Understanding what it is you want will guide what questions are important to you and who and where you want the surgery to be performed.
In this blog post Cosmetic Surgeon Mr Williams discusses breast augmentation.
Why have breast augmentation?
Women will seek information about enlarging their breasts for many different and personal reasons. It may be that during adolescence, your breasts never developed in proportion to the rest of you body. It may be that you feel your breasts are not appropriate for your body shape or size. Following pregnancy, with or without breast feeding the size and shape of breasts may change significantly or it may be that you feel your breasts are a very different size and need balancing.
Any of these factors may affect a woman’s self-confidence and the way she feels about her body. For thousands of women, breast augmentation has given them the confidence they desire and transformed the way they feel about their bodies.
Your surgeon will be able to guide you, dependent upon your goals as to how to achieve the best result, according to your desires and expectations. There are many options available to you, which will be raised here, but require a detailed discussion according to your personal circumstances.
Breast enlargement is the most common cosmetic surgical procedure performed on women in the United Kingdom. You should be confident that you are considering surgery for your own benefit and not due to external pressure.
The Breast
The female breast is a highly specialised organ, consisting of glandular tissue, fat, milk ducts and ligaments. It is contained within an envelope of skin and sits on a large muscle on the chest wall, the pectoralis major (pec muscle). Understanding the anatomy and the changes that occur in the breast during development, teenage years, pregnancy and beyond, explain the changes which we see on the outside.
Breast implants can be used to correct some of these changes, but their primary aim is to enlarge the size of the breast. It some cases they may offer a slight uplift, but this may require a further procedure, called a mastopexy. Your surgeon will be able to discuss your own individual needs with you in detail.
The Consultation
If you decide you wish to receive more and personalised information about breast augmentation, I would recommend booking in to see a surgeon and having a consultation. Everybody has specific desires and requirements, and every patient is an individual. You may have other medical problems, which need discussing. You may have certain size aspirations or want specific concerns answering. You should have realistic expectations about what can be achieved by breast enlargement. There are many factors which will influence the outcome, including your age, general health and the present appearance of your breasts.
The surgeon will need to examine your chest in order to confirm that the size increase desired is possible. You may be asked to try various implants in a bra to see how different sizes feel and look in your own clothes. Whilst this is not an exact indication of how your appearance will be following surgery, it is a useful method of demonstrating the approximate change expected.
You should expect to be seen at least once prior to surgery and often will be given the opportunity to return once you have had time to consider the suggestions made to you.
You may wish to take somebody to the consultation or take notes so that you remember more of the information which is given to you in the consultation. If you do have questions, it is worth writing them down, so as not to forget during the meeting.
Your surgeon will write to your GP about your consultation. This is so that if you do have any problems, which may be unrelated to breast augmentation, in the future, they are aware of your full medical history. If you do not wish your GP to know you should tell your surgeon.
The Breast Augmentation Surgery
Breast augmentation is carried out under general anaesthetic (with you asleep). You would normally be admitted to hospital on the day of your surgery and be seen by an anaesthetist and your surgeon, who will make some markings on your chest.
The surgery lasts between one and two hours and usually involves making an incision in the fold under the breast (inframammary). Other less common incisions are around the nipple (periareolar) or under the armpit (transaxillary). A pocket is created dependent upon your individual circumstances either above the muscle and under the breast (sub glandular) or below both the muscle and the breast (sub muscular). The implant is inserted into this pocket. If the implant is placed under the muscle it may reduce the chance of your implant being felt through the skin, may reduce the risk of capsular contracture and it may allow more of the breast to be imaged by mammography. It can however cause a slightly longer recovery period. The opposite is true of placing the implant under the breast tissue (shorter surgery and recovery, more chance of palpable implant edge, more capsular contracture and imaging problems at mammography).
Read our blog post to find out about the pros and cons of placing the implant over or under the muscle.
The incision is then closed with stitches in multiple layers.
A drain may be used and you may be kept in hospital overnight, or go home the same day. You will be advised, but you may feel more comfortable and supported if you wear a supported vest after surgery. Underwired bras are not recommended until some months after surgery due to the pressure they exert on the scar.
Upon discharge from hospital, you may feel uncomfortable for a couple of days. You will notice an immediate change in the size of your breasts, which may feel a little tender. Every individual has a different pain threshold and will have a different experience, but in general, the surgery may be more uncomfortable if the implants are placed under the muscle. Your surgeon will advise you but you should be able to start light activities after approximately one week. You should expect to return to normal, full activities after approximately six weeks.
Types of Breast Implants
Breast implants have been used for over fifty years and have gone through various stages and improvements in their design and composition. We use only the very highest quality implants, but you should check with your surgeon the type of implant they intend to use.
Most consist of a silicone shell and contain a silicone gel. The gel comes in various thicknesses dependent upon your breast and the feel which is desired. It is a cohesive gel, which means that it adheres to itself and will not run out of the implant if it is cut in a laboratory setting. These gels give a soft and natural feel to the breast. Saline filled breast implants are also available and you should check which your surgeon intends to use.
Your surgeon may discuss the use of polyurethane implants. These may result in a lower incidence of capsular contracture and are more likely to be used in patients who are prone to this complication.
The implants come in many different sizes and shapes such that nearly all patients’ desires and requirements can be fulfilled. Implants can be round, in which case they are unaffected by the ability to rotate and give more fullness in the top of the breast. Alternatively they may be anatomically shaped, like a tear drop, and give a more natural breast shape. Clearly if such implants rotate under the breast, they would give the maximum area of projection in the wrong place.
Implants may have a textured or smooth surface, which affects the likelihood of developing a contracted capsule.
Implants come in a range of sizes to suit your needs. Your surgeon will advise you according to various measurements, a range of implants which are suitable for you and which will give you the desired result. Breast implant sizes are measured according to their volume and it is not possible to say what cup size will be achieved by using a particular implant volume.
As well as the volume and shape, the width and height of the implant can be chosen(although with a round implant, these will be the same). This is best guided by your chest measurements. To increase the volume of implant within these parameters, the projection of the implant can also be varied.
Whilst it is possible to augment the breasts by taking fat from somewhere else on your body and injecting this into your normal breast tissue, this is rarely performed for cosmetic benefit, but is more often used in breast reconstruction following mastectomy.
Potential Complications
All operations expose patients to potential risks, and whilst breast augmentation is a safe operation, there is the potential of an unexpected outcome.
Immediately after surgery your breasts may be swollen and tender. Bruising and discomfort may persist for the first one to two weeks.
There is the potential for bleeding, requiring return to theatre. Infection may be treated with antibiotics, but may require further surgery and in the worst cases removal of the implants.
As a pocket is developed under the breast, the possibility exists of changing the sensation in the breast or to the nipple. This may result in reduced sensation in about one in seven patients or increased nipple sensitivity which may be painful for up to six months. It is possible, particularly if you are thin that the implant edge may be visible or it may be possible to feel it through the skin. There is a risk that silicone could leak out of the breast implants, and either be contained close to the implant or potentially spread to the glands in the armpit. Implants may rupture, which may result in a change in size or shape and may prompt replacement.
The ability to breast feed is unlikely to be altered by breast augmentation. Some evidence exists to show that the volume of milk produced may be slightly less than in women without breast implants. If a peri-areolar approach is used the milk ducts may be cut which could affect breast feeding. There is no evidence to suggest that breast feeding with silicone implants is unsafe to the baby.
Read our blog post "FAQ Breastfeeding and Breast Implants" to find out more.
The risk of complications, especially infection and wound healing difficulty is greater inpatients who smoke. You should be advised to refrain from smoking before and after surgery, or ideally stop altogether!
Scars are usually well hidden under the breast and heal without complication. In some cases they may remain red, thickened and lumpy and may take more time to settle.
Evidence has suggested that the rate of complications (such as implant loss, palpable folds, infection and skin wrinkling) is higher if very large implants are used (>350cc) and may result in the need for further surgery in the future to correct these problems. A large implant may also cause the formation of stretch marks on the breast skin and should you be prone to this, you may consider a smaller implant.
The appearance of your breasts after surgery is somewhat dependent upon the shape and size of your breasts prior to surgery. You may be dissatisfied by the shape, cleavage, feel and the way your breasts move after surgery. This is difficult to predict. Patients who are very thin with little breast tissue may be able to feel the edge of the implant and may suffer from visible wrinkling, rippling, creases or folds. Any asymmetry or breast irregularity maybe exacerbated by breast augmentation.
Breast implants, especially those placed on top of the muscle may reduce the amount of breast tissue it is possible to see during mammography and therefore affect the ability to detect abnormalities. If you tell the person performing the mammogram you have had breast augmentation, special views can be performed to maximise the effectiveness of this investigation.
Capsular Contracture
Whenever any foreign material is placed in the body, your immune system will wall it off. The scar or capsule which forms around a breast implant has the capacity to contract, causing the soft implant to change in shape and size. It is more common in augmentations placed on top of the muscle, and following infections or fluid collections post-operatively. It may be that pregnancy may increase or cause capsule formation. If the implant becomes painful or distorted you may require further surgery to remove the capsule and implant or replace the implant. This complication may differ significantly from person to person and even breast to breast.
This is the most common complication of breast augmentation, requiring one in ten women to require further surgery.
Safety of Silicone Implants
You may have read, or be aware of reports of women who claim to have had problems with silicone implants. This resulted in the Food and Drug Administration in America temporarily withdrawing silicone implants from use. They have never been unavailable in the UK for this reason. Rigorous and high quality research has now demonstrated that there is no increase risk of cancer or autoimmune disease in women with breast implants. In the UK an Independent Review Group concluded that there was no evidence to suggest that silicone implants were associated with connective tissue disease. The full report can be viewed at www.silicone-review.gov.uk. There is a similar conclusion from the European Committee on Quality Assurance and Medical Devices in Plastic Surgery. The National Academy Institute of Medicine(USA) in 1999 declared that the rate of medical problems which had previously been attributed in silicone implants was no greater in this group than in the general population and therefore they were safe to use. It has been shown that women who have silicone breast implants and are able to, can breast feed safely.
There is evidence to say that women with breast implants do not have an increased rate of breast cancer or breast cancer recurrence following surgery. Reports exist of an immune system tumour (ACLC) but no association with breast implants has been confirmed.
You may also have heard about the more recent PIP implant controversy. This French manufacturer used non-medical grade silicone in the production of implants, leading toa perceived higher rate of implant rupture. You will not receive PIP implants. We use only the very highest quality of implants, produced by companies who actively take part in research to ensure the safety of their product. These companies will also offer a guarantee against the price of the implant for rupture and severe capsular contracture.
Silicone implants are not expected to last the lifetime of the individual and it may be that you will require further surgery. It is not possible to say how long your implants will last. Some women have complications in only a few years, whilst other women will not have any problems after twenty years. Early thin walled implants commonly ruptured, whereas the present implants suffer from this complication far more infrequently. Rupture may not be identified as causing a problem, however if the gel does leak out of the implant and capsule it may travel to the armpit where it can form tender and hard lumps, known as siliconomas.
It is safe to travel in aircraft with breast implants.
There are many reasons why you may wish to have revisional surgery following breast augmentation.
The Future
You should be aware that deciding to undergo breast augmentation is likely to mean further surgery will be required in the future. This surgery will have cost implications. Implants do not come with a lifetime guarantee and the need for further surgery should be expected.
You should ask for and keep the details of the breast implants which have been used in your surgery as you may require this information in the future.
You should examine your breasts regularly and should report any change to your surgeon if still under follow-up or your GP.
Other helpful posts about breast surgery
About Mr Andrew Williams
Mr Andrew Williams is a Consultant Surgeon at Yorkshire Clinic. Graduating from Cambridge, he is a member of British Association of Plastic Reconstructive and Aesthetic Surgeons, British Medical Association, Medical Defence Union, Fellow Royal College of Surgeons (Plastic Surgery).
His main interests lie in microsurgical breast reconstruction for the treatment of congenital and acquired defects.
Ramsay is a leading provider of Cosmetic Surgery in the UK.
Please contact us if you would like to discuss any Cosmetic Surgery procedure in more detail.