Augmentation

In general, there are three variables I look at with regards to any cosmetic breast surgery. The nipple position, the quality and elasticity of the skin and the breast volume. If you feel that you have a small bust, but like the overall shape of your breasts, have good quality skin and a youthful nipple position, then enhancement surgery might be ideal for you. As a general rule, a youthful nipple should be at the most projected part of your breast. Enhancement can be achieved using a silicone prosthetic implant or with your own fat, for a more vegan approach, or a combination of the two. Implants however, are by far the commonest method used for breast augmentation. However, if you do not like the overall shape of your breasts and nipple position, but you like the overall volume, then a mastopexy might be a better option. If shape and volume are both a concern, then perhaps an augmentation mastopexy might be a better choice. This is very common post pregnancy and breast feeding, during which breasts can change considerably.

With implant breast augmentation, there is an inherent element of required maintenance surgery as you age. Implants do not last forever and the majority need replacing after about 10-15 years. However, this is not an absolute rule and I have seen women with acceptable results after 25 years with the same implants. Factors such as weight fluctuations and pregnancy can affect the overall result and ideally you should be at a stable weight and not imminently planning to start a family, before undergoing this surgery. The choice of implants also plays a part in the longevity of the result, with larger implants having a shorter life span, due to the effects of gravity. I always favour a more natural result, which inevitably is longer lasting.

Breast augmentation with implants takes approximately 1.5 hours. Augmentation with fat grafting is similar, but can sometimes take a little longer, depending on where the fat is taken from.

As with any surgery, there is an element of ache and mild discomfort. On the whole, patients having augmentation with implants under the muscle have a little more discomfort than those with implants over the muscle. Additional long acting local anaesthesia given during the surgery, combined with oral analgesia afterwards, should keep you very comfortable during your recovery.

I do not use drains for primary breast augmentation. If the surgery is more complex however, such as in revision cases, then drains might be used.

A surgical bra following breast augmentation provides support and comfort and depending where your surgery takes place, this will either be provided for you (Spire Clare Park), or one will be recommended to you for purchase. It is recommended that this is worn day and night for six weeks following surgery.

Recovery varies between five days and two weeks and it might be longer if the implants are placed under the muscle. As a general rule, you should avoid any heavy lifting or vigorous exercise for six weeks after surgery. You are of course encouraged to move as normal, to minimise the risk of chest infections and leg clots. The final results including scar appearance are usually evident once all the swelling has subsided and this can take up to 12 months. Using a single layer of the provided micropore tape on the scars for 6 – 12 weeks, will give the best results possible. If this is not tolerated, scar surgical massage is a good alternative, starting at about 3 weeks, when the wounds have fully healed. Scars should not be exposed to direct sunlight without the application of a high SPF cream for a year and products such as Cicaplast contain both silicone and SPF block. There are however other alternatives. A post-operative surgical bra should be worn at all times for 6 weeks, but there are also exceptions to this.

These include an element of discomfort, risk of poor scarring, risk of infection (1%), altered nipple sensation or loss, risk of bleeding, capsular contraction, implant rupture, implant rippling and bottoming out, need for revision surgery, implant animation (if submuscular), rotation (teardrop implants) degrees of asymmetry and delayed wound healing. The ability to breastfeed is not usually affected. If textured implants are used, there is also the risk (1 in 20,000, MHRA) of BIA-ALCL (breast implant-associated anaplastic large cell lymphoma), which is a type of very rare cancer that can develop in the breast capsule around the implant. The MHRA and BAAPS websites have further information on this condition. The use of smooth implants minimises this risk, but they are not suitable for all women. A detailed face to face discussion is essential on this topic. Other rare conditions that may develop also include BII (breast implant illness), which might be immune-mediated and is currently poorly understood. Your nipple sensation may also increase (hypersensitivity), decrease, or lost completely (including erotic sensation) and each side may act independently. Sensation recovers over time and this varies between patients, but it is not guaranteed. Smoking increases the risk of infection and I am very strict when it comes to smoking and cosmetic surgery. You are advised to stop smoking at least one month before and after this surgery. On the very rare occasion of an implant infection, this usually requires the surgical removal of that implant. A meticulous non-touch implant technique is used during the surgery, including the use of the Keller funnel and the implant and breast pocket are rinsed with betadine antiseptic solution. You will also be given antibiotics after the surgery for five days to one week. Bleeding after the surgery usually presents as a breast swelling and it is usually evident very soon after surgery. This requires a return to the operating room to remove the blood clot and stop the bleeding. This happens very rarely. Lastly like in all surgery, there are no guarantees for a perfect outcome.