Breast Englargement (Augmentation)

Breast Augmentation, or augmentation mammaplasty, is the surgical procedure performed to increase the size and shape of a woman’s breast(s) using implants. It may be performed for a number of reasons; cosmetic improvement for self-confidence, a correction of different sized breasts or as reconstruction following a mastectomy for cancer.

The initial consultation

At the initial consultation I will discuss what size your breasts are at present and what size you would like to be.  I will ask about any previous surgery to your breasts, any lumps or nipple discharge you have had that have had examined and family history of breast cancer. I will ask about your regular medication, including blood thinners and allergies. It is important to know if you smoking and whether you have any mental health issues.

I will examine your breasts and take measurements along with photographs, and  then will discuss surgical options and which is likely to best suit you of the operation with you. You should remember that not having surgery is an option and bra fillers may help you.

The discussion will involve choosing an implant size which is usually in cc's and usually my patients choose within the range of 200-350cc to fit with the shape of your body. I have trail implants to help you decide that best size for you. The shape is also important and a round implant gives a more predicable than anatomical one except in rare cases.  The placement of the implant can be either under the breast tissue (subglandular) or under the muscle (submuscular). For thin patients, submuscular may be better to reducing the likelihood that you can feel it though the skin, but also rippling and capsule formation (scar tissue around the implant) are less of a problem. It will arguably give you a more natural looking breast, but the cleavage, will not be as narrow as a subglandular implant.  It may also be more uncomfortable after surgery for a few weeks and it is a bit more bloody, so the drain may remain for longer. 

You should buy 2 sports bra (with no underwire) in the size that you would like to be after surgery. Sports shops or macom on line can help; https://www.macom-medical.com/

You may need a breast uplift at the same time as the implant, if your breasts are very droopy and this may be unexpected. It will add to the complexity of the surgery, there are more extensive scars and it is more expensive.  However, it maybe the best way to achieve a good aesthetic result. The two operations can usually be done at the same but if your breasts are very droopy it may been safer to do it in 2 separate operations to reduce the complication rate. 

The lifespan of an implant is about 10 years when it may require changing. You should factor this into your finances; you are likely to require a number these changes in the future if you have implants at a young age.

The Surgery

On the ward before surgery, i will measure and draw the incision line on your breasts. Surgery will be done under a general anaesthetic and takes about 1 1/2- 2 hours. You will be given antibiotics into your veins during surgery.  You should bring the sports bra with you to theatre.

I make an incision about 5-6 cm long under the breast and develop a space to place the implant, either in the subglandular or submuscular pocket as agreed during the consultation. All bleeding is stopped, the pocket is washed out with saline (salt water) and the implants are inserted with a no touch technique. I close the wounds with absorbable stitches and put a showerproof dressing in place them.the sports bra is then aplied over the top. When you wake up, you will have a drain in each breast and will spend 1-2 nights in hospital. The drains will be removed before you go home. 

Risks

When performed by a qualified surgeon, breast reduction is safe and most women are pleased with their results. Nevertheless, surgery carries risks which are listed below. 

Bleeding and bruising after the surgery can occur, which can rarely require a return to theatre to remove the blood. 

Seroma is a build up of clear fluid which comes from the underlying muscle.

Wound breakdown is a possibility but rare and may occur if the implant is too large for the space under the breast.

Infection can happen but it usually occurs 7-10 days after surgery. This may affect the breast skin which may require antibiotics or the implant itself may be infected when in implant will invariably have to be removed.

Wounds may be slow to heal and part of the breast and skin die and may need dressings.

Breast feeding You may not be able to breast feed afterwards.

Sensation of the nipples may becoming more sensitive but, more often they are less sensitive.

Scars may become thickened or widened but may improve with time, however treatment is available to help they don't. 

Shape, size and symmetry The breast may not be the same size and the shape and final size cannot be guarenteed. 

Numbness The breast may feel numb, but this should improve over the next few weeks and is rarely permanent. 

Casule formation All implants are naturally walled off by scar tissue from the patient's body. This is only a problem if the scar tissue becomes very thick or painful which is unusual. The scars are likely to be less noticeable if the implants are placed under the muscle as opposed to directly under the breast tissue. They also occur less with textured implants than with smooth ones. 

Rupture This rarely happens in the first years and requires a great deal of force to disrupt the implant envelope. However it may rupture after 10 years with natural wear and tear

Rippling This may be seen if the implant is placed under thin breast tissue or as the implant ages, can can be difficult to get rid of.

waterfall deformity This can occur because the breast tissue drops with time or because it has lost its eleasticity whereas the implants stays in its original position. It is also called a 'double bubble' deformity

Breast implant illness Some women develop an number of different symptoms such as fatigue and autoimmune diseases , but large studies have not found a conclusive link. However there is no doubt thjat some women do suffer after implant surgery and recover when they are removed. 

ALCL (Anaplastic large cell lymphoma) and SCC (squamous cell carcinoma). These are both rare cancers that are associated with breast implants. They occur more frequently with textured than smooth implants. Literature reports that mentor implants are associated with ACLC occurence of 1 in 43,000 of implants sold. SCC has first been reported a few years ago.

Breast cancer and screening There is evidence that women who request implants generally have a lower risk of breast cancer - this relates to having less breast tissue. If you are required to undergo breast scans (it may be as part of the national screening programme) please inform the radiographer, so that adjustments can be made to optimise visualisation of your. breast tissue. 

Preparation for surgery 

Your BMI should be less than 30 and you should mentally and physically fit. You should stop smoking 6 weeks before surgery and can start again when the wounds have healed at 2-4 weeks. Please do not take aspirin, naproxen for 10 days before surgery. You should have a shower the night before or the day of surgery. I will have emailed you a consent form, which you should print, read and sign and date the bottom of each page and bring the full document with you on the day of surgery.  We can then sign the last page together on the ward. 

What to bring with you

Toiletries, and regular medications and dont forget the sports bra. You should have bought 2, so that one can be washed and in the size that you would like to be after surgery. These can either be bought from a sports shop or from MACOM online , but ensure they are the right size before ordering, https://www.macom-medical.com/

Recovery period

Please keep the dressings in place and we will arrange a wound check at 1 week with the hospital nurses and i will see you at 2 weeks, to remove the dressings and advise about scar care. 

Recovery may take to 2-4 weeks and you should not to return to work for the 1-2 weeks after surgery depending on your work. You should not fly for 6 weeks after surgery. 

It is advisable to make arrangements for help at home during your convalescence, which should be at least the first fortnight, especially if you have young children. 

The Results

It will take 6-12 months to see the final results and these may last for 10 years. This longevity however can not be guarenteed and is dependent on skin quality, change of weight, pregnancy and smoking. You may require further surgery in the future after the 10 year lifespan of the implant has expired and should arrange your finances accordingly. 

If you are worried post operatively 

Please call the hospital ward you were on or Jan Richards 07722841078 9am-2pm monday-friday.

In an emergency, you may need to seek advice or attend your local hospital Accident and Emergency department

Appointments 

These can be made directly through the hospitals, via my PA Jan Richards or completing the form in the 'Contact' link above.