Breast augmentation surgery is one of the most popular procedures performed in cosmetic surgery. It is also certainly one of the most rewarding.
I have a special interest in breast surgery and has lectured on breast surgery both home and abroad on the subject as an invited speaker.
There are many different anatomic features of small breasts that must be addressed prior to breast augmentation. These features include not only the size of the breast, but also the breasts’ asymmetry, the size and distribution of the breast tissue, the tightness of the skin, and the chest wall shape.
I will give very careful consideration to your expectations to put a plan together with you. It will take account of your anatomy as well as your goals in breast augmentation surgery.
There are numerous techniques, types of implants, and types of incisions to consider so that surgery does not only increase the size of your breasts, but also provides a very beautiful and natural shape. Please see my ‘surgery explained” section.
Breast augmentation is not a one-size-fits-all operation. Most patients requesting breast surgery certainly wish to larger but also wish to maintain a natural look. In order to achieve the best possible outcome, a number of factors have to be taken into account. These include, patient goals, patient height, width of chest and breast, amount of existing breast tissue and degree of droop of the breast
In addition to these factors, there are many variations in the implants themselves and in potential positioning of the implants.
Implant Choice: High, Moderate or Low Profile, Round or Teardrop?
High profile implants give a more frontal projection and having a narrower base diameter, they tend to give a fuller figure without making breast augmentation patients look too wide or heavy. They are particularly helpful in patients with a moderate amount of droop to the breast as they give more lift.
For the wide-chested patient, the moderate profile breast implant is still an excellent choice, but because of its shape.
Low profile implants work well in patients wanting a more minimal change.
The choice of round or tear drop implants depends upon many factors or your anatomy including, of course, your personal preference. Please see below technical details for surgery.
Scar Position and Placement Under or Over The Muscle
I place the majority of my breast implants underneath the chest wall muscle. My goal is always to give the most natural breast augmentation results possible, and the more tissue between the outside world and the implant, the more natural the result. With the implant placed beneath the chest wall muscle, there is a gentler slope or transition in the upper pole of the breast.
In some situations, placement under the gland or indeed under the layer over the muscle called the epimysium in preferred. An implant in this position can give the appearance of a little more lift.
While there are several approaches through which breast implants can be placed, the most common are the periareolar (around areola) or the inframammary (under breast) approach. Most shaped implants require an incision beneath the breast as orientation and precision of placement is key. The incision is well hidden underneath the fold of the breast and, as the breast regains some if its laxity when the implants drop and then settle, the incision is extremely hard to find.
The axillary (underarm) implant procedure is now less favoured as scars can be extremely visible.
I will always perform a totally bespoke approach but for general guidance:
In patients with virtually no breast tissue, any size or type of breast implant can generally be used, but there are trade-offs. When there is little starting breast tissue, the larger the volume of implants used, the less natural the ultimate result. Breast tissue acts as camouflage on top of the implants to give a more natural result.
In patients with a relatively broad-based, moderate size breast to begin with, a small amount of droop allows the breast implants to fill out the skin envelope nicely. The existing breast tissue gives good camouflage and a very natural result. In these patients there is less need to impose shape and I will generally use round implants.
Patients with an intermediate amount of drooping of the breast require greatest consideration. In these cases particularly, the volume of the breast implants is important. If these patients go with larger breast implants, they will get more lift and probably not require a tightening procedure. However, this will should always be discussed.
Patients with a large amount of droop will generally require a tightening procedure. If the drooping is not addressed, the implant will make the breast look full but, eventually, the natural breast tissue will drape unaesthetically off the bottom of the breast implants. These patients require formal mastopexy at the time of their breast augmentation surgery.
Once you and I have agreed on the precise details of the surgical plan, they will outline a likely recovery, including time frame for return to normal activities including work, management of young children and exercise. As with all good medical practice, they will also discuss with you potential complications of breast augmentation.
Breast enlargement is performed under general anaesthesia and therefore you won’t be able to eat or drink for six hours before the operation.
You should expect detailed instructions to be provided by the hospital on exactly what you should and should not do before surgery. The procedure usually takes around 1-2 hours and an overnight stay is usual.
On the day of surgery you will be seen by myself and your anaesthetist pre-operatively. We will discuss with you the procedure and reaffirm the surgical plan. Your anaesthetist will speak to you about previous anaesthetics and provide a plan for minimising the discomfort that you will feel after your operation.
After your breast augmentation surgery is complete you will awake gently in the recovery ward and you will be seen by your surgeon and anaesthetist to make sure that you are comfortable post operatively.
You will then return to your ward. Before discharge a plan will be made for you to be reviewed in the outpatient dept usually at a week.
Of course, I don’t want you to put any strain on your new breasts and it is advised that you undertake a graduated return to normal activities, as guided by your surgeon.
As a general rule of thumb, however, following breast augmentation;
▪ You should be able to go home on the day or the day after your surgery
▪ You should be able to return to light work at one to two weeks
▪ You should be able to drive at one week
▪ You should be able to return to light exercise at two weeks but not building up to full exercise until 3 months
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