to breast feed.  If you have breastfed within the year before augmentation, you may find that you produce milk for a few days after your operation.

Occasionally, breast implants may leak or rupture.  Rupture can occur as a result of aninjury.  Normal compression of the implant by the movement of your breast may cause the implant shell to leak.  If a break occurs , one of two things may occur.  If theshell of the implant breaks but the capsule around the implant does not, you may not detect any change.  If the capsule also breaks, especially following extreme pressure, silicone gel may move into the surrounding tissue.  

The gel may collect in the breast and form a new scar around it, or may migrate to tissues away from the breast. There will be a change in shape or firmness of the breast.  Both types of rupture may require a second operation and replacement of the leaking implant.

A few women with breast implants have reported symptoms similar to diseases of the immune system, known as “connective tissue disorders”, presenting as arthritis-like conditions.  Research has found no link between silicone breast implants, confirmed by the Independent Review Group in 1998.

There is no evidence to suggest that breast implants cause breast cancer.   When you undergo a routine mammogram you should ensure that the radiographer is experienced in the special techniques required to get a reliable x-ray of the breast withan implant.  Ultrasound examinations are sometimes of benefit in women with implants to detect breast lumps or to evaluate the implant.  An MRI scan is another useful technique to establish the integrity of the implant.

While the majority of women do not experience these complications, it is important that you understand the risks and consequences of breast augmentation, and discuss them with me prior to your operation.

And finally….

For the majority of women, the result of breast augmentation can be a satisfying, if not exhilarating experience, as they learn to appreciate their fuller appearance.

 Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals, will help ensure that any complications, if they occur, can be detected and treated early.

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