BREAST ENHANCEMENT

This operation is performed through a scar placed in the fold between the breast and the chest wall. The scar is about 5 cm long.

The implant is put behind the breast tissue in a pocket, which is tailored for the desired shape of the breast and cleavage. Every chest wall is a different shape and the amounts of breast tissue on either side vary and, therefore, there is likely to be some size mismatch between the two sides once the breasts have been enlarged. In consequence, we cannot guarantee to make you an exact cup size.

The operation takes place under general anaesthetic and you may stay in hospital for one night after the operation. With the newer type of implant there is no need to wear a bra, but you may find wearing a sports bra more comfortable. Your exercise should be very limited for the first month after the operation, but we recommend putting your arms and shoulders to their full range of movement twice a day. This will help to reduce any stiffness, which you may feel.

There will be stitches under the skin and tape over this. You will be seen the week after surgery to check everything is settling well.

Occasionally after the operation, sensation to the nipples may be reduced, but this tends to return over subsequent months, though this may take up to two years. Usually the sensation will return. The operation may be complicated by a blood clot around the breast implant, which may need to be removed in the operating theatre. Other potential complications include infection around the implant, which may require it to be taken out. Also, the scars can become red, raised and itchy, leaving a lumpy scar, which may take eighteen months to settle.

We advise you to massage the scars twice a day with a cream to which you are not allergic, starting two weeks after the operation and can advise you on the type of creams to use. There will be no stitches to be taken out. They run underneath the skin and dissolve with time.

There are possible long-term complications known to be associated with breast implants and, perhaps, the greatest risk is that of capsule formation. The reason for this problem remains unclear, but with the newer type of implants the risk runs at approximately 8%. If it occurs patients may develop a feeling of unusual firmness in either one or both breasts. Breast tenderness may also be experienced and, with severe capsule formation, the breast may become hard and the shape may become distorted as the capsule becomes increasingly calcified. If this occurs then changing the position of the implant may be indicated, but removal may sometimes be the only solution.

Clinical studies (Kulmala et al – Ann. Plast.Surg. 2004; 53:413-419) have shown that capsular contracture is significantly lowered in patients receiving textured surface implants rather than smooth-walled ones and we always use high quality textured implants. Also, similarly textured implants (from different manufacturers) elicit different degrees of capsular contracture; the Kumala study showed that the lowest incidence was achieved when using McGhan implants.

Different implants from different manufacturers behave differently and have different life spans, but we normally recommend that you consider replacing your implants about every 15 years. Recent advances in implant technology, however, have led to certain manufacturers providing ‘lifetime’ warranties against rupture for their products. For example, Inamed Aesthetics (the manufacturer of McGhan implants) provide a written warranty called INAMEDPlus™. Any patient implanted with their product receives automatic enrolment into the programme and their implants are covered by a patient lifetime product replacement plus 10 years of guaranteed financial assistance consisting of up to £700 out-of-pocket expenses for surgical fees, operating room and anaesthesia expenses not covered by insurance. This programme applies to most McGhan gel-filled breast implants where loss of shell integrity results in implant rupture that requires surgical intervention - please refer to their brochure for more information.

It is also important that you check your breasts on a regular basis. If you notice any rapid change in size or shape in them once the implant is in place, please contact us. If a rupture does occur the ‘cohesive’ gel filler should not cause you any medical problems, but it is best to remove the old implant as soon as possible to reduce any risk of inflammation and to maintain your desired shape.

There is no conclusive evidence that silicone gel-filled breast implants are causative agents in the development of autoimmune disorders.

Of slightly greater concern is the potential for masking early breast cancer. There is no evidence that silicone increases the risk of cancer either in the breast or elsewhere in the body. However, the implant does prevent an ordinary mammogram from being performed. There is an alternative mammogram technique (known as a distraction mammogram) or ultrasound can be used to help pick up early lesions. It is very important that you undergo regular self-examination and that any lumps or bumps in the breast are seen by your doctor.

The risk of complications is low, but you should be aware that there are potential problems. A study has shown that 90% of patients are comfortable with their appearance when they are dressed, in a swimming costume or in a low cut top, but some do still feel uncomfortable when in a changing room or when naked. Remember that breast prostheses cannot flow like breast tissue and, therefore, remain proud on the chest rather than falling to the side when you lie down, and also scars on the chest wall will be visible when you are naked.

The NHS no longer provides breast augmentation. We suggest that you set up a small savings plan so that if there is a problem in the future, such as capsule formation or the implants need to be changed, this does not cause you a problem financially. We have looked at trying to insure patients undergoing breast enhancement as a group but it has not been possible to set up a policy.

Before undergoing this type of surgery, it is very important that you do not take Aspirin or rheumatic-type drugs like Brufen or Nurofen or Ginkgo Biloba for at least a week before the operation. These medicines alter the clotting of the blood and make bleeding after the operation more likely. Even one tablet can affect the clotting of the blood for up to ten days before an operation.

Whilst we do our utmost to try to achieve the best possible result for you, this cannot be guaranteed. If subsequent revision procedures are required, there may be additional fees.

For women who have not yet had children:

It should be possible for you to breastfeed after having a breast enhancement performed, but if the nipple sensation is altered this may be difficult. There have been some reports from the United States about silicone being discharged in the breast milk. A study has shown that the level of silicone in breast milk is lower than in formula milk. A report from the Medical Devices Agency in the United Kingdom has shown that there is no evidence to link the silicone with any problems with the baby. Also bear in mind the fact that teats for bottle are made of silicone and are siliconised.

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