Breast Enlargement with Lift
What does the surgery involve?
A breast mastopexy-augmentation is performed under a general anaesthetic (you will be fully unconscious). Providing all is well, you can expect to go home the same day.
Incisions are necessary to sculpt the breasts into a smaller and perter shape. The incisions are made around the areolar, vertically down from the areola to the breast crease and horizontally in the breast crease under the breast. The implant is inserted through the same incision so there are no additional scars.
The implant is inserted first, followed by removal of the excess skin, and the entire breast is reshaped with the nipples moved to a higher and more youthful position. The implants are placed either in front or behind the muscle, or a combination of the two (dual plane).
The incisions are closed with sutures that are hidden under the skin and dissolve. There will not be any visible sutures, thus keeping scarring to a minimum. The surgery takes approximately 3 hours to complete.
I use a long-acting local anaesthetic block during the surgery, which is used to temporarily stop pain from the nerves that supply the breast. This lasts for 72 hours and should provide pain relief making surgery as comfortable as it can be. Usually only simple analgesia such as Tylenol and ibuprofen are needed in the initial post-operative period.
What types of implants are there?
Breast implants are available in a variety of types, with different shapes and sizes. Some are round and some are more of a teardrop shape. Implants are made of an outer casing of silicone or polyurethane and filled with a silicone gel. For more information please see my guide below on implant selection.
Selection of the correct size and shape of implant will be done with you at your first appointment. Using Crisalix, we can create a 3D image and you can see yourself and compare simulations with what you may look like after surgery. This experience is enhanced by using Virtual Reality goggles. We can then see what different implant sizes and shapes will look like on you. You will then be able to use the sizing kit to confirm this. If you need further clarification you can try different implant sizes yourself at home using the ‘rice test’. It is important that you take your time in deciding what shape and size of implant you would like. We will help guide you with this decision.
How long do breast implants last?
Implants are designed to last for a lifetime and do not necessarily need replacing after a fixed period of time. However, they may still need to be changed at a later date if there is a problem. It is recommended that you have an ultrasound or MRI of your breast implants every 10 years just to confirm that they haven’t ruptured.
I only use implants that carry a lifetime guarantee from the manufacturer. However, should the implants require replacement in the future, this guarantee only covers the cost of the replacement implants but not the cost of surgery.
What are the risks and side effects of surgery?
Having cosmetic surgery can be a very positive experience. Complications are infrequent and usually minor. However no surgery is without risk and you should be aware of any possible problems.
Scars
Scars are hidden in the crease under the breast and tend to settle remarkably well, so that the scars are barely perceptible. However some people heal with thick scars and this can make them more noticeable.
Bruising and swelling
A degree of swelling and bruising is normal, and this may take approximately 3 weeks to settle.
Haematoma
This is a collection of blood in the pocket created by the implant. It does occur in between 1% to 4% of women who undergo a breast augmentation procedure. It tends to occur within 1 to 3 days post-surgery.
Any increase in swelling or pain should be reported immediately for assessment. Should the haematoma be significant, it will have to be washed out in theatre and any bleeding vessel(s) identified and cauterised. This does not normally delay your recovery or change the cosmetic result.
Infection
The risk of infection is inherent with any surgical procedure; this can be either:
- Superficial (does not involve the implant) and should respond to oral antibiotics.
- Deep (involves the implant) and requires temporary removal of the implant.
The deep infection risk is less than 1% but on the rare occasion, when infection occurs, the breast implant may have to be removed to allow the antibiotics to work effectively for the infection to settle. The implant will be replaced once the infection has resolved.
I use a no touch technique during surgery with Keller funnels to introduce the implant and minimise any possible infection risk. You will also be given antibiotics when you are put to sleep and post-operatively to reduce the risk of infection.
Rotation/displacement
Occasionally implants can sit in the wrong position or move position in the post-operative period. This may need a further procedure to return the implants to the correct position.
Numbness, reduced sensation or oversensitivity
This can occur in the nipple or breast. This is usually temporary, but occasionally these changes can remain to some degree.
Implant rippling or wrinkling
This can be more of a problem in very slim patients or those who have very little breast tissue. However, the chances are reduced if the implant is placed behind the chest muscles.
Asymmetry
Each breast is slightly different and will continue to be so following surgery; remember, “they are sisters and not twins”. However, if you have noticeable asymmetry prior to your surgery, then this can be corrected as part of the surgery as discussed with you.
Rupture
The implants I use are all guaranteed for your lifetime. However, as a medical product, they can still fail. If an implant is known to have ruptured then it should be removed. The ruptured implant is contained within the capsule of scar tissue so it will not ‘spill out’ into your breast tissue.
Capsular contracture
Following breast augmentation, the body makes a capsule of scar tissue around the implant. Sometimes this tissue can shrink and contract (capsular contracture). If this happens, it can make the breasts feel abnormally hard and may require further surgery to remove the capsule. Many studies show that the risk of this is approximately 20% after 10 years with standard implants and 1% with polyurethane implants.
DVT/PE
Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. In order to reduce any risks of this we give you special stockings to wear in bed and a blood thinning injection if you are not mobile.
Stretching of your breast tissue
The larger the implant you choose, the more likely it is to stretch your skin with time and this may require an uplift at a later stage.
Fat necrosis
Sometimes areas of fat within the breast scar form hard lumps called fat necrosis. Usually, no specific treatment is required, and the problem settles down over a 12-month period.
What is the estimated time for recovery, absence from work and return to usual activities?
When you get home, you should take things easy for the first week or so. Most people take approximately 2 weeks off from work. You should be able to drive from 2 weeks, return to the gym for lower body work at 4 weeks and begin upper body exercises at 6 weeks.
You must wear your support bra day and night for 6 weeks to help shape and support the breasts as they settle.
