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
- 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
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.
is one of the most commonly performed cosmetic
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
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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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
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silicone from my implants contaminate my
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.
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
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.
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.
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.
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
Breast feeding should not be affected by
implant surgery, but could be, at least
theoretically, by inserting an implant through
a peri-areolar incision.
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
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.
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.
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.
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
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.