Breast Augmentation

Increase your breast size with mammary prostheses

Do you have small breasts, and feel that they have been a problem throughout your life? If so, now may be the time to address the problem and resolve it once and for all.

There are several important things you will need to consider.

What kind of results do you want?

A natural result is one that resembles real breasts as much as possible. ‘Natural’ breasts will be in perfect proportion to the rest of your body, and will look as if they are the breasts you were born with.

This is the look that the majority of my patients request, and the approach that I have always recommended.

This is a look that cannot really be confused with the appearance of real breasts. With some rare exceptions, it should always be avoided because the excessively large dimensions of the implants, and therefore their extra weight, can lead to sagginess, stretch marks, rippling and other problems, in addition to causing disharmony with the rest of the body. The ‘fake’ look is characterised by an unnatural fullness of the upper pole (the top half of the breast) and an extremely spherical outline. Today, far fewer patients request this type of result.

Choosing your implants

The shape of the prosthesis chosen, together with the shape of a patient’s existing breast, will determine how natural the result will look.

Anatomical (‘teardrop’) implants, for example, are the best option when a patient has extremely small breasts and so requires shape in addition to volume.

On the other hand, round implants are preferable when the existing breasts already have a reasonable volume and it is simply a matter of enhancing this volume.

When choosing the particular implants to be used in a breast augmentation procedure, only those brands that provide the highest quality, guaranteed by the strictest tests, should be considered. Based on the universal principle that nothing is free in this world… if the cost of a prosthesis is very low, then its quality will be, too.

For this reason, I use just three brands: Mentor, Allergan and Nagor.

I only use implants that are made of cohesive silicone gel with a textured surface. These are the latest generation of implants; they adhere to the highest safety standards and are approved by the FDA (Food and Drug Administration) in the US.

For breast augmentation procedures in London, I do not use saline-filled implants, and I have never used PIP implants.

Position of the incision

The submammary fold provides the least invasive – and therefore least traumatic – access for breast augmentation because it enables the incision to pass under the gland tissue rather than cutting through it, as with the areola approach (see below).

A submammary incision not only allows for quicker insertion of the prosthesis and therefore a shorter overall procedure, but the resulting scar also remains well hidden in the natural skin fold of the inframammary crease.

This type of incision is placed along the inferior half-circumference of the areola. Although this was once the most frequently used access point, it is not always possible to utilise it, especially when a patient has areolas with a small diameter (less than 3cm).

An areolar incision has the additional disadvantage of requiring transection – that is, cutting through the gland in order to insert the implant.

Apart from rare circumstances where a surgeon needs to cut through the gland and ‘open it up’ in order to stretch the tissue – as, for instance, in the case of tuberous breasts – it is advisable to avoid damaging the gland, especially in young patients.

The armpit is the least direct and most complex way of inserting implants; it carries disadvantages for both the surgeon and the patient.

The scar can be quite noticeable, particularly as women often wear sleeveless tops.

This technique is also associated with a higher risk of complications, such as post-operative bleeding (haematoma), implant malpositioning and limphedema (fluid build-up) in the breast and arm.

Position of the implant

This is the most frequently used technique in slim patients with small breasts. The implant is inserted partially under the pectoralis major muscle, which will then cover the upper half or two thirds of the implant, thereby reducing the visibility of the implant’s borders in the décolletage area.

The inferior third of the implant remains subglandular in order to achieve optimal roundness and fullness in this area.

The prosthesis is inserted underneath the mammary gland tissue. In this case the pectoralis muscle is not utilised at all and remains as a base on top of which the implant will rest.

This approach is recommended for patients who perform sports activities at a professional level.

The subglandular technique achieves optimal results whenever the thickness of the patient’s soft tissue (gland tissue and subcutaneous) allows adequate coverage of the implants (that is, patients with at least a B cup), and when the selected implants are not too large.

The implant is entirely covered by the pectoralis major muscle. This technique is now used less and less frequently because results tend to appear less natural, with almost no mobility of the implants on the chest and an unnatural flattening of the lower pole of the breast.

The Surgical Procedure

Breast augmentation is carried out under general anaesthesia, whereby the patient is completely asleep and fully unconscious. Usually, intubation is not necessary and a laryngeal mask is sufficient.

Thanks to modern anaesthetic techniques, for this kind of procedure, only small and light doses of drugs are used. Patients are therefore able to wake up rapidly and without severe side effects, such as nausea and stupefaction.

The surgical procedure is carried out as a day case in a private hospital, where the patient will be given a private single room with an en-suite bathroom, TV and WiFi access.

The patient is admitted at 7.30 am, having fasted from midnight. Once the admission process has been completed (height, weight, blood pressure, heart rate, body temperature are recorded by a nurse), the patient then meets with the surgeon in order to confirm the surgical plan and sign the consent forms. The surgeon will also take pre-operative pictures of the patient and carry out the surgical markings on the patient’s chest.

The patient is then taken to the operating theatre, where she will be put under general anaesthetic. The surgical procedure normally takes 60 minutes. After a brief stay in the recovery room, where the patient is closely monitored, she will then be taken back – perfectly awake – to her room on the ward. During the course of the day the patient will be assisted with the most appropriate painkillers, and will have the opportunity to rest comfortably until the time of discharge.

In the late afternoon (normally after 5 pm), once the general conditions of the patient and her ability to stand and move autonomously have been checked, the cannula (a small plastic needle inserted on the back of the hand) is removed.

The patient will now be able to look at her breast results in a mirror, prior to receiving a fitting for the post-surgical bra that she will need to wear day and night for the next week, until the first check-up.

Upon discharge the patient will be given medication for the week (antibiotics, painkillers, muscle relaxants), together with the implant documents, and post-operative instructions in writing. She will also be provided with a private 24-hour emergency telephone number that will enable her to contact the surgeon if necessary.

After Surgery

The first 3 days are those during which the patient experiences most discomfort. The pain threshold varies widely among patients. However, any pain can be managed with the strong painkillers provided upon discharge.

During the first few days the patient might want to rest in bed or on a comfortable sofa. It is best to spend the entire day in a reclining position, with the chest slightly elevated (at a 45 degree angle) with the support of two or three thick pillows.

After 10 days, most patients will go back to work.

It is advisable to avoid full showers or full baths for 2 weeks in order to allow the wounds to heal; sink washing, baby wipes and wet flannels should be used instead.

No driving, housework or lifting is allowed for the first 2 weeks.

Sports activities can be resumed after 2 to 3 months.

The first check-up takes place 7 days after surgery. The dressings will be removed, the wounds checked and cleaned, and new dressings will be applied.

The second check-up takes place 14 days after the surgery. At this stage the dressings are usually replaced with tiny Steri-Strips (wound-closure strips). Patients are now permitted to take quick full showers.

The wounds take approximately 14 days to heal fully, so it is crucial for the area to be kept perfectly dry during this time. The stitches used are dissolvable and therefore do not require trimming.

Patients are then reviewed at 1, 3 and 6 months after the surgery.

As long as a patient carefully follows the post-operative guidance provided by their surgeon, complications are fortunately a very rare event.

Complications that may occur within the first 24 to 72 hours are generally linked to internal bleeding that can lead to a haematoma (a collection of blood in the cavity where the implant is located).

A small haematoma will be reabsorbed spontaneously by the body. A large haematoma will need to be drained in surgery.

Subsequent complications may include implant dislocation or capsular contracture (excessive build-up of scar tissue, caused by an abnormal reaction to one of the implants).

During the surgical consultation, the patient will be informed of all the possible risks and complications linked to the surgery, as well as the possible solutions. The consent forms provided at the end of the consultation – and signed by the patient on the day of the surgery – will also explain these issues in detail.

Post-surgical bras

You will be wearing your post-surgical bra for 2 weeks, day and night.

When selecting the right size, make sure that the bra is extremely comfortable around your chest in order to avoid having the bra-band rub or dig into the incision sites. Go up by at least one back size, so if you are normally 34 inches in back-size, you should go up to a band-size of at least 36.

For implants up to 300cc, I would suggest going up by 2 cup sizes (from A cup to C cup). If your implants are larger than 300cc, go up by 3 cup sizes (from A cup to D cup). If your implants are larger than 400cc, go up by 4 cup sizes (from A cup to DD cup).

Some post-surgical bras do not specify band or cup size. For implants up to 300cc, Small should be adequate. For implants between 300cc and 400cc, Medium and Large should be adequate. For implants larger than 400cc, size Large and Extra Large should be adequate.

There is extreme variability in bra sizes depending on the style and brand you select. Some bras are made of an extremely thin and stretchy fabric, which allows for more space. In these cases, there is no need to go too large. By contrast, some other bras are made of an extremely tight, almost inelastic fabric. In these cases, it’s advisable to go as large as possible.

In addition, as a general rule, I tend to suggest comfortable, loose bras made of stretchy fabric for patients that are having their implants positioned behind the muscle. For patients that are having their implants inserted above the muscle, I would suggest wearing tighter bras made of thicker, stronger fabric. (They should resemble a highly supportive sports-bra.)

Patients that are unsure about their size will often ultimately purchase two different bra sizes. I personally fit the right one on the day of your surgery, as the unused bra can be returned.

Choosing the right post-surgical bra can help to ensure a smooth and comfortable recovery after your surgery. I recommend RECOVA® Post-Surgery, a dedicated company providing the highest quality, specialised post-surgery bras. Their selection can be seen here.