| Breast Augmentation
Introduction
The indication for Breast Augmentation is to increase the size of the breasts and to improve their shape by implanting a breast prosthesis under the breasts. This operation is designed to help women with naturally small breasts or after loss of breast volume following pregnancy or weight loss.
(Before)
 (After)
Most patients who request breast augmentation do so in order to look normal. For a woman with normal breasts sometimes may be difficult to understand all those little humiliations suffered by the “not normal” person in their everyday life. The limitations they suffer in clothing as well as in social and intimate life. Their quality of life after a breast augmentation is enormously improved. It does not change the patient, but it changes her life.
There are many techniques to increase or augment the size of the female breast. The more common involve the use of Silicone or Saline-filled Breast Implants. Some times tissue from the same patient are used, like from other parts of the body, but these are usually reserved for breast reconstructions as they give extra scars in the donor sites (where the tissue is taken from).
There has been controversy about silicone and its effects on the body. We know from widely conducted medical research (see DHHS final report on silicone) that silicone is safe.
All breasts implants are made of a silicone shell (or outer “bag”), which can be filled with saline solution (“salt water”) or with silicone gel.
In the early days of breast augmentation, the silicone gel used was more fluid than the modern thicker gels.
Silicone in fluid-gel form can infiltrate tissue planes when free, and produces severe inflammatory reactions and in the worst cases Silicone Granulomatosis, that can only be treated by excising (cutting out) the granulomas with the tissues affected. This is why injecting fluid silicone is banned.
We now use a type of silicone called Cohesive, which is like chewing gum, in that it does not leak and it is easily removed if the prosthesis breaks after an injury. The shape of modern prosthesis is also more anatomical (reflects the shape of the natural breast) and our results are more natural.
In my practice when using silicone breasts prosthesis, only the Cohesive type is used.
Before Surgery
Before surgery, I, with my nurse present make a note of your clinical history and perform an examination. Together we make a diagnosis of your problem, make a decision and plan your surgery.
There are many types and shapes of breast implants and together we choose the one most suitable for you, i.e. shorter, wider, type of projection etc. this is in order to achieve a natural looking breast which “fits” your height, weight, rib cage, length of chest, etc.
The size of your new breasts will depend on your personal choice. I recommend techniques that will help you visualize your new size, as it is difficult to imagine it.
I will stress that it is your personal choice and no one else’s. People around you rarely notice your changes (remember all those helpful commercial tricks that have helped to camouflage your small breasts).
One week before surgery, my nurse takes blood samples to check your body’s environment. Samples are also taken from your nose and throat to check for bacteria like MRSA. In the presence of MRSA or any other dangerous bacteria, surgery is cancelled, the infection is treated and the surgery is re-scheduled when cultures are clean.
Smoking and poor diet do not help healing. In my practice I use complementary treatments like Arnica and Aloe Vera. Aspirin increases bleeding at surgery and is advised against if not needed for medical reasons. The use of leisure drugs is discussed.
The pre-operative planning includes recovery time, which varies with your occupation and the extent of the surgery.
Photographs are taken and developed by myself in my rooms.
You will be given written information to take home. This will remind you of the points discussed and may prompt other questions which my nurse or I will be pleased to answer when we see you again the week before surgery. You are welcome to come back for a second consultation any time.
The Operation
You will be admitted to the London Clinic for a minimum of one night. The operation is performed under General Anaesthesia and I use drains that are usually removed the next morning. The operation time is 1 to 2 hours.
The prosthesis is inserted through a skin incision under the breast and it is placed in a pocket under the breast itself (sub glandular) or under the Pectoralis muscle (sub muscular). Alternative incisions are around the areola or in the axillae.
I tend to use, when possible, absorbable sutures under the skin that do not need to be removed. The dressing is minimal and is fashioned as a “boob-tube” with hypoallergenic microfoam. This we leave in place for 5 or 7 days.
Before your discharge I will measure you and advise on the new bra that you will need to bring with you to the first follow-up consultation.
After Surgery
I prefer if a relative or a friend takes you home on discharge.
In general there is bruising and swelling for about 3 weeks. Pain varies from patient to patient. You will receive medication for the pain. This is not a particularly painful operation.
The dressing is removed on your first post-op consultation and you go into a soft bra, day and night for 2 weeks.
Sports and driving are to be restricted during the recovering period. Gentle swimming is fine after 3 weeks, but vigorous exercise only after 6 weeks. Driving is not advised for the first week.
Anti-embolic (Ted’s) stockings should be worn for 10 days or until fully mobile to avoid Deep Venous Thrombosis (clots in your legs). The scars and skin are to be kept clean with daily shower and Aloe-Vera spray. We will provide an information sheet for post-operative care.
My Secretary, my Nurse and Myself are available for advice 24 hours a day. The Plastic Surgery Floor at the London Clinic can also advise you as our nurses specialize in Plastic Surgery.
You will look good after 3 weeks but the breasts absolute final and natural shape takes about 3 months.
Complications
Infection is rare and does not settle in the presence of an implant. If it occurs, the implants have to be removed, the infection treated and 3 months later fresh prosthesis are implanted. This is the reason for the careful pre-operative tests. During surgery the pocket and the prosthesis are washed with an antibiotic.
Bleeding can occur with the collection (Haematoma) of blood around the prosthesis (Haematoma) and this is why I recommend a minimum of one night stay during which I use drains. This complication does not jeopardize the final result.
Changes or loss of sensation on the nipple is possible but rare.
During your initial consultation we will give you relevant lists of possible complications.
In about 8 - 10% of the cases, the body reacts to the presence of the implants (a foreign body) with the formation of a thick scar around the prosthesis, this is called a Capsule. Sometimes this Capsule Contracts deforming the prosthesis and making the breast tight. Severe Capsular Contracture requires further surgery.
The cause of this problem is not fully understood and there are no tests that can give us warning that this may happen. We know that in 80% of the cases this occurs during the first 6 months. This is one of the reasons why I will need to review you for 2 years.
I will also need to see you 8 years after discharge to check the integrity of the prosthesis. Modern prostheses do not need to be exchanged if intact and most are guaranteed for life.
This is one of the most successful operations in Plastic Surgery and one that gives great patient satisfaction, as much as a breast reduction.
There is no problem with breast-feeding after this operation. Mammograms and breast self-examination are not affected.
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