Breast Surgery

There are several different ways in which cosmetic surgery can change the size, shape and uplift of your breasts. These include breast lift (mastopexy), breast enlargement and breast reduction. Do make sure you understand exactly what your operation involves before you take the plunge.

Mastopexy

A breast-lift operation is usually for sagging breasts – it removes excess skin and raises the
nipple. The smaller the breast the better the result. It can be combined with augmentation
if your breasts are small, or reduction if your breasts are very large. Without reduction,
mastopexy is not very effective on large breasts because gravity will pull them down again.

Be realistic. Mastopexy can’t give you the pert breasts of a teenager, and it will leave
scars. Discuss the operation with your surgeon in some detail before proceeding.
As with all breast operations, make sure you see before and after photographs so that you
can check good, moderate and poor results. Ask for a description of the kind of cuts that
will be made, and even get the surgeon to draw on your breasts where the scars will be.

You should bear in mind that your breast-lift, just like a face-lift, is by no means
permanent. Your breasts will continue to age and eventually sag all over again. Ask your surgeon if the technique to be used gives you the option of breast-feeding if it’s important to you. It’s advisable to have a mammogram before you go ahead with any type of breast surgery.

The Operation

A general anaesthetic is usual. Your surgeon will remove excess skin and fat from under the breasts and move the nipple upwards by pushing it through a hole in the skin higher up your chest.

After Effects and Follow-up

Mastopexy is usually very successful and there are few side effects, although you may notice
loss of sensation in your nipple and areola. There’s a 50-50 chance you’ll be able to breast-feed after the operation, as long as the milk ducts aren’t cut. You can expect to have all the
stitches removed after two weeks and, if you’re an active person, you’ll have full movement of your arms and shoulders and be able to take up sports after about three weeks.

Although it may be slightly uncomfortable, it’s advisable to wear a good supporting bra
after the operation to support the inflamed breast and skin and help healing. You should
be prepared to wear your bra day and night for at least three months after surgery.

Breast Reduction

There are two groups of women who look for breast reduction. The first group dislike their
large breasts because of the inconvenience and social embarrassment. The second group want cosmetic breast reduction to achieve firm, well- positioned breasts, and are happy with C or D cup as long as the breasts look good.

The operation

While different surgeons have slightly different techniques for reducing the size of breasts, the basic operation is very much the same no matter who does it. It requires a general anaesthetic and it’ll probably take as long as four hours. The nipples are important. Ask whether your surgeon’s going to simply move your nipples up, or remove them and then graft them back in a different position.

You can request that your nipple is preserved on a stalk of tissue – called a pedicle – so the tissue is taken from the sides and the underside of this stalk. This is essential if you want to breast-feed in the future. If you wish to know exactly what’s going to be removed, ask your surgeon to draw the shape on your breast with a pen. The nipple can be lifted up and stitched into the breast at a higher level. The flaps of skin underneath are stitched together, resulting in reduction and some uplift You’ll be left with scars around the areola, in a line from the nipple to the underside of the breast and in the skin fold where the breast joins the skin of the chest.

After Effects and Follow-up

The results of the operation are usually extremely good, but this is major surgery, so you can expect to have some discomfort for several weeks after. By the time you go home two or three days later, however, the pain should have subsided. Wear a bra day and night for support and to aid healing. The stitches should be removed within about two weeks, after which you could restart work. After a month you’ll virtually be back to normal.

Breast Enlargement

Breast enlargement can only be accomplished with the aid of implants, which are inserted in
front of or behind the muscles of the chest wall – the pecs – underneath the actual breast.
Implants have received a lot of medical attention in recent years and their safety has been questioned. If you’re considering breast augmentation, you owe it to yourself to become informed about these issues.

• Breast augmentation can have complications, so read as much as you can about it. Ask your surgeon if he can put you in touch with someone who’s had the operation so that you
  can go into it with your eyes open.
• Have a detailed discussion about the size you’d like your breasts to be. Be realistic. If
  your frame is small and you already have tiny breasts, think twice before going for a D cup.
  Your surgeon will probably advise against it anyway. The best prostheses now are shaped
  and are of standard width. You will be measured for the appropriate size and shape of these biodimensional prostheses.
• Make sure that your doctor checks for cysts in the breast that might require treatment in
  future. It’s difficult for a surgeon to interfere with the breast once an implant is in place.
• Ask about the possibility of contracture (see below) and ask where the scars will be.
• Ask whether the incisions will interfere with breast-feeding or sensation in the nipple.
• Make Hire that your surgeon tells you the size and the manufacturer of your implant in case it needs replacing at a future date.

Types of Implants

Silicone gel implants feel more natural than saline-filled ones and they’re still the first choice of most surgeons in the UK. The likelihood of contracture is about the same with both types, but obviously there’s no risk of silicone leakage with saline-filled ones. If silicone implants leak, they’ll deflate and will need to be replaced.

All implants used to be smooth, but nowadays a textured surface is preferred as this seems to reduce the frequency of contracture. Alternative implant-fill materials are being researched. It’s hoped that these new materials will be absorbed by the body if leakage occurs, won’t react with breast tissue and won’t obscure mammography X-rays. One new implant available in the UK contains triglyceride, which is similar to body fat, and has a built-in electronic chip with a unique code to identify it.

The Operation

The length of the operation is largely determined by where the implant is placed. If it goes underneath the muscles of the chest wall, the operation will take less time than if it is placed underneath the breast tissue but on top of the muscle layer, because there’s less bleeding in the former operation. You might want to stay in

You might want to stay in hospital for 24 hours to recover from the anaesthetic, but then you can go home. You’ll be asked to return to hospital in about 10 days to have any stitches removed.

The incision for an augmentation operation may be made in the armpit, around or across the areola, or under the breast. Scarring may occur in any of these areas depending on which incision your surgeon uses.

After Effects and Follow-up

Make arrangements to be off work for at least 10 days to a fortnight. Don’t attempt to drive a car for a full two weeks and avoid overhead lifting for about four weeks. You should be back to normal in about three weeks, but it’s best to avoid sports for about six weeks.

Things You Should Be Worried About

Breast cancer

There’s no proof of a link between silicone implants and cancer. The Food and Drug Administration (FDA) in the US concluded in 1989 that a carcinogenic effect in humans could not be completely ruled out, but if such an effect did exist, the risk would be very low. Breast surgeons around the world have found this statement reassuring enough to continue using silicone implants.

Mammography

Implants can make it difficult to read mammograms precisely. This means that women who have a strong family history of breast cancer should probably not use silicone implants. It’s a good idea for all women to have a mammogram performed before any breast surgery. It’s possible to get a good mammogram of a breast with implants, but more than one view will be needed.

Contracture

The capsule of scar tissue that forms naturally around any implant can be quite thin and pliable but it may contract and become as hard as wood. One research study puts the possibility of contracture as high as 7 out of 10 at two to four years alter surgery. Massaging the breasts may reduce hardness, but if they’re very hard, treatment can be quite complicated.

Your surgeon can ease the tension by cutting a wider space around the implant. Or, if the implant lies above the chest wall muscles, it can be removed and a new one inserted below the muscle, where contracture is less likely.

Other complications

Breast pain, loss of sensation in the breast, difficulty with breast-feeding, infection and movement and leakage of an implant are all well-known complications. A more uncommon one is rupture of the implant, which can occur spontaneously or through physical force such as a blow. You’ll need immediate surgery if this happens to remove all traces of silicone from the breast.

Some authorities say half of all breast augmentation patients will have some side effects by 10 years after the operation; others estimate a one-in-three chance. So it’s not plain sailing, though none of the above side effects is life-threatening.