The procedure in detail
Breast enlargement surgery is generally performed under general anaesthetic. The procedure takes around one hour to perform and patients may be able to go home the same day.
Breast augmentation surgery is performed by making a fine incision in the crease-line beneath the breast itself (sub-mammary route), or through the armpit (axillary), or around the underside of the nipple area (periareolar). In the UK the sub-mammary incision method is generally favoured, though any decision is made on the basis of a patient’s personal preference, in conjunction with the surgeon’s advice and judgement. The implant can be positioned in one of two places within the breast cavity in order to push the breast forward and to enlarge the original breast volume.
The two potential sites are:
a) In front of the pectoral muscle. This route is typically chosen when a patient has sufficient skin and breast tissue to give good natural looking coverage over the breast implant.
b) Behind the great pectoral muscle. This route is typically chosen when a patient has insufficient skin and breast tissue to give a natural looking coverage over the breast implant. This method is often favoured for very slim or particularly flat chested women.
It can take up to 14 days for initial swelling and bruising to settle to an acceptable appearance, but residual swelling will settle down gradually over several months. Typically the fine incisions and subsequent scars that are made by performing this procedure are well hidden in the natural breast crease, or arm pit, or in the pigmented margin (areola) surrounding the nipple area. Every surgeon's breast augmentation procedure technique can differ slightly and wounds can be sutured (stitched) with either dissolvable or removable fine line sutures, or by surgical glue. Sutures are typically removed 10-14 days following surgery.
What are the risks?
All surgery involves an element of risk from developing complications. However, cosmetic surgery is usually undertaken voluntarily and only when a patient is in good health. Therefore, the probability of experiencing complications from this kind of surgery are substantially lower than those who undergo surgery due to ill health.
General risks such as bleeding, infection and asymmetry and scarring will be discussed openly at consultation, as well as our scrupulous efforts to manage and minimise these risks to their lowest possible potential. However there are also specific risks to this procedure that need to be considered. These are:
Capsular contracture (hardening) - Modern day implants have ensured that the risk of capsular contracture has never been so low; however, capsular contracture is still the most common complication experienced by women following breast augmentation. Capsular contracture occurs when the human body puts a wall of scar tissue (fibrous capsule) around an implant. This scar tissue can then thicken and shrink and is noticed by the patient as an apparent hardening of the breast implant. Where a capsular contracture becomes noticeable or unsightly to the patient, remedial surgery to correct this problem can be performed.
Rupture rates and life expectancy of breast implants - Recent advances in implant technology and manufacture mean that breast implant ruptures are highly unlikely. A true evaluation of the life expectancy of modern-day implants is difficult to predict accurately, as new implants may have the potential to last a lifetime, but they have not been in use for long enough to produce proof to substantiate such a claim. Consequently, the Department of Health asks manufacturers and plastic surgeons to advise women that they may need to consider renewing their implants after a ten-year period.
Scarring - Scars resulting from breast augmentation surgery are typically fine and insignificant once the healing process is complete. However, very occasionally a scar may heal abnormally and become thick, raised and painful (hypertrophic). This condition can be treated with a special dressing or with anti-inflammatory injections or occasionally with corrective surgery, although results cannot be guaranteed.
Infection and rejection - It is important that all patients quickly recognise any signs of infection, such as excessive pain, fever or offensive wound discharge. Antibiotics given during your operation will help reduce this risk to a minimum, as will meticulous attention to your personal hygiene. On very rare occasions a patient’s body may be unable to cope with the introduction of a foreign body (such as a breast implant) and a resulting infection may lead to a total rejection of the new breast implant.
Changes in breast sensation - It is typical for most patients to notice an alteration in breast sensation following surgery. These changes usually subside when the breast has fully recovered from surgery. Occasionally, patients report that their nipples or breast skin remain either more or less sensitive in the long term following surgery.
Palpability - Women with very little natural breast tissue should be advised that the rim of the breast implant may be visible or detectable to touch (palpable). Your surgeon may recommend placing an implant behind the pectoral muscle to minimise this effect if he believes that the implant ridge would appear unsightly.
Implants do not interfere with a woman’s ability to breast feed. There is no known association between breast cancer and breast implants.
Mammography - Women with breast implants should inform any future radiographer that they have breast implants, so that the most appropriate method of breast screening and mammography can be performed.
Travelling at high altitudes - Breast implants are not subject to strain, pressure or rupture when travelling in an aircraft or at high altitudes.
Smoking - Heavy smokers may be precluded from having breast implant surgery due to their increased risk of infection and rejection complications.
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