What to Expect at Initial Consultation
At your initial consultation I will spend time to get to know you personally, understand your lifestyle and take a full medical history. As a woman and a Plastic Surgeon, I intimately understand how your feelings about your breasts can influence body confidence, self-image and femininity. I aim to give you the result you are looking for and to do this I really need to understand your likes, dislikes and expectations. It is important that you are open and honest at this stage so that I can appreciate your reasons for seeking a mastopexy-augment and your expectations for the outcome. I will examine your breasts, and if you are an appropriate candidate for this surgery, your options will be described in detail. We will use a sizing kit to help us both better understand the volume that you are hoping to achieve. Where I feel an alternative surgery will better achieve what you have described this will also be fully explained. Whatever we decide you will be given full details of the type of surgery, its risks and limitations. I always see you for a second consultation prior to booking surgery to ensure that you have had time to fully digest the options and information I have given you.
Preparing for Mastopexy-Augment
You should be physically fit and at your ideal weight which should be stable prior to embarking on Mastopexy-Augment. Your health will be assessed pre-operatively and you may need some tests that will be arranged if required. You should stop aspirin, anti-inflammatory medications and any non-prescribed medication at least a week before surgery. If there is any change in your health prior to your surgery date you should let me know. Your health and general well being are my primary concern when I am treating you therefore if you are unwell for any reason it may be necessary to postpone surgery.
What To Expect on the day of Surgery?
Mastopexy-augment is perfomed under a general anaesthetic as a day case procedure. It usually takes 2-3 hours depending on the patient. An incision is made as per your individualised treatment plan, excess skin is removed, the nipple is lifted and the breast tissue rearranged. The breast implant is placed in the position that we have agreed. The wounds are closed with dissolvable stitches and I do not usually use drains. If we have agreed that you wish to have liposuction to help shape the outer of the breast, and back regions this is done at the same time. You will be back on the ward around an hour after the procedure and able to go home later that same day.
What to Expect After Surgery
You should arrange for someone to pick you up following surgery and have someone to stay with you overnight. For the first few days you will need some support at home. In the initial post-operative period you will feel swollen and will have some discomfort requiring analgesia. When you have liposuction you may be bruised in the area for several weeks post-op.You will be asked to wear a supportive post-op bra immediately and for six weeks day and night. You should keep the wounds dry until your first dressing change at one week. You should avoid any strenuous exercise in the first week and should continue to wear a support bra for 6 weeks after surgery. You will be able to start light exercises after 2 weeks and normal exercise by 3-4 weeks provided you have a supportive bra. You should be able to return to work by two weeks. You should begin massage to the scar once healed, a simple moisturiser can be used for massage. Bruising and swelling last for a few weeks and redness and discharge may occur. The two breasts often settle down at different rates so you may notice some asymmetry in the initial weeks. You should be fully healed by 6 weeks but it may take longer for the final results to be apparent. It can take many months to years for the scars to fade.
Is a Mastopexy- Augmentation Part of a Mummy Makeover?
Breast lift and augmentation is a favourite of Mums as part of their Mummy Makeover. It often addresses the unwanted changes to the breasts that result from pregnancy and breast-feeding. At your consultation you will be assessed and the various components of your individualised treatment plan will be discussed. Please see my Mummy Makeover section to learn more about changes that commonly occur in the breasts, the tummy and other areas of the body after pregnancy.
What Are Potential Risks and Complications of Mastopexy-Augmentation?
When you are considering any type of surgery, you should be fully educated about potential risks and complications. The majority of patients are delighted with the outcome of mastopexy-augment. Early complaints include change in sensation, bruising and swelling. This may differ on each side causing slight asymmetry in the early post-op period. Over the first few weeks this will settle and by six weeks the results will start to become evident. Other uncommon early complications include infection, haematoma, delayed healing, extrusion of the implant, seroma formation and abnormal scars. It is quite common to get altered sensation in the first few months but this is rarely permanent. Implant rotation is another rare complication. There is also risk associated with general anaesthetic, including respiratory/cardiac arrest and deep vein thrombosis.
A rare complication is implant infection. The treatment for this is usually to remove the implants and allow things to settle before considering re-implantation around three to six months later. Thin ladies will be able to feel the edges of the implants. There is no way to avoid this and it will be permanent. The upper part of the implant can be placed behind the pectoralis muscle to try and reduce this but the implant edges will still be felt further down the breast. As a rough guide if you can see your ribs when unclothed you will be able to feel and possibly see the edges of the implant. Over time ladies who are thin are more likely to develop rippling of the implant that becomes palpable or even visible in certain positions.
Recently there has been much interest in a type of lymphoma that is associated with breast implants. Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BI-A ALCL) is a type of lymphoma that develops in the capsule of breast implants in some ladies. There is currently much research going on to assess the true incidence and cause of this lymphoma. The reported rates vary from 1 in 1000 in certain types of implants to 1 in 10 000. The actual incidence is as yet truly unknown. The condition most commonly presents with unilateral swelling of a breast associated with a fluid collection around it. It usually presents at least a year after augmentation but more commonly later than this. Diagnosis involves sending the fluid for special tests. The treatment is to remove the implant and the surrounding capsule. In very rare cases some ladies have required chemotherapy.
Is Breast Feeding Still Possible after Breast Augmentation?
Provided the breast tissue and ducts are not divided during surgery all the structures that lead to the nipple are preserved. This is one of the many reasons why I normally recommend an inframammary incision. You should maintain the ability to breast feed, assuming you would have been able to prior to having surgery (there is a minority of women who find that they are unable to breast feed irrespective of whether they have ever had breast surgery).
Can I have Mammograms With Breast Implants?
Having a breast augmentation does not interfere with breast self-examination, breast examination by a doctor, mammograms, ultrasound, MRI or any other cancer detection techniques. However it is important that you notify the mammogram technician that you have implants. When you have implants the radiographer will perform additional images (Eklund displacement views) to ensure that all breast tissue is fully assessed. If you are of breast screening age you should be up-to-date with your mammograms prior to embarking on any breast surgery.
Will I need Additional Surgery after Breast Augmentation?
During your lifetime it is likely that you will require at least one additional procedure to maintain your implants. The most common reason for needing further surgery is the development of capsular contracture this is usually treated by removal of the capsule and replacement of implants. Other procedures you may require include removal of implants, adjustment of size or further uplift (mastopexy) depending on changes in your body, your desires or personal situation. Breast Implants do not need to be routinely changed at certain time periods.
I offer long-term follow-up appointments to ensure that you are still looking and feeling as good as you did immediately after surgery. If time, aging, weight change or gravity have influenced the result we can discuss at that stage what options are best for you and your lifestyle (which may have changed radically since your first augment). However, there is no reason to undergo any additional surgery unless you are experiencing a problem or you wish to have another procedure in the future.
