Breast Augmentation

Questions you should ask

At this stage you should be clear you understand the entire breast surgery procedure and feel comfortable both about the outcomes and with your chosen surgeon.  If you have any queries or doubts about any aspect of the procedure, you should ensure you voice them now. 

You should definitely ask your surgeon about:

• The choice of implant and its pros and cons for you
• The type of surgery to be performed and any resulting scar tissue
• The realistic outcome of your surgery
• The possibility of breast lift at the same time as your augmentation surgery, if you think you might want this too
• The immediate care of your breasts and your convalescence post op
• Any risks or complications, both in the immediate aftermath of surgery and in the months and years to follow
• The use of anesthesia during your breast augmentation surgery

Other aspects which may be important to ask about include:

• Breast feeding and implant surgery, if applicable to your needs
• Mammography and breast implants

What happens during Surgery

Your step-by-step guide to the procedure

A breast augmentation operation usually lasts between 1.5 to 2 hours and is generally performed with the patient under general anaesthetic.  In some instances, it may be performed within a day without the need for an overnight stay in hospital.

Before the operation, depending on your age and fitness, you will have to undergo some health checks such as blood tests.  If you decide on surgery you will be required to sign a consent form giving permission for the operation. This is your indication that you are aware of the risks and any complications involved with the procedure.

Step 1 - Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 - The incision

The surgery involves placement of an implant either under the skin and breast tissue or deeper under the muscle under the breast.  Incisions are made in areas that are almost hidden so as to reduce visible signs of scarring. You will need to have discussed at consultation stage the type of incision/surgery best for your needs.  Generally the incisions are in the fold beneath your breasts, and near the armpit.  Incision options include:

• Inframammary incision
  • This is the most common incision. It is made in the crease where your breast meets your     rib cage.  It is ideal as it results in very little visible scarring. 
• Transaxillary incision
  • This is made in the armpit and can be done without endoscopy
• Periareolar incision
  • This is a common incision around the areola, the colored skin around the nipple.

Step 3 - Inserting and placing the implant

After the incision is made, a breast implant is inserted into a pocket either:

• Under the pectoral muscle (a submuscular placement), or
• Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)

The method for inserting and positioning implants depends on the type of implant, degree of enlargement desired, your body type, and your surgeon’s recommendations.

Step 4 - Closing the incisions

Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin. Over time the incision lines will fade.

Step 5 - Seeing the results

You will notice the reults of breast augmentation straightaway.  Once any post-operative swelling has subsided, you will find incision lines fade too.

Your recovery

What to expect immediately

Immediate post-operative recovery is usually one to two days and you will need to refrain from more strenuous activities for several days.  You are likely to feel soreness and have swelling for a few weeks after surgery in any case. Within time, your swelling will reduce and you will notice the incision lines fading.

Your surgeon will give you specific advice on how to care for your breasts in the following weeks as well as longer terms.  You will be advised to take pain killers and wear a supportive bra day and night.  You may have dissolvable stitches but any permanent stitches will need to be removed at around 10 days.

Long-term care

You should avoid lifting, driving and strenuous activity for up to 3 weeks. Depending on your job, you should be able to return to work 2 to 4 weeks after the operation. Patients are usually fit to fly within 8-10 days post-op, yet some cases may take up to 3 weeks to fully recover. This is decided by the surgeon.

We recommend you keep in contact with your surgeon to take directions about how and when you resume normal activity or exercise.  You will also be given instructions relating to any medication to apply or take orally and also about booking check ups with an accredited clinic back in your home country.

It is possible to have mammograms after breast enlargement surgery and it may also be possible to breast feed in many cases.

Safety

All surgery does of course carry risks.  Breast augmentation surgery therefore has its risks, but it wise to remember that is has been performed safely for women for over 40 years.

Implant safety

The main focus of attention has been on the types of implants used, with silicone-filled implants coming under scrutiny.  The last scientific research supports the use of silicone-gel-filled implants for breast implant surgery and has shown that these implants do not pose any additional risks to women’s short- or long-term health.  Saline-filled breast implants have always been safe, a fact that has been supported by more than 30 years of clinical experience.  Silicon-gel-filled implants are widely used in Europe and across the world, and since 2006, the American FDA has approved their use in the USA after lifting a ban following concerns about their safety in the early 1990s. 

See also:

• www.breastimplantsafety.org
• http://www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Breastimplants/index.htm

Longer-term safety of breast implants

Breast implants won’t last a lifetime.  They generally last up to ten years.  So you will need to have your implants checked regularly – ideally annually – by your surgeon or with a mammogram at competent clinic in your home country.

General Health Risks

There are general risks associated with a general anaesthetic including chest infection and DVTs (clots in the veins of the legs). There are also some risks specific to breast surgery.

Bleeding: this sometimes requires a return to theatre and problems with wound healing and infection can occur particularly in those who smoke and it is therefore advisable to stop smoking before the operation. 

Infection: In some cases infection might result in the implant having to be removed.

Scarring: In most cases scars fade and are hardly noticeable in normal underwear or swim wear.  Scars vary enormously from one woman to the next and some people can have problems with red, raised, and lumpy scars (keloids).  Internal scarring around the implant, known as a capsule, occurs to some extent in up to 10% of women.  In the worst cases this leads to hard painful breasts and may require further surgery. 

Asymmetry: (one side different in size or shape) can occasionally be a problem as can numbness or altered sensation.  Rupture or leakage of the implant is rare. Despite media reports, there is currently no convincing evidence linking implant to increased risk of breast cancer or other health problems such as autoimmune diseases and rheumatoid arthritis.