Bilateral Breast Augmentation

Breast enlargement using implants (breast augmentation) is usually a very straightforward and satisfactory procedure. It is usually performed for individuals who are unhappy with the size of their breasts and gives a great boost in self-confidence.

How is the operation performed?

It is carried out with you asleep (general anaesthesia) and takes about one hour. I mostly make the cut in the fold below the breast (submammary). Other approaches are around the areola (circumareolar) and near the armpit (transaxillary)

I may place the implant underneath the existing breast tissue (subglandular), underneath the muscle (subpectoral), or use a combination of both(dual plane), depending on the specific features of your breast. Placement of the implant in the subpectoral plane is necessary where the skin and breast tissue are thin such that any wrinkles and folds that can occur in the implant are visible. The muscle provides an extra layer and helps to disguise any irregularities in the implants. This position is a bit more uncomfortable immediately after the operation and perhaps more prone to bleeding. Also, contraction of the overlying muscle can distort the shape of the breast.

What is the postoperative care?

You may stay overnight in hospital. I may leave drains, which are usually removed the next day before you go home. The wound is stitched up with dissolving stitches and covered with a waterproof dressing so that you can shower the next morning. Although you may feel tight and uncomfortable, usually simple painkillers are adequate. You will be given antibiotics. You should wear a support bra for 4-6 weeks.

What are implants made of?

There is a silicone shell that is textured or smooth. This is filled with either salty water (saline) or silicone gel. Saline filled implants are rarely used in the UK nowadays for regular breast enhancement procedures. Silicone gel implants are manufactured in three main groups, the softer gel, which has a more natural feel but is more prone to wrinkling, the more cohesive gel which is firmer and recently there is a intermediate firmness gel. At present all are considered equally safe. Implants are made in different sizes, profiles, which can vary from a flat doughnut shape to almost spherical. We will discuss at your consultation, which implant shape and size may be appropriate for you, however the final choice is yours.

What are the possible complications?

The majority of breast augmentation procedures proceed smoothly, but, like all surgical operations, problems can develop.

1. Bleeding can occur in about 3% of patients usually in the first 24 hours. This may necessitate a return to the operating theatre to remove the pooled blood. However, the loss of blood is usually minimal. It may cause some extra bruising and swelling and an extra night in hospital.
2. Infection is very uncommon (less than 1%). It may only become apparent after you have returned home some three or four days following the operation. The breast becomes swollen, red, and tender and you will feel ill, like you have bad flu. The infection will not settle with antibiotics alone. The infected implant will need to be removed at operation and the pocket washed out and a drain placed in the pockets. A new implant can be put in some months later once everything has settled down. But in the meantime you would obviously have one breast larger than the other. Because of the scarring inside the breast the eventual result may not be as good as it might have been.
3. Occasionally body fluid collects around the implant (seroma). This usually resolves rarely requiring drainage.
4. Capsular contracture. All foreign material placed within the body becomes walled off with thin scar tissue. The scar which forms around the breast implant is called a capsule. Sometimes this thickens and as all scars contract, it squeezes the implant into a round shape. This can happen over months, or more usually years and the breast ends up like a tennis ball on the chest wall; firm to the touch and may become uncomfortable, tender or painful. The problem can be dealt with by removal of the scarring encasing the implants (capsulectomy) and changing the implant.
5. Implant related problems. (A) Folds and wrinkles in the implant shell can form. If you can feel them, but they are not visible, it may be best to accept this. However, if they develop so you can see them it may be possible to change the position of the implant to behind the chest wall muscle or change to a firmer implant. (B) Malposition- sometimes the implant may shift position and may need to be adjusted. (c) Rotation- shaped (teardrop) implants may also shift position requiring reoperation.
6. When the implant pocket is made, little nerves can be cut or damaged, which can lead to altered or loss of sensitivity to the nipple areolar and surrounding skin. Often the sensation returns to normal, but occasionally can remain reduced, lost permanently or rarely remain over sensitive.
7. The scar under the breast usually heals to a fine white line. Sometimes it is red and lumpy and takes many months to settle. Rarely, the scar remains red and lumpy and may be difficult to treat. Sometimes the scar is uncomfortable as is the breast itself on occasion.
8. Residual asymmetry of the breasts and nipple areola as they are rarely symmetrical from the beginning.
9. Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). This is a rare and emerging problem, which appears to start in the capsule around the implant. Lots of research is going into this and understanding of this rare condition may increase but also change as more is understood. I will give you separate information on this as well.

Did you know!

1. There is no increased risk of breast cancer from breast augmentation, but implants can cause difficulty with performing and interpreting x-ray screening (mammography). Furthermore, folds within the implant shell can be mistaken for lumps within the breast and may need investigation by ultra sound scan, MRI scan or even an open biopsy. Do let the radiographer know that you have implants.
2. Breastfeeding ability is unaffected by implants and their presence with current knowledge poses no danger to a baby.
3. Breast implants should last for many years and do not have to be changed every ten years or so. Although it is expected they will last many decades, this cannot be guaranteed.
4. In certain situations fat grating can be used alone or with breast implants for augmentation

What size implants to choose? The Rice bag test can be helpful

Buy a support bra (Marks and Spencer high impact support bras are good) the size you think you might like to be. Fill loosely a soft plastic bag (or a portion of a old pair of tights) with rice, closing it with an elastic band and place in the bra cup. Smooth it into a breast shape and alter the volume of rice until you are happy that you are filling out the bra fully. Wearing a tight light coloured top will help outline your profile. Check your front and side views in the mirror. Once you are happy with your breast size, measure the volume of rice in your kitchen-measuring jug in mls (make sure its level!) and make a note of the volume.

Contact my secretary with this information or bring it with you to a consultation. I may also use sizers and the Crisalix system to help in choosing an appropriate size as well.