What should I look for in choosing a surgeon?
Since you want success and peace of mind, always check the surgeon’s qualifications and credentials, such as GMC registration and inclusion in the Specialist Register of Plastic Surgeons. Feel free to ask questions (such as how many procedures does he or she perform per year), and to request to have a look at pre-operative and post-operative pictures of some of their work.
Make sure you feel comfortable with the surgeon and clinic you have chosen.
Make sure your surgeon provides you with a comprehensive and thorough consultation. Anyone considering cosmetic surgery should be fully informed about their planned procedure and accept the risks and limitations of the procedure.
How will you decide which implant is right for me?
A range of sizes can be selected according to the “base width” (that is the diameter) of the patient’s breasts and the “compliance” of the skin envelope (that is, the degree of tightness or looseness of the skin).
The shape of the implant (round or tear drop) and the projection (low, moderate, high profile) can be chosen by the patient, according to her personal preferences.
Teardrop implants tend to avoid excessive fullness on the upper pole of the breasts, but should only be positioned behind the muscle, due to the risk of implant rotation.
High profile implants provide more projection to the breasts and nipples and tend to be more suitable for patients with a narrow frame, while low profile implants are wider and flatter devices, where the volume is spread over a larger surface and tend to be more suitable for wide-framed patients, in order to adequately cover the natural diameter of their breasts.
It is always important to remember that the larger the implants are, the less natural the result will be.
How do you know what size implant I will need to go from where I am to where I want to be?
The best and probably easiest way to anticipate what cup size (bra size) will be achieved following surgery is to try the actual implants in a soft (non padded, non structured) bra.
It might not always be technically possible to achieve the size originally requested by the patient. This can be the case in very slim patients with an extremely narrow chest wall.
This has to be evaluated and clarified during the initial consultation.
Why do some surgeons suggest having the implant behind the muscle whilst others prefer to place it in front?
The decision on whether to insert the implants behind or in front of the muscle should be made according to the soft tissue pinch thickness, that is, depending on how much soft tissue coverage is available to “hide” the implants.
Patients with virtually no breast tissue are suitable candidates for subpectoral augmentation (“behind” the muscle).
Patients that have already got a sufficient amount of breast tissue of their own are suitable for a subglandular augmentation (“in front” of the muscle).
When positioned behind the muscle, the implants will be covered by 2 tissue layers (that is: pectoralis muscle and breast tissue). Therefore this surgical option normally allows to achieve the most natural results.
On the other hand, it is not always advisable to go behind the muscle in the case of patients with a significant amount of breast tissue and in patients with a mild degree of ptosis (that is breast “sagginess”).
How much pain is it normal to expect after a breast enlargement operation and how long will it last?
A subglandular augmentation normally involves minimal postoperative pain; patients might experience a variable degree of discomfort for the first few days.
Recovery after a subpectoral augmentation is definitely less comfortable and patients can experience a variable degree of pain during the first week.
Painkillers are always provided to patients and are normally extremely effective.
Will I have scarring and how bad will it be?
Implants can be inserted through a small incision positioned in the submammary crease (that is, the natural fold just below the breasts). The length of the scar varies from 4 to 5 cm, depending on the size of the selected implants.
Implants can also be inserted through an incision positioned on the lower margin of the areola (that is, the brown skin around the nipple), or through an incision hidden in the armpit.
Surgical scars are permanent, but after 18 months they tend to fade and normally look like very fine, white-silvery lines.
Will I lose any feeling in my breasts?
The sensitivity of the nipples will most likely be affected by the procedure. Some patients experience reduced sensitivity or numbness in the nipple area. Some others will experience increased sensitivity. In most cases this alteration in only temporary, and sensitivity will fully recover within 12 months; in some other patients (approximately 10%) the alteration is permanent.
What happens if I don’t like the results?
If a patient is not completely satisfied with the result, revision (corrective) surgery is almost always possible.
What’s the best support bra to get and how long do I have to wear it for?
Ideally, a “post-surgical bra”, that is a soft, non-padded, non-structured, non-underwired bra in a cotton wool fabric. It is advisable to wear this type of bra for 4 weeks (day and night).
How long after the operation will the swelling go down and when will I see the final results?
Swelling normally subsides within the first 6 weeks, and this is when the breasts’ size can be finally assessed.
Following a subpectoral augmentation though, it might take longer to see the final result, as the implants will take longer to settle in the surgical pocket and to drop in a more natural position.
How long after the operation should I expect to see my surgeon again?
The patient will need a first wound check 7 days after surgery. This will be carried out by either the surgeon or a cosmetic nurse.
The patient will also see the surgeon for her follow up appointments (3 weeks, 3 months, 6 months and 12 months after surgery).
What happens if something goes wrong after the operation?
In the unlikely event of complications (such as infection, post-operative bleeding, etc), the patient needs to get in touch immediately with the hospital or directly with the surgeon.
The management of all the possible post-operative complications is included in the initial cost of the procedure.
How long will my implants last for?
It is normally advisable to have the implants replaced every 10 to 15 years.
How long after can I resume normal activities? What about exercise?
The recovery time is approximately 2 weeks for a sub glandular augmentation and 2 to 4 weeks for a subpectoral augmentation.
Patients can start exercising 6 weeks after surgery when implants are inserted above the muscle.
When implants are positioned behind the muscle, it is preferable to avoid physical exercise for 3 months.
Can having breast augmentation affect my ability to breastfeed in the future?
Is breastfeeding safe for women who have breast implants?
The breastfeeding ability is normally unaffected by the procedure and it is definitely safe to breastfeed for women that have undergone breast enhancement.
Are there any other adverse, long-term effects of having breast implants?
The main long-term potential risk associated with breast implants is “encapsulation” (or capsular contracture), that is the hardening of one or (rarely) both implants.
Implants are foreign bodies and therefore the body will want to isolate them by building a thin layer of scar tissue all around the implants.
In some cases (approx 6%), the scar tissue becomes very thick and tight and can end up constricting the implants, causing their hardening.
In the event of severe encapsulation, revision surgery might be required in order to fully remove or release the scar tissue (so-called capsulectomy or capsulotomy).
Another potential adverse effect is ptosis, that is breast “sagginess”.
Implants are not secured against the patient’s chest wall; therefore they can stretch the tissues and drop in the course of time, especially in patients with very soft skin. This is another very good reason to avoid choosing large (heavy) implants.
Is there a good way for me to measure different sizes, and “try them out” when I am at home?
A rice-test can be performed at home.
The test involves filling the desired cup size bra (unpadded bra) with rice bags and then measuring the volume of rice used in a measuring cup. This will give a rough estimate of the implant size required in order to achieve the desired bra size.
What should I be paying for a breast enlargement procedure?
The cost of a breast enlargement procedure should normally be in the region of £ 5000 (prices may vary according to whether the procedure is planned as a “day case” or with an overnight stay in the hospital).
Are there any special instructions I should follow before and/or immediately after the surgery?
It is imperative to avoid “blood thinners” prior to surgery.
Medications such as pain-killers and anti-inflammatories (Aspirin, Nurofen, Ibuprofen, Volatarol, Diclofenac etc.) should be strictly avoided for a month before the surgery. For the same reason, vitamin supplements containing vitamin E, green tea and St John Wart should be avoided for a month leading to the surgery date.
Smokers should cut-down as much as possible the number of cigarettes per day and should stop smoking completely 2 months prior to the surgery.
After the surgery, it is important to be at rest for 2 weeks. This means that patients need to strictly avoid driving, lifting and any form of housework for at least 2 weeks.
Most patients will need 2 weeks off- work (the exact time required off-work is also determined by the type of job, that is, whether it is office-based or more physically demanding).
It is important to sleep on the back (ideally in an elevated position) and avoid rolling on the side. A maternity (V – shape) pillow may be helpful.
Patients should rigorously follow the post-operative instructions given in writing by their surgeon regarding medications (antibiotics, pain-killers and muscle-relaxants).
Ice- packs can be applied on the chest area during the first couple of days in order to help with both – discomfort and swelling.
With all good wishes for your beautiful looks and joy of life.
For more information do not hesitate to contact Dr Linda Fiumara, London plastic surgeon, an expert in breast augmentation.