Breast Augmentation

I advise patients on whether breast augmentation would be appropriate, the lifetime implications of the surgery, and on the optimal operation and implant choice.

News as of 18 December 2018:

"The CE certificate for textured breast implants and tissue expanders manufactured by Allergan (Microcell ® and Biocell ®) expired on 16 December 2018.The MHRA has advised that Allergan has stopped selling these implants and expanders, and intends to withdraw all remaining supply in European markets. Smooth implants and expanders manufactured by Allergan still have a CE mark. The MHRA advises that patients who have already Allergan breast implants or expanders do not need to have them removed or replaced."

https://www.gov.uk/government/news/mhra-statement-on-allergan

I suggest that patients considering breast augmention, wanting anatomical implants, should at this time chose Mentor implants.

Planning breast augmentation surgery

I take a series of measurements from the patient, and match these to the specific dimensions of different implants. This enables me to accurately choose the right implant and the right technique to get a consistent result for each individual patient.
I use external-sizers in the preoperative consultation to allow prospective patients get a clear understanding of the effect of implants of differing volume. I do not hurry this initial consultation and encourage patients to return for a second visit (at no charge) if there are unanswered questions. Prospective patients can review the before and after images of women who have previously had this operation.

The operation

I use the dual-plane technique. At the end of surgery the upper part of the implant sits below the lower fibres of the chest muscle, this helps to make the implant less visible. The operation is under general anaesthetic, and usually lasts between 80 and 100 minutes. I do not routinely use drains. Patients usually stay in hospital for one night.

After-care

Patients wear Micropore™ tape across the infra-mammary crease for the first week after surgery. Most patients are confident to shower and freely mobilize, comfortably lifting their arms above their heads. I ask patients to avoid lifting heavy objects for three weeks after surgery. Most patients will wear a sports-bra continuously for four weeks after surgery. I will give specific individual advice before surgery on when and how quickly to return to sport.


Before Surgery	Marking for surgery Style 410 325 CC implant

First morning after surgery with Micropore™ tape support	One month after surgery

Risks

The most immediate risk is of bleeding requiring a return to the operating theatre. This should happen in less than 3% of patients.
In the days and weeks after surgery there is a risk of infection. Most infections can be treated with antibiotics.
In the medium and long term there is a risk of asymmetry, discomfort, movement of the implant, changes in nipple sensation, and tender or lumpy scarring.
The risk of deep venous thrombosis and pulmonary embolism is minimized by the use of thrombo-embolic stockings, and early mobilization of the patient after surgery (getting out of bed as soon as fit enough to do so with the support of the nurses).
Patients who experience a rapid onset of calf pain, or shortness of breath in the weeks after surgery, need rapid assessment (usually best carried out by a local hospital emergency department) to exclude the possibility of a deep venous thrombosis (a clot in the calf veins) or a pulmonary embolism (a blood clot obstructing a lung blood vessel.
The risk of sepsis after breast augmentation surgery is extremely low, however, any patient who develops a fever and feels unwell in the days and weeks after surgery, should seek urgent medical assessment and advice. This could mean attending the emergency department of a local hospital.

Further information about breast augmentation surgery
Patients should read the latest information on the MHRA website: www.gov.uk, and can find further information on the BAPRAS website: http://www.bapras.org.uk/public/patient-information/surgery-guides/breast-enlargement