Mass media depictions of cosmetic surgery often impact negatively on public perception of the specialty. Aesthetic procedures can work miracles: not only genuinely lead to remarkable physical improvements, but also revive one's self-esteem and confidence which are even more important. We should not be too judgmental about cosmetic surgery, but accept that modern medicine can improve quality of life and make us feel better, not simply treat illnesses. In my practice, patients who have undergone successful cosmetic intervention are among the most satisfied and grateful patients I have had the privilege to treat.
Breast augmentation is used to enlarge, equalise or simply reshape the breasts. It is one of the commonest and most popular aesthetic operations and patient satisfaction is generally very high. The main objection is to make a pleasing difference in the breast size, but maintain a natural look. This goal is achieved by using silicone breast implants which come in all sorts of shapes, sizes and textures. Each type has is advantages, disadvantages and indications highly dependant on patients anatomy, skin and tissue quality and surgeon’s judgement on what will create natural look. I only use implants which have passed vigorous testing and have been reported to produce superb clinical results and are manufactured by companies with immaculate safety records. During consultation, I often show patients some of the breast implant samples as I belief you should be familiar with the basic concepts of products used for your surgery.
It always helps to plan things in advance of surgery and adjust work and life activities accordingly. Therefore, please consider the following issues prior to your operation:
- Anticoagulation medication (Aspirin, Brufen, Warfarin, Clopidrogel) should ideally be stopped few days before the operation to reduce the risk of bleeding, but advise from the clinician who prescribed them is wise beforehand. I would strongly advise you to stop smoking prior to surgery as this can badly affect the outcome of surgery and increase complication rates.
- Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery.
- Plan your time off school / work / sports.
- Allow at least few weeks after surgery before considering a travel
Operation is performed under general anaesthesia and takes approximately 90 minutes. You will need to fast for several hours before the surgery and you will receive instructions about this beforehand. Operation is performed by placing a silicone implants under the breast gland (known as subglandular plane) or under the muscle upon which breast lies (submuscular or subpectoral plane). I most commonly use a short incision in the skin crease beneath the breast (inframammary fold), but if indicated, access can be made through the lower part of the nipple too. Decision on which plane to use, what size, shape and type of implant is made after clinical examination. Decision is essentially, based on individual anatomical characteristics and when possible, patients’ preferences. At the end of operation surgical drains (tubes) are inserted under the implant. The skin is sutured neatly and taped with splash and shower-proof dressings, so you will be able to shower from the day after surgery. Surgical drains are usually removed on the ward one day after operation. Although, breast augmentation can be done on a day care basis, I personally, prefer patients to stay in the hospital overnight for multiple reasons, least to mention that you may feel week after prolonged general anaesthetic, possibly nauseated and a bit frail in the first 24 hours.
After operation, you will be nursed in semi-sitting position, wearing a well supporting bra. You should bring a bra with you on the day of surgery and I will advise you on adequate types at the time of consultation. I usually encourage ladies to wear bras up to 6 weeks after operation. This is not a nuisance – on the contrary, most patients found it very comforting. You will be able to return to sedentary activity (i.e. an office job or light duties) within a few days, depending upon how you feel. You must avoid vigorous arm movements, must avoid all exertion and take things quietly for the first 3-4 weeks. The team will arrange your review in the clinic two weeks after operation when we will review wound and remove tapes.
Unfortunately, complications can occur following any surgery and patients need to be fully aware of this. I always tend to carry out surgery in a safe manner and take all sensible measures to minimise risks and complication rate. Below are the commonest complications associated with breast augmentation:
- Bleeding and haematoma
- Wound healing problems
- Capsular contracture
This is the formation of a sheet of scar tissue around the implant and it forms in everyone. In a small percentage of women (5-10%) the scar layer (capsule) becomes firm enough to alter the feel of the breast. In most cases this produces a breast that is slightly firmer than the other and is of little consequence. In rare cases the capsule becomes hard and distorts the shape of the breast, making it uncomfortable (this is known as a contracture). In such rare cases you may need to have some secondary surgery to relax the capsule or even to remove the prosthesis, This sort of secondary procedure, performed some considerable time after the initial surgery, would incur extra cost.
- Altered nipple sensation
The scars are generally of little consequence. The wounds heal to fine lines, well hidden under the breast so that scars are hardly visible beyond 6 months. Lumpy (hypertrophic) scar are very rare after this procedure
- Breast-feeding and pregnancy
Breast implants generally do not normally interfere with breast-feeding or pregnancy. There is no evidence of increased quantities of silicone in breast milk
- Breast cancer screening
Breast cancer detection by mammography is possible after augmentation, but mammography might not show all of the breast tissue on the X ray. You must tell the radiographer that you have implants so they can modify their technique
- General health risk
Many studies have been conducted to establish whether silicone breast implants cause certain diseases. As a result of these studies we can say that at present there is no evidence to suggest that silicone breast implants are associated with an increased incidence of breast cancer. There is also no evidence to suggest that these implants cause autoimmune diseases such as rheumatoid arthritis.
There has been a recent concern that women with breast implants may have a very low, but increased risk of developing Anaplastic Large Cell Lymphoma (ALCL), a rare form of lymphoma, a cancer of the immune system. The main symptoms of ALCL in women with breast implants were a delayed fluid collection around a breast implant, often years after implant placement. For more detailed information on the latest update on ALCL please see the next section.
- Implants durability
The manufacturers expect that the life expectancy of breast implants is at least 10 years. A good quality implants can stay in without problems for a much longer time. However, if you are considering breast augmentation you should ask what manufacturer’s warranty or insurance is available to cover potential problems in the future.
In general, breast augmentation leads to significant improvement in appearance and psycho-logical wellbeing and predictably highly satisfied patients. Essential to that, however are realistic expectations, thorough and honest consultation, surgical expertise and above all, mutual trust. I am very keen to show patients illustrations on augmentation surgery, before and after results achieved in my previous patients during our consultation. Few examples on what can be achieved are shown on the right.
This page provides only basic and generic information. Full details and explanations are provided at the consultation as no two patients are the same and personal circumstances are highly individual. Patients will be provided with detailed leaflet, comprehensive informed consent on risks and complications associated with this operation, few of which are mentioned above.
Breast implants have recently once again been at the centre of the safety scare. The latest fears apply to suspected, yet not confirmed, link between the breast implants and blood cell cancer called Anaplastic Large Cell Lymphoma (ALCL). This is rare and, usually treatable condition
It is estimated that 100 million women have had breast implant insertion worldwide. Against that number, there have been an estimated 250 cases of women with breast implants who have developed ALCL of whom 8 died. It appears that there are at least 13 cases identified in the UK and 18 in France. The incidence is extremely low, at the current time i.e. 1:100,000, with a mortality of 1:12,500,000. Current research suggests the risk of developing this condition in the UK is approximately 1 in 24,000 breast implants sold. For comparison the general incidence of breast cancer in the UK is 1 in 9 and affects women with and without breast implants equally.
ALCL occurs when diseased white blood cells multiply rapidly, building up in the neck, armpit or groin. Whilst cancer can readily be treated with chemotherapy, the disease can kill. The clinical hypothesis is that the disease can be triggered by bugs which cling to implants, meaning that women who have had breast enlargement surgery are at higher risk than usual. It usually develops after women have had the implants for several years, with the main symptom being a painless swelling of the breast. All patients presenting with late onset swelling/fluid collection (seroma) around implant or any breast lump, should be referred to a breast clinic. When a seroma is present, aspiration to obtain CD-30/ALK levels is required to establish a diagnosis.
Regulatory bodies confirm that no proven risk to the health of women with these implants has been clearly demonstrated. They had however, identify shortcomings in existing data and have ordered implant manufacturers to urgently provide more evidence on safety of their products, especially ‘textured’ (roughened surface) range of implants. No action is currently suggested other than properly informing patients on current information and the action required in the case of any post-operative concerns.
The British Association of Aesthetic Plastic Surgeons (BAAPS) advises that concerned patients need not take any action at this stage. There is no need to remove or exchange any current implants based on the most up-to-date scientific data available. Indeed, unnecessary surgery may cause additional harm in a small number of patients. If you want to read more on BAAPS position towards ALCL please click on this link https://baaps.org.uk/about/news/1411/baaps_statement_on_alcl_2015.
I would urge all patients who have undergone breast enlargement in the past under my care and have new symptoms such as swelling or pain to contact our office and arrange a follow up for further advise.
|Hospital stay||1 night|
|Surgery time||1-1.5 hours|
|Wound healing||2 weeks|
|Shower / Bath||from week 1|
|Time off work||average 2 weeks; those involved in manual activities might need more then 4 weeks|
|Sports and exercise||from week 4; jogging/hopping based workout from week 12|
|Full recovery||3 weeks|
Urgent concern after your surgery ?
Please ring the hospital where you have been operated on or my secretary and they will get in touch with me