Frequently asked questions about breast augmentation surgery

What can be done in breast enlargement surgery? Are implants safe? PIP implants
How do I prepare for breast augmentation surgery?
What does breast enlargement surgery involve?
How quickly will I recover after breast augmentation surgery?
Is breast enlargement surgery safe?
How do I arrange a consultation with Mr Hamilton in London regarding breast augmentation?

What can be done in breast enlargement surgery?

 

Breast implants can be used to increase the volume of the breast, usually giving more fullness and an improvement in overall shape.The procedure is technically called breast augmentation though in the popular press it's often referred to as a "boob job" or "breast enlargement" . Whilst not the answer in every case, many women can achieve a breast shape and volume more in keeping with their desired body proportions.

Are breast implants safe?

Breast implants have been used for over 30 years and have a very good safety record. Serious concerns were raised about 10 years ago regarding the use of silicone breast implants. Fortunately, several very large studies involving many women with and without breast implants have led to the conclusion that these fears were unfounded. There has been considerable coverage of PIP implants recently and the situation continues to develop.

I'm worried about PIP implants...

There has been much coverage of the disgraceful story of PIP implants which has understandably caused considerable distress and worry both to those women with PIP implants and also to those with other types. Mr Hamilton is firstly keen to reassure his patients that he has NEVER used PIP implants in his practice. The best option for worried patients is to contact their original treating surgeon. If this is not possible, then Mr Hamilton would be happy to see patients concerned regarding PIP implants for assesment and advice.

Click here to go to MHRA / Department of Health website info on silicone breast implants

What types of breast implants are available?

Several manufacturers now produced implants in varying size, shape and cost. Mr Hamilton generally prefers to use high-quality silicone-filled rather than saline-filed implants as they tend to give a more natural feel. Both traditional round and newer “anatomical” or teardrop shaped implants can be useful depending on the individual patient.

What size breast implant should I have?

At your consultation, Mr Hamilton will seek to get a clear idea of your desired final size and will help guide you towards a sensible implant choice. For many ladies, the shape and contour of the breast will guide the choice of implant. Most patients wish to avoid an obvious breast implant appearance and Mr Hamilton is well known for his skill in attaining as natural an appearance as possible.Mr Hamilton will be able to guide you in breast implant selection, taking into account your aesthetic aims and will use some sample breast implants at your consultation to get an idea of the change achieved.

Will there be scars?

Yes. A variety of surgical approaches are possible and the exact details of any scars will be discussed with you at consultation. For most patients, a small scar near the crease under the breast is a good route, allowing accurate placement of the implant and control of any bleeding during surgery. For some patients, the incision may be made around the edge of the areola (the pigmented area outside the nipple) or in the armpit. Fortunately, in the vast majority of patients these scars fade well over the months following surgery.

Where is the implant placed?

Implants are usually placed in one of two positions: either under the breast over the pectoral muscle (“subglandular”) or under the pectoral muscle over the ribs (“submuscular”). For some patients, particularly those with a reasonable volume of breast tissue before surgery, a subglandular approach may be best. In very slim ladies, a submuscular approach may be better, allowing a more natural contour to the edge of the implant. Mr Hamilton also employs the newer “dual-plane” approach which may be more suitable in some cases. The merits of each approach will be discussed in detail at your consultation.

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Before surgery

 

How do I prepare for breast augmentation surgery?

Where possible, it is important to avoid aspirin or non-steroidal anti-inflammatory drugs such as ibuprofen (Brufen) and diclofenac (Voltarol) for two weeks pre-operatively. These drugs reduce the ability of the blood to clot and can make bleeding more of a problem during and after surgery.

Smoking can increase the likelihood of wound problems and abstaining from smoking for at least 2 weeks preoperatively and postoperatively is a sensible precaution.

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What does breast augmentation surgery involve?

 

What happens when I come into hospital?

You will be admitted to hospital on the day of surgery and Mr Hamilton will come to re-discuss the procedure and to make some marks on your skin. You will be seen by our consultant anaesthetist who will discuss the anaesthetic with you and answer any questions you might have.

How long does the operation take?

Typically, the surgery takes about 1½ hours.

What does the breast enlargement operation entail?

With you asleep under general anaesthetic, local anaesthetic is placed in the area to be treated to reduce any postoperative discomfort. Mr Hamilton will then carefully create the “pocket” precisely tailored to the new breast implant. Any minor bleeding is controlled before the new breast implants are placed in position. Final adjustments to the shape are then made. Occasionally a small drain connected to a suction bottle is placed in the wound to remove any fluid which might collect and reduce bruising. Very often, however, Mr. Hamilton does not find surgical drains to be necessary, allowing for a more comfortable recovery period. A supportive dressing is placed over the breasts and our consultant anaesthetist will then gently wake you before you are returned to your room on the ward.

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Recovery after breast augmentation surgery

 

What happens after the operation?

Usually, after a relaxed night in hospital, you will be able to go home the following day. If drains are used, they will be removed the morning after surgery in the ward prior to discharge. Occasionally patients wish to stay another night but the majority prefer to go home the morning after surgery. We usually recommend that you use a sports bra after surgery to give extra support and comfort. Our nursing staff will help you into your sports bra before you go home. Sports bras are usually used for 4-6 weeks.

Mr. Hamilton will usually see you back in the consultation room 7-10 days after surgery to check that all is well and to reduce the dressing. Usually, only dissolving sutures are used, though some of these may need trimming when you come back to the clinic. Typically, you will be seen again a week thereafter at which stage dressings usually be dispensed with. A further follow up visit is planned around 3 months after surgery.

Is it painful?

Some discomfort is inevitable, and is a little more pronounced in patients who have implants placed below the muscle. Fortunately, this discomfort this is usually well controlled with the painkillers provided by our experienced consultant anaesthetist. On discharge home, patients are generally comfortable using mild painkillers such as paracetamol and codeine. Most patients find they are able to resume normal activities over a 1-2 week period.

How quickly will I recover?

If all goes to plan, normal activities can be resumed by about 2 weeks and most patients are back at work by 2-3 weeks. Vigorous sporting activities and gym work are probably best left until 4-6 weeks after surgery.

Can I breastfeed after breast enlargement?

Breast implants do not seem to significantly likelihood of successful breastfeeding. Silicone is not found in large amounts in the breast milk and, in fact, bottle-fed babies probably receive more silicone from the teat on the bottle used.

Can I have a mammogram after I’ve had breast implants?

Yes. It is true to say that breast implants can make taking mammograms more difficult and it is important to tell the radiographer that you have implants so that special positions and views can be used to maximise the efficacy of the mammogram.

How long will my breast implants last?

Modern implants are very much more reliable than those used in years gone by. The manufacturers suggest that implants will last more than ten years on average and it is probably true that high quality modern implants may have an even longer lifespan. The implants will, however, almost certainly need to be replaced or removed at some point in the future.

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Safety and potential risks in breast augmentation surgery

The great majority of patients undergoing breast augmentation in the hands of an experienced surgeon achieve good results with a rapid recovery. However, in a small proportion some complications are a possibility, including the following:

• Unfavourable scars – In some patients, especially those of Afro-Caribbean origin, scars can be thicker than expected or become raised. In the vast majority of cases, these settle spontaneously but occasionally other measures to improve the scar may be necessary. Most patients find that the scars settle well though all individuals are different and in some cases, scars can take many months to settle. Mr Hamilton will advise you on massage techniques to help speed up the rate at which the scars mature. Scars, of course, never disappear and some form of scar will always be present.

• Infection – fortunately, infection is rare in this type of surgery and the risk is minimised by careful surgical technique and the use of a dose of antibiotic before surgery commences. You will receive a course of antibiotics to take home to further reduce the risk. Where infection affects the implant (perhaps 1% of cases)  it may be necessary to remove the implant to allow the infection to clear.

• Nipple sensation – Most ladies find that there is some change in nipple and breast sensation after breast augmentation. A minority of patients find sensation is reduced though this tends to improve with time.

• Asymmetry – Most women have a degree of asymmetry between the breasts prior to surgery. Breast augmentation may tend to emphasise differences between the breasts and some minor differences are always likely to be present.

• Capsular Contracture – The body naturally makes a scar around any implanted material and silicone implants are no different. For the vast majority of women this scar is soft and cannot be felt. In a small proportion a thicker scar develops and some of these women may require further treatment or even removal of the implant.

• Leakage of silicone – Older implants contained very runny, liquid silicone which could leak out of the implant shell if it developed a small hole or crack, though it would usually be retained within the scar mentioned above. Modern implants often contain firm (“cohesive”) silicone gel, similar to a set jelly, which has a lower likelihood of leaking from its original position

• Haematoma – Rarely, small blood vessels in the wound may bleed after the surgery leading to a collection of blood under the wound (a haematoma) which needs to be released and washed out before resuturing the wound. If this problem arises, it is typically on the day of surgery and does not affect the final result.

• Any surgery carried out under general anaesthetic carries a small risk of postoperative chest infection (particularly in smokers) and of thrombosis of the veins of the legs (DVT or deep venous thrombosis) and the concomitant risk of clot moving to the lung (embolism). Patients wear protective stockings during and after surgery to help minimise the risk of DVT and embolism. Early mobilisation after surgery is an excellent way of reducing the risk we also use a compressive massaging device on the calf muscles in theatre to further reduce the small risk of this complication.

Summary

Breast augmentation surgery can be very effective in increasing breast volume and enhancing breast shape.  Mr Hamilton will be happy to discuss the surgical options available at your consultation. To arrange a consultation on breast augmentation surgery in London (UK), please see our contactus page or use the local rate telephone number at the top of the page.

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