Breast Augmentation, or augmentation mammaplasty, is the surgical procedure performed to increase the size and shape of a woman’s breast(s). In certain circumstances it may also provide some degree of uplift to the breasts. It may be performed for a number of reasons: cosmetic improvement for self-confidence, correction of breast asymmetry or as reconstruction following a mastectomy for cancer.

If you are considering a breast augmentation, this information will give you a basic understanding of the procedure: when it can help, how it is performed and the results you can expect. There is a danger of information overload when talking to a surgeon about breast augmentation – different incisions, implants, sizes, shapes etc., may leave you feeling more confused than informed! – so I will try and talk you through this in simple terms.

Who is suitable for breast augmentation?

Breast Enlargement Any woman who wants larger breasts may be suitable for this operation, but it is highly unlikely to be performed on girls in their teens whose breasts have not yet fully developed. If you are unhappy with very small breasts, increasing their size can improve self-confidence and self-esteem.

Breast Firming and Re-Shaping With ageing, pregnancy, breast-feeding and gravity the skin can stretch and breasts may droop. Most ladies complain of upper pole emptiness as they get older. In these circumstances, a certain amount of lifting and filling can improve the shape of the breasts considerably, and simple augmentation may achieve this. Sometimes the surgery may be accompanied by a tightening of the skin and lifting the nipples to raise the breasts (a procedure known as mastopexy).

Breast Asymmetry Most women have some degree of breast asymmetry. The left breast is often shorter and squatter than the right, simply because the left chest is broader to accommodate the heart. However, where there is pronounced asymmetry, or a particular condition such as Poland’s Syndrome or tuberous breasts, breast augmentation can be used to correct the imbalance.

Breast Reconstruction Although a mastectomy is often a final resort in the case of breast cancer, the outward appearance and psychological effects of the operation can be reduced through breast reconstruction. Some women choose a reconstruction at the time of the original mastectomy and sometimes it is done later. In either case, the shock of mastectomy can be eased by cosmetic reconstruction of the breast. I no longer undertake breast reconstruction following cancer surgery.

Lipofilling to breast Some woman may be suitable for carefully selected lipofilling for either breast enlargement or to smooth out irregularities. In this procedure fat is harvested from other areas
of the body and then re-injected to the defect or breasts. Not all the injected fat survives
this process (about 60%) so repeat procedures may be necessary.
Please see this link: https://baaps.org.uk/patients/procedures/8/fat_transfer_to_breast

What to expect at the initial consultation?

At the initial consultation, I will discuss your thoughts and needs with you and elicit a past medical history. At this stage, I will assess whether breast augmentation is suitable for you and whether the operation will meet your specific needs. Your breasts will then be examined and measured.

When it comes to a preferred size for your new breasts, this will be discussed in detail with me. Surgeons define implant size in millilitres (ml), and a typical implant may vary between 200ml and 350ml; implants are not measured in ‘cup sizes’ as bra manufacturer’s definitions of size vary considerably. As a guide to the preferred size of breast implant, try filling a freezer bag with warm water or rice and measuring accordingly. I used to use only textured, silicone-filled implants and usually either round implants; rarely I will use tear-drop (anatomical) shaped implants, depending on the patient’s body and chest shape.I now use smooth implants again (see ALCL below)

It is important that you mention to me any previous breast problems that you may have had. Such problems could include breast lumps, nipple discharge, breast pain, breast cancer or any other surgery you may have had on the breasts. You should also inform your surgeon if you have any family history of breast cancer, particularly in your mother or sisters. Tell your surgeon if you are on long-term medication, have any allergies, have a tendency to bleed or bruise easily, have had any previous surgery, have had any problems with local or general anaesthesia or if you have any medical ailments.

The surgery takes approximately 1.5 hours and you will wake feeling tight but pain-free. You will have dressings and drains in place, which will be removed the following day. I usually use a small incision in the natural crease under the breast. You can expect to spend one night in hospital recovering from the operation before going home. On discharge you will be supplied with painkillers and you will need to wear a well-fitting sports bra for at least two weeks after your operation. All stitches will be dissolvable.

Where does the treatment take place?

Your operation can take place at either:

Parkside Hospital, Wimbledon, SW19
St Anthony’s Hospital, Cheam, Surrey
The New Victoria Hospital, Kingston

What can go wrong?

In general, breast augmentation is associated with a high-degree of patient satisfaction and the vast majority of women are very pleased with their results. Nevertheless, no surgery is without risk and I will explain the risks and possible side effects of treatment with you at your consultation. Possible complications include:

• Bleeding and haematoma
• Infection
• Wound healing problems
• Poor or absent nipple sensation, which invariably recovers
• Poor scars, including hypertrophic and keloid scars
• Asymmetry
• Long-term problems with capsular contracture, pain and distortion of the breast

ALCL ( Acute Large Cell Lymphoma) This is a very rare lymphoma that seems to be related to only textured breast implants and then to some specific manufacturers. It has not yet been described in primary augmentation using smooth walled implants. This is why Mr Fleming has now largely moved to the use of smooth walled implants. There is considerable scientific research underway to establish the exact cause and incidence of ALCL and please see the link below. Swelling of a breast some months or usually years after enlargement is the commonest early sign. If this occurs please consult Mr Fleming or your doctor.

https://baaps.org.uk/_userfiles/pages/files/biaalcl_information_1.pdf

Breast Implant related disease A small number of women with breast implants have reported symptoms similar to those of known diseases of the immune system, such as systemic Lupus Erythematosis, rheumatoid arthritis, scleroderma, and other arthritis-like conditions. To date, after several large epidemiological studies of women with and without implants, there is no scientific evidence that women with either saline-filled or silicone gel-filled breast implants have an increased risk of these diseases. These diseases appear no more common in women with implants than those women without implants. The effect of breast implants in individuals with pre-existing immune system and connective-tissue disorders is unknown. There is the possibility of unknown risks associated with silicone breast implants and tissue expanders.

https://baaps.org.uk/_userfiles/pages/files/bii_information.pdf

How long does it take to recover?

Recovery can take up to three weeks and you are not advised to return to work or driving during the recovery period.

How satisfied can you expect to be with the procedure?

Because this is a common plastic surgery procedure, the results are predictable. After the operation, many woman report feeling exhilarated by their new, fuller appearance, with a resultant increase in self-confidence.

A breast augmentation always leaves a scar (the implant has to be placed through an incision) although the scar usually becomes inconspicuous over time, and is frequently hidden beneath the breasts so that it is only visible when the breasts are lifted.

I will discuss the exact nature of your treatment, including procedure details, recovery times and any possible side effects at a consultation. This will reflect your exact circumstances and needs. All the manufacturers that I use will guarantee your implants for at least 10 years if not for life; problems are usually related to your body’s reaction to the implant(s) not the implant itself. The information included here is provided for general guidance only. A more detailed DOH guideline is available at:

http://www.mhra.gov.uk/
How to book an appointment

PIP breast implants

Many of you will be very aware of the current scare around these breast implants – http://www.dailymail.co.uk/health/article-2081089/PIP-breast-implants-Governmentadviser-says-50k-women-SHOULD-removed.html. In pure health terms, however, there is no reason to be urgently seeking their removal. If you have concerns about the shape of your breasts, hardness, abnormal lumps (either in the breast or armpits) or pain then you should consult either your own surgeon or any reputable Plastic Surgeon (a good source of these is the BAAPS website: http://www.baaps.org.uk/component/surgeon/search/120/init1)

I am however very concerned about the long-term safety of these implants and urge anyone who believes they have had PIP implants to check the documentation supplied to them at the time of their original operation – whether for cosmetic or reconstructive purposes. If you cannot track down your own record of your operation then either get hold of your operating surgeon and/or clinic so that they can reassure you that PIP implants were not used on you. We did use some PIP implants at St Georges Hospital in the early 2000’s but my reading of the current situation would suggest that the dodgy shells and inferior quality silicone only came into use after 2005.

If you have PIP implants in place then it depends on the current situation with your breasts. If the implants are apparently trouble-free then a consultation and perhaps scan may be all that is necessary until it becomes apparent how the removal (and perhaps replacement with a reliable product) of these implants will be funded – by the NHS or by a class action. If, however, you are having problems with your implants then a choice between paying for their immediate removal or waiting as above is one you need to make.

I have never used any PIP implants in my private practice.

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Disclaimer
https://baaps.org.uk/patients/procedures/1/breast_augmentation
PIP Implants: https://baaps.org.uk/patients/safety_in_surgery/breast_implant_safety.aspx