Breast Augmentation

A good and successful breast augmentation relies upon careful planning, a clear understanding of what it will realistically achieve in your particular case, meticulous surgery, a quality implant and appropriate aftercare. Under the care of Mr Macmillan you will be seen twice before surgery to discuss and plan your surgery. You will try sizers in your bra and you will have a 3D simulation showing you the likely outcome of surgery.

Most women requesting a breast augmentation have an image in their mind of what they wish their breasts to look like. Sometimes it is useful to bring to your consultation pictures of the shape and size of breast that you would ideally like to aim for. Much of your initial consultation will be to make sure that your aspirations are understood and are realistic.  The best way of trying to achieve them will then be discussed. To this end, after an initial discussion you will be examined and a variety of different measurements taken. In most cases an implant size and shape can be chosen based upon these measurements and an understanding of your own desires.

As far as implant size (volume) is concerned, most women have a size that is the most suitable one for them. It is possible to put in a slightly bigger implant (this would make you as big as you can safely and realistically be) and it is possible to put in a smaller one. If the ideal size of implant has been assessed in your case and you wish to be a lot bigger than that, I will refer you to another surgeon. You will always find a surgeon who will be prepared to insert oversized implants but such situations are unlikely to result in a happy outcome and will ultimately end with problems. After seeing many women with such problems, I believe they are best avoided.

Choosing the right implant

This involves not just assessing the ideal size (volume) but also the ideal height, shape, consistency, surface texture and projection. There are now many different types and shapes of implants. The particular implant that is most suited to your particular case needs to be found. The differences between certain implants and the reasons why one particular implant is being recommended for you will be discussed and examples shown.

What will I look like?

It is possible to show you the approximate results of using a particular implant in your own case using a photograph and special software. Such 3D simulation of outcome can be very useful for discussing things that you do and don't like. See example of 3D simulation below and examples of outcomes of Breast Augmentation

Do I need a breast lift?

Sometimes performing a breast lift at the same time as a breast augmentation is a good option. This is usually the case if you have a lot of lax skin. See examples of Augmentation Mastopexy

Do I need the implant over or under the muscle?

A discussion will be had about the operation itself, the ideal position of the implant in your case: on top of the muscle or to varying degrees under the muscle. It's fair to say that most women having a breast augmentation need and have a better long-term result with the implant partially under the muscle. However, in certain situations it is safe and better to have the implant on top of the muscle.

Admission and aftercare

You are admitted on the day of surgery. You will be re-examined and the measurements used originally to choose your implant size re-checked. The site of incision will be marked. This is usually at the site of the new fold underneath the breast. The operation takes just over 1 hour. Dissolvable stitches are used and special glue is spread over the wound. This makes you waterproof such that you can shower the next day. Drains are not usually required. A support dressing is used for 24 hrs and after it is removed you will be fitted in a bra. Most women stay one night in hospital, although getting home the same day is possible. You will be advised to wear a support bra day and night for the first 3-4 weeks. In addition you should avoid any strenuous upper body activity (e.g. weights at the gym) for about 6-8 weeks. The scar usually heals as a fine white line. Ways in which you can maximise the chances of your scar healing perfectly will be discussed with you.

Recovery

Breast augmentation is an operation that is not associated with a lot of pain. It is however associated with tenderness that gradually settles over a few weeks. You will need to take mild pain-killers for the first few days. If your implant is placed under the muscle, discomfort and the need for mild painkillers can continue for 2 - 3 weeks. Most women are able to perform normal activities within a few days of this operation. Overall recovery and return to work will depend upon a variety of factors including what type of work you do (e.g. lifting may be unadvisable for a few weeks).

Aftercare

A full aftercare service is provided. Most implants that I use come with a lifetime guarantee. In addition the price you pay includes a post-operative check by the nurse the week after surgery and a final consultation with myself at 3 months (although I am happy to see you anytime if there are any concerns). It also includes the unlikely possibility of any further surgery that was necessary for any reason up to 12 months.

Complications - What can go wrong?

Any operation can be associated with infection and every effort is made to avoid this. You will receive antibiotics when you are asleep in theatre and for 24 hours afterwards. Any operation can be associated with bleeding, anaesthetic problems (nausea in particular), venous thrombosis (although precautions are taken routinely) and allergic reaction to drugs or dressings. Sometimes sensation to the nipple can be affected and very occasionally the nipple or a patch of skin just below the nipple feels temporarily numb after breast augmentation. No two breasts are the same and this is true after breast augmentation - you will not be 100% symmetrical. Some people heal with better scars than others. Scars can sometimes thicken or stretch. Longer term problems after breast augmentation include the following:

Capsule formation

Capsule is the tissue that forms around the implant. It is the result of your body walling off the foreign material. In some cases it can become quite fibrous and contract such that the implant gets squeezed. This can produce tenderness, pain and distort the shape of your breast. It is more common in smokers or if there has been a previous infection. If neither of these factors is present, troublesome capsule is uncommon.

Implant rotation

This is only a problem with shaped implants. Very occasionally (<1% of cases) the implant can rotate, sometimes many months after surgery. It is possible to correct this with further surgery

Visibility

Implants can be more "visible" in some women. This is most often the case in very thin women or women who have lost a lot of weight. However, it will also occur if you have an implant that is too large for you. The effect is such that you can see where the edges of the implant are and see some rippling of the implant when the breast is not supported. It may also be possible to feel the edge of an implant or a crease within the implant.

Infection

This can occur some time after surgery, sometimes years later, although it is rare. There is often a cause such as an infection elsewhere in your body particularly a dental infection.

Rupture

Modern quality implants rarely rupture. That is not to say they are indestructible but rupture is usually a phenomenon of older or cheaper implants. Modern implants are made from silicone gel. Their lifespan is not precisely known but with vigorous testing in a laboratory it is about 12-15 years. In real life we expect implants to last longer than this.

Ageing

Both your body and the implant will age. As you age the breast tissue overlying the implant may thin, in some cases sagging off the implant slightly. The implant in the very long term may no longer be the correct size and shape for your breast and you may need or wish further surgery.

Mammography screening

Although mammograms can be performed after breast augmentation, their sensitivity at detecting breast cancer is affected by implants. Essentially they mask part of the breast.

BIA-ALCL

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a very rare type of blood cell cancer, which has been described in relation to breast implants. The first UK case was reported in 2012 and the most up to date figures indicate an estimated risk of around 1 case of BIA-ALCL for every 25,000 implants sold. 

BIA-ALCL can appear several years after the implant surgery and usually presents with rapid, painless swelling of one breast as a result of fluid collecting around the implant. It is diagnosed by sending off a sample of this fluid to be analysed in a laboratory. BIA-ALCL is very treatable and, if diagnosed early, is most often treated with surgery alone. Surgery involves removing the implant and the capsule surrounding it. Very occasionally treatment also involves a type of chemotherapy.

The reason why breast implants can cause BIA-ALCL is not fully understood and may involve a variety of factors. One of the suggested theories is that it is caused by the way some patients react to the surface texture of implants. Another theory is that it is caused by a low-grade chronic infection around the implant. Research is on-going but is yet to provide a definitive answer. 

In the UK and in Europe in general, the vast majority of implants used are textured. This is because texturing of an implant surface reduces the risk of capsule formation (scar tissue that forms around implants) and in naturally shaped implants it also reduces the risk of implant rotation. Hence textured implants are generally preferred over smooth implants. Preventing infection in breast implant surgery is always of the utmost importance for many reasons and lots of steps are taken to avoid it.

In my practice I have almost always used textured implants and have always chosen those that I believe to be the best that are available. Since being alerted to the risk of BIA-ALCL this rare risk has been included in my discussion about risks of implants and problems that we see with them, of which there are many. However, implants remain extremely safe and the benefits of using them in the right situation massively outweigh the risks.

There is no evidence for and hence no need for anyone with breast implants to have their implants removed or to change their implants because of the recent publicity around BIA-ALCL. However, anyone with breast implants who is aware of breast swelling, particularly one that just affects one side and has appeared quite quickly should see their GP and be referred for an examination and ultrasound scan.