Surgical Procedures - Breast Surgery
Breast Enlargement (augmentation Mammaplasty)
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A surgical procedure to enhance the size and shape of a woman's breasts using implants.
Breast augmentation is performed for a number of reasons:
- To enhance the body contour of a woman who, for personal reasons, feels her breasts are too small.
- To restore loss of breast volume after pregnancy.
- To balance a difference in breast size.
- As a reconstructive technique following surgery to remove tissue.
RIGHT FOR YOU?
The process can make you look younger and so may enhance your self-confidence. But remember it can't alter your appearance completely, or give you back your youth. Please discuss your expectations thoroughly with your surgeon before deciding. The most suitable breast augmentation patients are physically healthy, emotionally-stable women who are realistic about what the surgery can accomplish. You should be looking for improvement, not perfection.
Implants
A breast implant is a silicone rubber shell filled with either medical grade silicone gel. Long-term experience with medical grade silicone shows that it is the least reactive substance in the human body of any man-made substance that we know. Many people do feel that silicone-filled implants give a natural look and feel to the breast. Hurlingham Clinic & Spa only use the highest quality cohesive gel implants manufactured by Allergan.
New Technologies allow breasts to be reshaped and balanced and take into account anatomical variations and personal preferences. They produce shapes that are natural and proportional for each individual woman, using what are known as anatomical breast implants.
Some Risk
Breast augmentation is relatively straightforward. But all surgery carries risks and specific possible complications. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This can cause the breast to feel hard. Treatments include the removal or 'scoring' of the scar tissue, or perhaps removal or replacement of the implant. As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If this bleeding continues, a further procedure may be necessary to control it and remove the accumulated blood. Rarely an infection may develop around an implant which, if it is going to happen, usually occurs within a week of surgery. This may mean the implant has to be removed for several months until the infection clears and a new implant can be inserted. Some nipples become oversensitive, undersensitive, or even numb. The small patches of numbness around your incisions usually improve over time, but may be permanent in some patients. There is no evidence that breast implants affect fertility, pregnancy, or your ability to feed a baby. If, however, you have been breast feeding in the year before surgery, you may produce milk for a few days after surgery. Although this may cause some discomfort, the condition can be treated with prescription medication.
Occasionally breast implants break or leak as a result of injury or even from normal compression. If a saline-filled implant breaks it will deflate in a few hours and the salt water will be harmlessly absorbed by the body. If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the surrounding scar capsule does not, you may not detect any change. If the scar also breaks or tears, especially following a lot of pressure, silicone gel may enter surrounding tissue. The gel may then collect in the breast where a new scar will form around it, or it may migrate to another area of the body. This may cause a change in the shape or firmness of the breast. Both types of break will normally require a second operation to replace the leaking implant. In some cases it may not be possible to remove all of the silicone gel in the breast tissue after a rupture.
Though some women have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions, research has found no clear link between silicone implants and the symptoms of what doctors refer to as 'connective-tissue disorders'. Again there is no evidence that breast implants cause breast cancer, but they may change the way mammography is done to detect cancer. When requesting routine mammograms women with implants should be sure to go to a radiology centre where technicians are experienced in the special techniques needed to get reliable X-rays of implanted breasts. Additional views are required. Ultrasound examinations may help to detect breast lumps in some women with implants or to evaluate the implant. While the majority of women do not experience any complications, you should discuss each of them with your physician to make sure you understand the risks and consequences involved in breast augmentation.
PLANNING
Your surgeon will initially evaluate your health and recommend which surgical techniques are best for you, based on your age, the condition of your breasts and your skin tone. If the breasts are sagging your doctor may also recommend a breast lift. Discuss your expectations fully frankly with your surgeon. He or she will be equally frank with you, describing your choices and the risks and limitations of each. You may want to ask your surgeon for a copy of the manufacturer's usage instructions that come with the implant so that you are fully informed. Be sure to tell your surgeon if you smoke, and if you're taking any medications, vitamins, or other drugs. Your surgeon will also explain the type of anaesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Most insurance companies do not consider breast augmentation to be medically necessary and so do not generally cover the cost of this procedure.
PREPARATION
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.
WHERE?
Our surgeons perform breast augmentations in the operating theatre in the Hurlingham Clinic or in one of the London private hospitals where they serve as a Consultant. The surgery usually takes from one to two hours. Many patients are able to go home on the day of the surgery; some remain in the hospital for one or two days.
ANAESTHESIA
The Hurlingham Clinic and Spa offers a modern, patient-friendly approach to anaesthesia TIVA - Total Intravenous Anaesthesia. TIVA, is a newer anaesthetic technique which has risen in profile within the last 5-8 years. It has been made possible with the advent of a new generation of intravenous medications with unique properties. TIVA patients sleep soundly during the entire operation, feeling no pain and experiencing no anxiousness. They wake up quickly and comfortably with no memory of their procedure. Many patients prefer this type of anaesthetic to traditional general anaesthetics since they feel comfortable, wake quickly, have less nausea, experience none of the 'hang-over' effect of a full general anaesthetic, and therefore can be discharged earlier. TIVA is safe, effective, extremely well tolerated and is the anaesthetic of choice of Hurlingham Clinic surgeons and most of their patients.
Alternatively, for some patients, they and their surgeons may decide that a full general anaesthetic is still the best choice. Discuss your options for anaesthesia during your consultation with your cosmetic surgeon.
WHAT HAPPENS?
The method of inserting and positioning your implant will depend on your anatomy, your preferences and your surgeon's recommendation. A short incision can be made either in the crease under the breast, or around the areola (the dark skin surrounding the nipple), or in the armpit. If the implant is placed through the armpit, your surgeon may use a new, technologically advanced method of implant placement called 'endoscopically-assisted' breast augmentation. Using a small television camera mounted on a thin, lit tube, he inserts the implant via the armpit incision leaving no scar on the breast. Be sure to discuss with him if this approach is right for you.
Regardless of the location of the surgical incision, every effort will be made to ensure that the resulting scars are as inconspicuous as possible. Working through the incision, the surgeon lifts your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoralis muscle). There are different reasons for placing the implants on top of or underneath the muscle and your surgeon will discuss the pros and cons of these alternatives with you before surgery to make sure you fully understand the implications of each. Drainage tubes are rarely needed following the operation which usually takes about one and a half hours to complete. Dissolving stitches are used to close the incisions which will also be taped for greater support.
AFTER SURGERY
You will feel tired and sore for a few days but should be up and around in 24 to 48 hours. Most of your discomfort can be controlled by prescription medication. Within a few days any gauze dressings can be removed and you may be given a surgical bra. You should wear it as directed by your surgeon. You may also experience a burning sensation in your nipples for about two weeks though this will subside as the bruising goes away. The swelling in your breasts may take a couple of months to go completely.
RECOVERY
Most patients can return to work within a few days. Follow your surgeon's advice on when to begin exercises and other normal activities. A post-op course of Endermologie may speed your recovery. Your breasts will probably be sensitive for two to three weeks, so you should avoid most physical contact. By three to four weeks after surgery they should no longer be sore. The scars will be firm and pink for at least six weeks. They may then remain the same size for several months, or even appear to widen. After several months, however, your scars will begin to fade, but they will never disappear completely. Routine mammograms should continued after breast augmentation for women who are in the appropriate age group.
HAPPY?
Many women find having larger breasts satisfying, even exhilarating. Regular examination by your surgeon and regular mammograms for those in the appropriate age groups will help ensure that any complications, if they occur, can be detected early and treated. Your decision to have breast augmentation is a highly personal one. Not everyone will understand. The important thing is how you personally feel about it. If you have met your goals, then your surgery is a success.
Contact us for your breast surgery consultation.
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