Mrs Dalia V Nield FRCS(Ed) FRCS(Eng)
CONSULTANT PLASTIC AND RECONSTRUCTIVE SURGEON
Formerly Consultant at
St Bartholemew´s and Homerton Hospitals
5 Devonshire Place London W1G 6HL Telephone 020 7616 7693
Introduction
Breast Augmentation is carried out to increase the size of the breasts and to improve their shape. This operation is designed to help women whose breasts are naturally small or have lost volume following pregnancy or weight loss.
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Preoperative |
Postoperative |
4 years later |
The Implant
There are many techniques to increase or augment the size of the female breast. Most involve filling out the breasts by inserting implants (often called prostheses). It is possible to use tissue taken from other parts of the patient’s body but this leaves a scar at the donor site (where the tissue is taken from). It is usually only used for breast reconstructions, as after cancer. There has been controversy about silicone and its effects on the body. We know from widely conducted medical research summarised in a report prepared for the government in 1998 that implants using silicone are as safe as any other kind.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 modern gels and was sometimes injected directly into the breast. Silicone in the fluid form can infiltrate tissue planes when free, and produces severe inflammatory reactions and in the worst cases Silicone Granulomatosis. This condition can only be treated by excising (cutting out) the granulomas and the tissues which contain them. This is why injecting fluid silicone is now banned. We now use a type of silicone called Cohesive, which is more like chewing gum. It does not leak and is easy to remove if the implant breaks after an injury. The shape of modern implant is also more anatomical (reflects the shape of the natural breast) and our results are more natural. In breast implants I use only cohesive silicone.
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. Some are shorter, some are wider and there are various styles of projection. Together we choose the one most suitable for you, to achieve a natural looking breast which fits your height, weight, rib cage, length of chest, and other factors.The size of your new breasts will depend on your personal choice. It is difficult to imagine the and I will show you techniques that will help you visualize your new look. 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. If MRSA or any other dangerous bacteria is found, surgery is cancelled, the infection is treated and the surgery is re-scheduled when the tests are clear. Smoking delays healing and poor diet does not help. 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. Our pre-operative planning includes recovery, the time you will need and any assistance you should arrange. All this varies with your normal activites and the extent of the surgery.
Photographs are taken and printed 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 the drains are usually removed the next morning. The operation time is 1 to 2 hours. The implant is inserted through an incision in the skin under the breast and 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. For the stitches , when possible, I use absorbable sutures under the skin. They do not need to be removed. The dressing is minimal and is fashioned as a 'boob-tube' with hypoallergenic microfoam. We leave it 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 recommend that you arrange for a relative or friend to takes you home on discharge. In general there is bruising and swelling for about 3 weeks. This is not a particularly painful operation but pain varies from patient to patient. You will receive medication for the pain.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 you should not do vigorous exercise for 6 weeks. Driving is not advised for the first week. Anti-embolic (TED) stockings should be worn for 10 days or until you are fully mobile, to avoid deep venous thrombosis (clots in your legs). Keep the scars and skin clean with daily showers and Aloe-Vera spray. We will provide an information sheet for post-operative care. I am available for advice 24 hours a day. The nurses on the Plastic Surgery Floor at the London Clinic can also advise you; they 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. If it occurs, the implants have to be removed while the infection is treated. 3 months later fresh implants are inserted. 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 and blood may collect around the implant (forming a haematoma). This is why I recommend a minimum of one night stay with drains in place. This bleeding does not jeopardize the final result. Changes or loss of sensation in the nipple are possible but rare. In about 8 - 10% of cases, the body reacts to the presence of the implants (as foreign bodies) by the forming a thick scar around the implant. This is called a capsule. Sometimes the capsule contracts, squeezing the implant out of shape 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 it may happen to any particular patient. We do know that 80% of cases of capsular contracture occur 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 that the implant is undamaged. Modern implants do not need to be exchanged if intact and most are guaranteed for the patient's life. There is no problem with breast-feeding after this operation. Mammograms and breast self-examination are not affected. During your initial consultation we will give you relevant lists of possible complications. In my experience this is one of the most successful operations in Plastic Surgery and one that gives great patient satisfaction.