Breast Augmentation

A breast augmentation is performed under a general anaesthetic and is usually performed as a day case although occasionally an overnight stay maybe required. The operation involves placing an incision in the natural crease underneath the breast. A pocket is then created for the breast implant. This pocket may be underneath the breast tissue (subglandular) or beneath the pectoralis muscle (submuscular). The dual plane technique involves placing the implant partly under the muscle and under the glandular tissues. The decision on where the breast implant is placed is dependent on your breast characteristics and will discussed during your consultation with Mr Nassab. Once the breast implant is placed in the pocket the incision is then closed with sutures and dressings applied.

Breast implants can be classified according to their shape, composition or coating. The shape of the breast implant may be either round or anatomical, commonly referred to as teardrop. The round implants tend to produce a fuller cleavage and upper pole of the breast. The anatomical implants produce a more subtle result.

In the UK, most breast implants are filled with silicone whilst in the US some surgeons use saline filled implants. The silicone gel is termed as cohesive meaning that it retains its shape even when cut.

Breast implants can also have differing coatings that are either smooth, textured or polyurethane. Read more about choosing breast implants in our blog here.

Breast augmentation surgery has been performed for many decades and there have been numerous studies looking at the safety of silicone breast implants. These studies, which comprise of several thousands of women, have not shown any links with diseases such as autoimmune disorders, connective tissue diseases or cancers. There has been much news recently regarding PIP breast implants, which were made of industrial grade silicone rather than medical grade silicone. Mr Nassab has never used PIP implants in his practice.

There is currently no evidence that breast implants cause an increased risk of breast cancer.  There are, however, some very rare types of cancer such as ALCL or SCC that may be related to breast implants.

Breast augmentation like any surgery may result in potential complications although these are uncommon. The main complications following breast augmentation include:

Bleeding and haematoma formation

A haematoma is a collection of blood that may form in the pocket of the implant and this may require surgery to wash the pocket and stop any bleeding.

Infection

The risk of infection is rare. You will normally be given some antibiotics during the procedure to reduce this risk further. Most infections occur soon after surgery although they may happen many years after the initial surgery as well. If the infection is severe then the breast implant may need to be removed. The cavity is then washed and closed. Usually we would then need to wait a number of weeks to months before replacing the implant.

Scarring

There will be a scar from the incision to insert the breast implant. The scar is most often place in the crease beneath the breast. Scars can sometimes become raised or lumpy and this is referred to as a hypertrophic or keloid scar. This may need further treatment in the form of silicone dressings or creams and possibly a course of steroid injections.

Change in Nipple Sensation

Most women will notice an alteration in the sensation to the nipple following breast augmentation. Most often there is reduced sensation although some women may notice increased sensitivity after breast enlargement. This is often temporary although some permanent changes may occur.

Asymmetry

All breasts have some degree of asymmetry and even after breast augmentation there may be some minor degree of asymmetry. There are occasions when minor asymmetries preoperatively may be exaggerated postoperatively. There main also be differences in terms of nipple position after breast enlargement.

Implant Extrusion

Implant Rupture

Gel Bleed

Capsular Contracture

The main long term complication with breast implants is the formation of a capsular contracture. When an implant is placed into the breast the body forms a thin capsule around it. In some women this capsule can become thickened and cause discomfort and distortion of the breast. This may require further surgery and the risk of it recurring is high if you have already had a capsular contracture.

Changes with Time

When you age or have children, there will be changes in your breast shape and volume. Generally, the skin loses its elasticity and thins resulting in drooping of the breast, known as breast ptosis. This may require an uplift procedure or mastopexy to correct. Thinning of the skin and tissues covering the breast implant may result in the implant becoming palpable, show signs of rippling or wrinkling.

The majority of women are able to breast feed after breast augmentation. It has also been shown that the breast milk in women with breast implants does not contain any significant amounts of silicone. In fact, silicone is commonly used in baby products such as bottle teats and soothers.

I would recommend waiting for 6 weeks before flying long haul.  This is to ensure that everything has settled and there are likely to be no problems prior to flying.  You may be able to travel short haul after 2 weeks but you will still need to wear your support bra for 6 weeks following surgery.

The normal recommendation is 6 weeks for strenuous physical activity.  Exercising earlier may cause increases in blood pressure and heart rate that may increase the risk of bleeding.  Patients that have the implants under the muscle will also find that they will have more discomfort initially.

Patients are advised to wear a support bra for the first 6 weeks following breast implant surgery.  The support bra should ideally have a zip at the front for easier changing.  After the 6 weeks, you should be able to wear normal under-wired bras again.

Almost all patients will have their scar in the breast crease just underneath the breast.  A small number of patients may have the scar around the areolar.  I do not perform breast augmentation using an armpit or axillary incision.

I use the highest quality Mentor breast implants that are owned by Johnson and Johnson.  These are breast implants with a high safety track record that have been on the market for over two decades.  They are one of the only brands with long term published clinical results.

Silicone is made from silica which is the most common substance on earth. Heating silica with carbon dioxide forms silicon. This is then processed silicone that is a gel like substance used in making breast implants. Silicone is commonly used in many household products from creams to baby bottle teats.

Studies have shown that higher levels of silicone are found in cows’ milk or infant formula milk compared to breast milk produced from mothers with breast implants. Therefore, it is unlikely that your baby will have any harmful exposure to silicone from your breast milk.

ALCL stands for Anaplastic Large Cell Lymphoma.  This is a very rare form of cancer that can develop around the implants.  The relationship with breast implants is not fully understood yet although a various factors have been reported.  It is thought to occur in about 1 in 300000 breast implants.  Patients that have had implants for several years that develop sudden onset swelling should be investigated to exclude this.

I have never used PIP implants in any of my patients.  I see many patients that have had PIP implants previously that I have removed or replaced.  I believe in only using the highest quality implants with long term safety data.

All patients that have breast enlargement will form a capsule around the breast implants. In a proportion of women, these capsules can become thickened or hardened resulting in capsular contracture. The symptoms of this may include pain or discomfort of the breasts. If the capsules become very hard they may begin to distort the shape of the implants. It is not fully understood why some women develop this whilst others do not. There are a number of factors that increase the risks of capsular contracture, which include: haematoma, infection, smooth implants and implants placed over the muscle. There are factors that also help reduce the risk of capsular contracture. Mr Nassab uses antibiotics during your procedure to help reduce infection risk. He would normally recommend using textured implants to try and risk the risks. During your procedure, he uses a Keller funnel for inserting the implant. This is a technique that results in minimal handling of the breast implant. In some cases, going under the muscle may also reduce the risks of capsular contracture.

The life expectancy of breast implants will vary greatly between patients. Most patients, that do not have any complications such as capsular contracture, will expect to go 10-20 years without the need to change their implants.

We would recommend that you avoid smoking for 4-6 weeks before and after your breast augmentation surgery. This includes the use of nicotine replacement such as gums, patches and e-cigarettes. Smoking reduces the blood supply to the skin and cause problems with wound healing. Smoking also increase increases the risks associated with the anaesthetic for your operation.

The weight of the implant will depend on the size of it. It is generally considered that the size is roughly equivalent to the weight in grams. Therefore, a 250cc implant will weigh about 250 grams.

The cost of the procedure will vary slightly according to where it is performed and types of implants used. The prices start from £7500 for breast augmentation using round implants performed in Cheshire. To find out more information about the cost of breast enlargement surgery book a consultation with Mr Nassab.