Why Choose To Have A Breast Enlargement?
This popular and very successful procedure is obviously for patients wishing to increase the size and fullness of the breast and/or remove some minor drooping. Patients tend to be those that have either always had small breasts or those that have lost breast volume following children. For a small group of patients with very different sized breasts then you may wish to have surgery on one side only. Stephen McCulley has performed this operation for over 15 years and has a special interest in this procedure offering all types of implants and latest operative techniques.
Procedure In Brief
The procedure involves the placement of an implant under the breast tissue. This can be placed directly below the breast (sub glandular placement) or under the chest wall muscle (sub-muscular placement). Access to place the implant can be through the arm pit (trans-axillary approach), nipple (trans-aereolar approach) or most commonly under the breast at the crease (infra-mammary approach). The advantages of these different options are discussed below.
Under The Muscle Or Under The Breast?
Stephen McCulley will help judge which is best for the patient. Under the muscle is usually for patients who are very thin or specifically request this type of procedure.
Under the Breast
Implants placed directly under the breast fills any laxity slightly better. It can therefore give a slightly better ‘lift’. It is less painful to have done and frequently removes the need for a drain.
Under the Muscle
Placing the implant under the muscle gives more ‘padding’ over the implant and therefore can reduce the chances of feeling or seeing the implant edge. This is often preferable in very thin patients where the ribs are easily noticeable. Under the muscle also has a slightly lower capsule formation. It does require the partial division of the muscle, which is uncomfortable, and increases the risk of bleeding slightly. However, the cut in the muscle prevents it from flattening or moving the implant when it contracts.
The armpit incision avoids a scar on the breast. However, it does leave a scar in the armpit, which can be visible in some patients, and it is only good for sub-muscular placement.
Under the breast crease (infra-mammary approach) is mose frequently performed and can be used for all operations. The scar heals well and can be hidden in the crease.
The nipple approach is useful if the nipple is larger and the breast is small. Some concerns remain regarding higher infection risks for this type of approach, but if you wish to have this option the risk of infection can be discussed during your consultation.
Fat Injection Techniques
This method involves using patients own fat to increase fullness or volume in the breast or face, for both cosmetic and reconstructive purposes.
The fat is removed by Liposuction from the thigh or abdomen, specially prepared and re-injected into the area using small needles. This procedure is used for both breast augmentation and breast asymmetry (differing breast sizes). It is also a well established technique in treating defects or indentations following breast cancer removal.
The great advantage of the technique is the ability to permanently enhance these areas with the patients own fat. The disadvantage is the unpredictable survival of the fat. Usually about 50% of the injected fat survives and the treatment may need repeating. There are virtually no scars and depending upon the area to be treated it is performed as a day-case under local or general anaesthetic. Click here to read more about Fat Injection techniques.
The scars will depend on the technique used (as above). They tend to be quite pink in the first 6 weeks moving to purple over the next 3 months and then fade to white. Most patients will form very good quality scars over time. Some reach this quickly, others take longer or may form raised or stretched scars. How other wounds have healed in the past may be an indication.
A full medical history will be obtained before any surgery. As a precaution, do not take any over the counter medicines or herbal remedies prior to surgery or for 3 days following. Also avoid aspirin, ibuprofen and Voltarol based tablets. It would be useful to bring a list of any prescribed medications to your pre-op assessment.
If you are a smoker, try and stop for a minimum of six weeks before and five days after surgery as it can reduce the chances of complications.
Breast Screening, Self-Examination & Breast Cancer
There is no direct link between silicone implants and an increased risk of breast cancer. In fact, the incidence of breast cancer in patients with implants is marginally lower. If you are considering having implants and have a family history of breast cancer, we would recommend mentioning this in your consultation and having a breast screening before proceeding.
Implants will make mammography and self-examination more difficult as the implant appears solid. This can usually be overcome by taking more views during a mamogram, and in some patients it will help by pushing the breast tissue forward.
There is no one ideal implant for all patients. The main differences between implants lies in the shape and projection (pertness) of the implant, as well as the size. Silicone implants are available in round shape or tear drop shaped (anatomical) implants. The best type of implant to suit your body shape and needs will be discussed during your consultation with Stephen McCulley.
The anatomical implants have slightly less volume in the upper part of the implant which can avoid some fullness in the upper aspect of the breast. Hence they may give a more natural look in patients with very small or ‘empty’ breasts where the implant will decide most of the breast shape. They are available in many differing proportions (some taller than they are wide and visa-versa).
Round implants give excellent results in many patients, especially if they are starting with a B-cup breast or larger. Many of our patients request a fuller rounder breast shape which is obtained by round implants.
Implants also come in different profiles; low, medium and high. The higher the profile the more pertness it creates in the breast. The best type of profile to suit your body shape and needs will be discussed during your consultation with Stephen McCulley.
Stephen McCulley has never used PIP implants - he uses two of the best brands on the market, Natrelle and Mentor.
All breast implants are made of a silicone shell, which can be filled with either silicone (usually used) or saline. The silicone implants feel better than saline. This difference is less noticeable if the implant is placed under the muscle. The silicone within implants used to be quite runny, but now most implants contain a thick gel (similar to a jelly baby), and is called cohesive gel. The cohesive gel implants vary in firmness, and have been designed to help maintain implant shape and theoretically to prevent gel movement if the implant shell breaks. All anatomical implants are cohesive gel. It must be stressed that there is no evidence this makes a difference to apparent ‘safety’.
What Size Implants Should I Have?
This is partly a matter of patient preference but also a matter of what is ideal for your body size and shape. In order to gauge what size you're looking for you could try the 'freezer bag technique’ (it is not essential to do this prior to you consultation with Stephen McCulley).
Freezer Bag Technique
Fill sealable freezer bags with varying volumes (mls) of water or uncooked rice while ensuring all air is removed from the bag. Try differing volumes with 25-50 ml differences. Then place these into a new bra of your preferred size. Try on different clothes to get an impression of your new shape. As an approximate guide, if you are an A cup breast a 300ml implant will take you to a C/D cup. However, the implants come in volume (mls) sizes not cup sizes, ranging from 80-800mls. The most commonly used range is from 200-400 mls. A more formal assessment can be done at consultation with silicone implants but this is not always required.
Is Silicone Safe?
Yes. Silicone is the most used of all medical substances and has been used for over 40 years. Large studies have shown no increased association with breast cancer, arthritis, autoimmune diseases or fatigue syndromes. Based on this evidence, Stephen McCulley is confident to use silicone implants on his patients. However, he is also happy to use saline filled implants if patients are uncomfortable using silicone.
Are There Problems Associated With Implants?
Yes. Although not in themselves dangerous, there are potential problems associated with implants and these are outlined below.
Implants Becoming 'Firm'
For the majority of patients the scar or capsule formation around an implant is thin and soft, and the implant is therefore held nicely in place. However, in a small number of patients this scar becomes thick resulting in the implants 'going firm'. It can also result in distortion of the breast and discomfort. Treatment is by removal of the scar and replacement of the implant (often in a slightly different position). This can solve the problem for about 50% of those affected. This problem is now quite rare in the early years but may affect 10% patients over the first decade.
Infection is very rare, especially in cosmetic augmentation, but can result in the need for temporary removal of the implant until the infection is fully cleared.
How Long Do Implants Last?
There is no clear amount of time, but on average implants can last between 10-40 years. Stephen McCulley advises all patients, especially younger patients, that they may well need to replace their implants at some point in life.
There is evidence to suggest that the implant shell weakens over the first two decades. This can lead to implant rupture and although not dangerous, can cause problems if the silicone leaks beyond the capsule or scar tissue surrounding the implant. These problems can include lumps in the breast or lymph glands. If an implant changes in shape or texture then they can be imaged with an ultrasound or MRI scan, in which 95% of ruptures are detected.
If a rupture is found then it should be removed. When held within the capsule or scar (known as an Intra-Capsular rupture) there is no rush to have the implant removed and can be left for a number of months. Indeed, a number of patients may have a rupture of this kind for many years without knowledge or problems. However, if there is evidence of rupture beyond the capsule (Extra-Capsular rupture) then the implant should be ideally replaced within a few months.
If you have any questions about the implants or regarding them rupturing please do discuss this with Stephen during your consultation. Useful information can also be found at the Department of Health website www.silicone-review.gov.uk
Recovering from Breast Enlargement (Augmentation)
Length Of Surgery
The operation takes 1.00-1.30 hours depending on the type of technique used to insert the implants.
Nights In Hospital
Usually one night.
You will wake up with either simple dressings or more commonly skin glue on the wounds, and there might also be strapping on the breasts. Dressings will be reduced either on the day of discharge or a few days later. The wounds will then be checked again at 7-10 days.
The glue dressings are water-resistant so you can shower after surgery. However, we suggest avoiding vigorous washing over the wounds for the first five days. After this time you can be less cautious.
Drains may or may not be required. They are usually used for implants that are placed under the muscle, and are kept in for 24-48 hours.
You should bring a soft (non underwired) sports bra in the planned new cup size into hospital with you. The bra should feel comfortable, whilst still providing support. You will need to have two bras at home that can be worn on rotation. The chest measurement does not usually change but can reduce by 1-2 inches. You will be able to wear an underwired bra after 8 weeks; this should be properly fitted to your new shape and size.
Time Off Work
People vary in recovery; younger patients tend to experience more discomfort with this type of surgery, but patients should allow at least 2 weeks of recovery (full anaesthetic can take longer to recover from). Patients with highly active physical jobs may require longer
Time To Exercise
Patients usually feel able to walk a distance at 5-7 days, swim by 10-14 days (if fully healed). Strenuous exercise (aerobics etc) should be avoided for 6 weeks.
Day 1-4 You should be taking it very easy! You should not be looking after very young children or doing housework without help.
Day 5-14 You can start doing more exercise including walking for longer, shopping etc. You will have very little pain by the end of this period. If all wounds are appear fine at day 10 you are unlikely to 'damage' anything by increasing your activity. Build up activity as you feel fit.
Week 3-6 You should be back to work and doing anything you wish by 6 weeks.
Although you may feel able to drive by 7-10 days, you need to be completely free of pain and restriction, being able to confidently perform an emergency stop without hindrance or pain. This is to ensure you will be covered by your insurance and may be in your second to third week.
Recovery and final outcome
You should expect some bruising and some swelling in the breast. This will last for 2-3 weeks. Your breasts will be slightly firmer and higher than the expected end result. You will have a good shape immediately but it will soften and become more natural by 4-6 weeks, continuing to improve over 6 months.
We will check your wound at day 7. If you require any further follow-up this will be done by the Cosmetic Nurse or Stephen McCulley. You will then have an appointment with Stephen McCulley at 3 months. You will not be charged for any follow up appointment relating to your surgery.
Potential Complications With Breast Enlargement (Augmentation)
This is a routine operation that is a great success for the vast majority of patients. However, as with any procedure, it is very important you understand what can go wrong as well as right. The potential complications are listed below.
- Loss or altered nipple sensation: It is common to initially have a loss of sensation following surgery, but it returns for the vast majority of patients. It is also common for it to affect only one side of the breast. Less than 5% of patients will experience a permanent loss of sensation.
- Remaining asymmetry: Most women have different sized breasts and it is likely that surgery will improve any asymmetry. However, it is possible for one breast or nipple to be marginally different to the other side after surgery.
- Scars: The quality of scars vary between patients.
- Wound breakdown: Although possible it is very uncommon.
- Bleeding: A blood clot can collect in the breast, which would result in going back to theatre for its removal. However, if a blood clot is to form it will be within the first 24 hours post surgery. Blood clotting results in approximately 2% of patients.
- Breast feeding: About 80% of women are still able to breast feed after breast augmentation.
- Infection: Very uncommon but if an infection does occur it can be serious and sometimes results in removal of the implants.
- General operation risks: Chest infections, Blood clots in the leg or lung (DVT or PE). Although rare it is important to avoid these by not smoking, being excessively overweight and moving about after surgery as soon as possible.
- For implant related problems and capsule formation (hardening of the implant) please see 'Silicone Implants' section.
If you experience any side-effects that you are concerned about please don't hesitate to contact us.
What does Breast Enlargement (Augmentation) cost?
Breast augmentation including premium round or shaped implants £3,325 - £4,695
What Is Included In The Cost?
The prices listed are all inclusive and cover:
- The pre-operative assessment and investigations
- The operation
- 10 year guarantee on implants
- Hospital stay and any treatment required
- All follow up (nursing and with Stephen McCulley) relating to your surgery
- Any emergency problems or re-admissions relating to your surgery within the first year