Procedures




Reconstructive Plastic Surgery

 
 
 
 
Breast augmentation (Breast implants)


Base-line information you need to know about breasts in order to make the informed choices if you are considering cosmetic surgery to your breasts

It is important to realise several facts:

  • Most women have one breast larger than the other.
  • Most women have one breast that sits lower on the chest wall than the other.
  • Breasts are composed of a mixture of fat and glandular tissue. The glandular tissue (the part which secretes breast milk) weighs more than the fat, so the larger the proportion of glandular tissue your breasts have, the heavier they are and the more they will droop without support.
  • Breast fat increases and decreases in tandem with variations in body fat generally.
  • Breast glandular tissue increases and decreases in tandem with variations in female hormones (for instance before and after menstruation and pregnancy). 

Armed with these pieces of information, you will find it much easier to decide whether this operation is for you, and which variant of this operation will suit you best.

Breast augmentation

Breast augmentation is one of the most commonly performed cosmetic surgical procedures.

It is an operation to enhance the size and shape of a woman's breasts and involves placing a silicone gel implant behind each breast to increase its volume and enhance its shape. In suitable patients, who have either never had, or have subsequently lost breast volume and shape after childbirth, weight loss or with time and gravity, breast augmentation can improve your physical appearance and enhance your self-esteem.

It is also a suitable operation for correcting breast asymmetry; improving the appearance of very small breasts or congenitally absent breast tissue and also, to correct deformity resulting from cancer surgery.

For suitable patients, breast augmentation enhances both appearance and self-esteem.

Commonly asked questions about breast augmentation

Am I a good candidate for breast implant surgery?

This is best decided during a consultation, but generally speaking, the best candidates for breast augmentation are women who are physically healthy and are seeking a realistic improvement in the size and shape of their breasts.

If your breasts are sagging, I may recommend a breast lift instead of, or in combination with augmentation.

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Are silicone implants safe?

Breast implants have an outer shell made of silicone. Most have an inner filling made of a cohesive silicone gel (which has the consistency of a jelly baby and won’t leak if damaged) but some can be filled with salt water. There has been a great deal written in the press about silicone breast implants. In essence, after many studies, there is no evidence that silicone-filled breast implants are harmful.

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Will silicone from my implants contaminate my breast milk?

There is no difference in elemental Silicon concentration in the breast milk of women with and without implants. Silicon concentrations are up to & 10x higher in cows’ milk & infant formula feeds, than in breast milk.

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Do implants increase my risk of breast cancer?

There is no evidence to support this, with all published epidemiological studies showing cancer rates at the same levels as for women without implants, or lower.

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Will having implants mask a new breast cancer or delay breast cancer diagnosis?

A study comparing breast cancer in women with and without implants shows both groups have the same 5 year survival rates from breast cancer, but women with implants present with smaller tumours and are 12 years younger at diagnosis on average - this is probably due to increased contact with their surgeons as a result of having had implants, meaning tumours are found earlier and younger.

After breast augmentation, you will be able to perform breast self-examination as before.

For women over 35, I advise you to have baseline mammograms before surgery and another 6 months after surgery, which will give screening services in the future a frame of reference to aid in detecting any future changes in your breast tissue.

If you have had implants and need mammography, a special displacement technique has been developed that maximises view of breast compared with standard mammography, so you should tell your radiographers so they can use this technique.

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Do silicone implants cause Connective Tissue Diseases?

Analysis of 20 large studies shows no evidence to link silicone implants generally or gel-filled implants specifically, to connective tissue or autoimmune or rheumatoid-like diseases.

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Will my breast implants stay the same forever?

Breast implants are treated by the human body as foreign material and so they are walled off by the body’s cells which weave a fibrous capsule around them. In a proportion of patients these capsules become firm, painful and cause distortion of the breast mound - so-called adverse capsular contracture. This can happen at any stage after surgery, but usually happens in the first 2 years after implantation.

Adverse capsule formation has been related to several factors and implant manufacturers and surgeons have developed strategies to minimize it. The outer shells of implants are textured and antiseptic irrigation is used to minimize infection and inflammation in order to combat adverse capsule formation but in a small percentage of patients this becomes problematic enough to warrant re-operation and occasionally, patients choose to have their augmentation reversed.

Breast implants have a finite life. At some stage they will break and need to be replaced. This is not a complication it is to be expected with passing time - unless a particular implant has been manufactured with a fault and ruptures unreasonably soon. Currently research findings and the claims of manufacturers of gel implants suggest they may last over 15 years - this may be less or more in practice. The corollary of this is that implant surgery may need to be repeated several times over the life-time of a patient who embarks on this surgery when relatively young, and that all possible complications associated with this operation may occur at each operation.

A very small proportion of implants migrate from where they were placed during the operation, leading to breast asymmetry that may need surgical correction. This can be secondary to trauma soon after surgery, but it can also occur for no apparent reason. If caught early, it may be treatable using skin strapping for several weeks.

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Can surgery affect my nipples?

Up to 15% of patients experience altered (usually diminished) nipple sensation after implant surgery. This is due to nerve damage and may never improve - so if nipple sensitivity is an important factor in your sexual arousal, weigh this carefully before embarking on surgery.

Breast feeding should not be affected by implant surgery, but could be, at least theoretically, by inserting an implant through a peri-areolar incision.

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What should I expect from my consultation?

During your consultation, I will take a full medical history. I will ask you specifically about any breast disease you have suffered, as well as any previous surgery you may have undergone and about your family’s history of breast diseases such as cancer. If you have had mammograms, I will need to know the results. I will also ask about your desired breast size and shape and anything else related to the appearance of your breasts that you feel is important.

I will examine you completely, then focus on your breasts to assess their size, symmetry and shape and the quality of their skin envelope. I will then take standardised photographs in order to help plan and discuss your operation. Finally I will measure you for a sports-type bra, which you will choose and bring with you to be used as a comfortable dressing over your surgical dressings in the days immediately after your surgery.

By all means bring pictures from magazines to show me examples of women who seem to have breasts of a size that equate with your desired breast size - these will be useful in discussion.

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How is the surgery performed?

Implants can be placed between the breast and the chest (pectoral) muscles, or beneath both the breast and the chest muscles, lying just superficial to the ribs. Skin incisions can be made in the skin crease below the breast mound (at the lower junction of the breast with the chest wall) or at the junction between the areolar and normal skin.

The method used to insert and position your implant will depend on your anatomy.

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What does my operation involve?

Before surgery, you will meet and be assessed by your anaesthetist who will prescribe medications for your comfort and to lessen anxiety if need be.

On the evening before, or the morning of your operation I will review what we have discussed and planned previously and we will both sign your operative consent forms. Then I will measure and draw guidance marks for surgery on your chest and breasts with you sitting upright.

The operation is performed under General Anaesthesia - you will be asleep. The operation usually takes less than an hour, depending on the technique used. After surgery, you will awake in a recovery area and soon afterwards you will be returned to your room. A drain is placed under the incision in each breast that will remain overnight to remove the normal healing fluid that the body produces and be removed the next day. Once drains have been removed you can shower normally. Most patients go home the day after surgery on simple pain relieving medications and a short course of antibiotics.

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What about my recovery and return to normal activities?

You will feel tired and somewhat sore for a few days following your surgery, but you will be able to move around and function quite normally, and a proportion of patients feel well enough to go back to (light) work within a day or so.

You will have buried, soluble stitching which will dissolve and doesn’t need to be taken out.

Generally, so long as you can do so with due care and attention, you can begin driving 7 - 10 days after surgery. You should restrict yourself to light exercise for 2 - 3 weeks - avoiding lifting anything over 5Kg and aerobic exercise for at least 3 weeks.

Your breasts will be swollen for at least 4-6 weeks, but at that stage your new breasts will have attained almost their final appearance. Your final operative result will continue to mature for 3-6 months and your scars will continue to mature for up to a year.

New scars benefit from friction-free massage (using vaseline, for instance, to lubricate the massaging process). Beginning to massage scars two to three weeks after surgery, will help them mature, soften and flatten faster than if left to their own devices. New scars should be protected from sunlight for 2 years to avoid them pigmenting differently from the surrounding skin and becoming a different colour permanently. Factor 15 sun block should be applied whenever they are exposed - even to a British winter sun.

In the longer term, final size, shape, symmetry and aesthetic result of breasts after implant surgery will vary according to individual factors which are due to genes, life style, life events and gravity. After surgery, lack of support, alterations in weight or hormonal variation may alter your breasts’ appearance and symmetry markedly.

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