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BREAST SURGERY FAQs
Who is a good candidate? Breast augmentation can enhance the appearance and self-confidence. The improvement of the size of the breasts and improvement in body contour is ideal for patients who for personal reasons feel that their breasts are too small, as well as woman who have lost volume due to pregnancies or to balance different sized breasts.
It is however important to realise that even though most patients experience a positive change in their lives, that a breast augmentation will not perfect your life or cause people to treat you differently. Therefore if you have realistic expectations to improve the size and shape of your breasts, then you are a good candidate.
How will I be assessed by my surgeon for the suitability of my breasts for a successful breast augmentation?
Dr Wilkinson will do a physical examination, take measurements and if necessary photographs to assess your breasts for surgery. She will take into account the size and shape of your breasts, skin quality, nipple and areola placement and general medical history, including information about any medical conditions, drug allergies, medical treatments, current medication and previous surgeries. In addition she will need to be told of your plans (if applicable) to lose a significant amount of weight in the future. Many women find their breasts sag / shrink with weight loss. In this instance she may recommend that you schedule surgery for once your target weight has been achieved.
Using breast sizers we will make a decision on the correct size and shape implant for your body. Depending on your breasts and skin tone, she may also recommend a breast lift. Be sure to discuss your expectations frankly with her.
What types of implants can I choose from? The choices range from silicone to saline and from rough to smooth textures? When deciding take into account your body type. Dr Wilkinson has experience in inserting all the type of implants . Any family history of breast cancer should also be kept in mind.
Is the implant placed under or above the muscle? My aim in most patients is to give them the most natural result. Small-breasted women who are very thin are usually advised to have the implant inserted under the muscle to cover the implant. In my view, the advantage of a prepectoral implant(ie in front of the muscle) is to give the breast tissue a mild lift and is therefore the procedure of choice in patients with more sagging breasts...Medical evidence does however show that by putting the implants behind the muscle, the potential for development of capsule contracture is reduced. It is also easier to perform a breast examination and mammogram in patients with implants placed behind the muscle. The disadvantage of lifting the chest wall muscle however is a longer recovery period. It is therefore of extreme importance that you discuss these pros and cons with Dr. Wilkinson before the procedure.
Where, and how big, will the scar be? The main sites for scars are in the armpit, under the areola or in the crease under the breast. Scars will vary depending on the severity of the natural droop and if any breast tissue needs to be removed Scars improve over the course of the two years following surgery.
What happens to the nipple? It is usually not necessary that the nipple be transposed higher on the breast, however in patients where there is sagging of the nipple, a simultaneous breast lift ensures a natural look while the sensation and functions of the nipple are maintained
What can I do to prepare myself for surgery? Dr. Wilkinson will advise you to stop smoking if you are a smoker. You will also be advised to avoid certain medications which can increase bleeding prior to surgery. It is possible that she may recommend that you undergo a mammogram before the procedure is booked, especially in cases where there are risk factors for breast cancer such as a family history. Clinic staff will provide you with any additional pre-op instructions specifically for your case. Enjoying a healthy eating and exercise regime before and after surgery will result in optimum results! (SEE GENERAL NOTES PREPARING FOR YOUR SURGERY)
How is the surgery performed? Your surgery will be performed at the Renaissance Surgical Clinic. Most patients are admitted as day cases. Occasionally, the surgery may be done as an inpatient, in which case you can plan on staying for a day or two.
Breast augmentation is performed under a conscious sedation, which will make you feel drowsy and relaxed, however you'll sleep through the entire operation and not be aware of the procedure. The advantage is that you will wake up feeling refreshed without the side effects of general anaesthesia. Occasionally I may use a general anaesthesia, In all cases a certified anaesthetist will be responsible for your wellbeing
An Augmentation takes between and hour an hour-and-a-half to two hours.
The surgical procedure (ie incision and implant placement) will depend on your anatomy and your preoperative discussion with Dr. Wilkinson. She creates a pocket by lifting the breast tissue, either in front or behind the chest wall muscle (pectoral muscle), and inserts the desired implant. The incisions are closed with sutures and reinforced with tape and a gauze dressing to help with healing. Drainage tubes may be used for several days following surgery.
How Much Will It Hurt? Be prepared for between 2 and 3 days of acute pain following augmentation. Most of your pain will be controlled by prescribed pain medication For two weeks following surgery you may not drive or lift your arms above waist height. Some women report pain in the breast for some months, but by the end of a year this should have decreased.
What can I expect following surgery?
While you will be encouraged to get out of bed for short periods of time on the day after surgery, straining, bending and lifting must be avoided for several days as this could result in bleeding or swelling. Sleeping on your back will help to keep pressure off your breasts. If you have drains they will be removed within a few days and your dressings will be checked and changed or removed. It is advisable to wear a support bra for a few weeks post surgery until all swelling and bruising has subsided. Expect stitches to be removed on day 10. Temporary loss of sensation is common and can take up to a year to recover. In addition do not be alarmed if your breasts take some time to assume a natural shape and for scarring to fade - once again a complete recovery can take anywhere up to 12 months. If you are at all concerned about anything during the post-op period, always contact Dr Wilkinson for advice and reassurance. She will be able to ascertain if there are complications.
When can I expect to resume normal activities?
In most cases it is possible for patients to resume work within a week of a breast augmentation surgery unless the nature of the work is excessively strenuous. You may also resume exercise, starting slowly, within a few weeks. It is normal to experience mild discomfort periodically but severe pain must be reported immediately. Sexual activity may be resumed after around 2 weeks but you will be advised to handle the breasts gently for the following weeks. If you have any concerns or questions regarding specific activities and time frames, check with the practice staff.
How long can I expect the results to last? Implants look good for up to 15 years, but as the body ages the results are less pleasing. The results of breast surgery are permanent.
What are the risks? Breast augmentation is today an extremely routine procedure but it is still important to be aware of risks associated with surgery and specifically those associated with implants?
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.
As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.
A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.
Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients. There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.
Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the body will harmlessly absorb the salt water.
If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.
A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as "connective-tissue disorders," but the FDA has requested further study.
While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology centre where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.
While the majority of women do not experience these complications, you should discuss each of them with Dr Wilkinson to make sure you understand the risks and consequences of breast augmentation.
FOR MORE INFORMATION REGARDING YOUR PROCEDURE
www.plastic surgery.org
www.emedicine.com
www.cosmeticsurgeryexplained.co.uk
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