Professional Cosmetic Surgery and Healthy Ageing Clinic
Breast Augmentation or enlargement is the most commonly performed cosmetic surgery in the UK . It is also, the most satisfying procedure for the client and the surgeon. It has been performed for over 40 years now and there has been massive improvements in the surgical technique (thereby requiring lesser anaesthesia) and the implants (material, texture, technology of making) over this time.
There are a number of factors that contribute to a successful and satisfying surgical result. It is important to understand, that any cosmetic surgery and most especially breast augmentation, is more of an art, than just science. The choice of breast implants depends on various factors, such as height, weight, and shoulder width, waist to hip ratio and breast height width and projection. A patient’s general nature, occupation, ribcage, spine and muscle position is taken into consideration for a breast augmentation surgery. It is also very important to take into consideration one’s individual taste or preference, the age group and if one is planning on having more children.
Breast Augmentation is a procedure to increase the size and improve the shape of the breast in proportion to the rest of the body by means of breast implants. In most cases this enhances the individual’s confidence, self esteem and adds a further touch of feminity. This procedure does not give an uplift effect; you will need to consider a breast Uplift procedure which is a surgery in itself.
One should expect to have a natural improvement – a natural look, feel and movement. The beauty in the breasts should be considered not only static position, but also in dynamic movement, in all positions and posture. To achieve this one has to be realistic in selection of implants (the appropriate size, shape, profile and type of implant, and the placement of the implant). The surgeon will advise you on the appropriate implants to ideally achieve a hand to glove fit, of implants to the body. Too small or too big breast will not be in line, with a natural look.
One should plan well ahead of surgery to educate themselves about the Do’s and Dont’s, have clear goals and understand the limitations of the procedure particular to them with regard to their body, lifestyle and age group. It is very important to establish the surgeon’s compatibility, with the type of planning and procedure planned.
General advice – do not expect a perfect breast, always aim for a good natural looking improvement. Be ready to accept minimal asymmetry, feeling the edge of the implant, visualisation of rippling and the minimal risk of capsular contracture. Prepare yourself for long term follow-up scanning and future revisional surgery if necessary like maintenance of any device.
Selecting a Surgeon:
The surgeon should care for your wellness and explain fully the does and donts of the procedure to you. He should also be prepared to follow-you up, long term. He should be ready to say no to you if it is not suitable for you.
There are different types, sizes and shapes of implants available. Implants do not come in cup sizes but in different volumes(cc) and a certain bra size cannot be guaranteed. The choice of the size of the implant, depends on a number of factors, which will be taken into account when the surgeon recommends a particular size for you. The commonly available shapes are round and tear drop shaped implants. Tear drop shaped implants are more for individuals who require fullness at the bottom of the breast and whose primary concern is the shape of the breasts. Round implants are the more commonly used implants that fill the emptiness at the top of the breast as well and look natural in all positions (sitting, standing or lying down). The different profiles of implants available are low, medium and high profile which will be discussed in further detail at the consultations. The commonly available types of implants are saline, hydrogel and highly cohesive Silicone Gel implants.
Generally highly cohesive silicone gel implants with bio-cellular multilayer shell cover that will resist the wear and tear are used. An average sized implant must be chosen, medium profile, usually round occasionally bio dimensional shaped implant. These implants come from a well reputed company with good warranty.
Incision Site and scarring
The most common incision sites are at the breast crease, around the nipple and at the arm pit.Out of the 4 sites, the preferred site is under the crease as it will be easy to hide, offers good access for natural placement and is also advantageous if any revision is required.
The breast crease incision, is usually 3cm to 6cm under the breast, following the natural crease of the breast. The scar in most cases appears as a white line with time and is hidden in the bikini line. In some cases, the scars can become raised and obvious, in which case a scar revision needs to be considered.
Anaesthesia and Hospital Stay
The procedure is usually carried out under a combination of sedation and local anaesthetic and occasionally under a combination of general and local anaesthetic, occasionally. This combination of anaesthesia reduces the amount of anaesthesia required, thereby facilitating quick and smooth recovery with less post operative pain. The procedure can be performed as a day case although in most cases a one night’s stay at the hospital is recommended.
The procedure usually takes 45 minutes to an hour. The length of the incision is usually 3cm to 6cm under the breast crease, depending on the size of the implant. The plane of cavity is made usually under the gland in front of the muscle. An adequate pocket is made depending on the size of the implant, so that the implant can move naturally. Total blood loss is usually less than 3ml. Bleeding is stopped using a diathermy. The implant insertion and positioning takes less than 3 minutes including both sides. Drains not necessary usually. The sutures are done in 2 layers (inside dissolving, outside taking out). 3 layers of outer dressings are placed (strip, square and long). Usually patient regains consciousness immediately after surgery.
Post surgery the patient is kept in the recovery room for a while, before being sent to their room. Usually after an hour or two patients can walk around. The pain is like a tense tight pain similar to a milk engorgement pain. You can start drinking after 2 hours and eating after 3 to 4 hours providing there is no sickness. In normal circumstances, it is important to eat and drink at the earliest possible as this will help with feeling well soon. Usually after 4 to 6 hours after surgery you feel the maximum pain. Common oral pain killers are sufficient for the pain in most cases.
The important thing to look out for, is increasing swelling, more bruising, intense pain suggestive of bleeding and haematoma. It is usually rare and if it occurs the bleeding needs to be stopped and drained.
Usually stay overnight and go home the next morning with adequate bra support (medium impact non-wire sports bra). Appropriate antibiotics and pain killers are given at the time of discharge to take for a week. Always remember to arrange for transportation home with an escort.
One week of rest and gentle movement with minimal stress on the shoulder and chest is necessary. Everyday wash without wetting the dressings and removal of dressings after 2 weeks is essential. Increase activity after 1 week and resume full strenuous activity from 4 to 6 weeks post surgery. Attend the clinic for suture removal at the end of 2 weeks. Depending on the type of work yu may be able to return to it at the end of 2 weeks.
2 weeks (suture removal), 6 weeks, 3 months, 6 months, 1 year (every year thereafter for 3 years)
- Breast Uplift
Limitation of End results
- Does not provide a breast uplift effect
- In the case of capsular contracture, revision may be necessary (removal of capsule or the implant itself with repeated contracture)
Longevity of Results
The results of the surgery are not permanent and are subject to the body’s acceptance of the implant and the life expectancy of the implant. The average life expectancy is 10 to 20 years depending on several factors. Good diet and life style factors can help prolong the results of the surgery.