Breast Augmentation

The problem

The ideal breast size is individual to every woman.

As a plastic surgeon, I am aware that many women desire bigger breasts for many reasons including satisfaction with appearence, better fitting clothes, sense of femininity and feeling attractive among many reasons.

Breasts may be objectively small but in keeping with body type but in some instances may be smaller in proportion to body type.

Whilst having small breasts in itself is not a problem per se, if it bothers you and occupies brain space or causes low self esteem then it can be a problem with which I can help.

The solution

Breast augmentation or boob job is one of the most popular plastic surgery procedures.

The operation itself is relatively simple to perform but the important parts of it is what happens before the operation ie. the patient selection, holistic assessment, choosing the correct implant size for you and an artistic appreciation of how this will change your chest contours.

How is a boob job performed

Breast augmentation involves placing an implant into the breast to enhance both its size and shape.

It is performed with you asleep under general anaesthetic.

A 4-5cm incision is placed into the breast crease to create a precise pocket for the implant.

Dissolving sutures are then used to close the wound.

Drains are not usually required.

Consultation

There are several decisions that will be made at your consultation including:

Implant fill:

I use latest generation silicon gel implants which are soft and have a feel closest to the breast.

Implant shape:

Round implants:

these are much more forgiving as they dont need a particular alignment.
They don’t lead to a cosmetic anormality if they rotate in the pocket therefore the pocket can be generous.
They theoretically do not fill out the upper breast as teardrops but this is argued amongst surgeons.
These implants can have a smooth shell which would reduce your risk of complications related to the texturing that is required for teardrops such as ALCL (see below).
They are more cost effective than teardrops.
In women with thick upper breast to start with, round implants are just as good with fewer potential problems..

Teardrop implants:

These are called teardrops due to their shape.
They theoretically fill out the upper breast to give a better gentle slope to the breast, a better décolletage.
To maintain such an advantage they would need to be in a much tighter pocket. This is not easy to achieve consistently giving more room for the implant position to change, causing visible changes in the look of the breast.
They also require texturing on their surface to a fine sandpaper feel to allow them to better stick to your chest. Texturing is associated with higher rates of ALCL (see below).
Many surgeons believe that latest generation round silicon implants form a teardrop shape anyway once in the breast and therefore the cost and potential problems of teardrops may not be justified.
I would prefer to use these in women on the petite side who still want to avoid the augmented look.

Implant size:

Many women will have an idea of what bra size they would like, usually a DD cup size.

However, the bigger the implant the bigger the potential problems as they cause more pressure to your breast and chest wall.

The size of implant you will take will depend on many factors that you might not have considered including the broadness of your shoulders, amount and quality of breast tissue and skin. It is my job as a surgeon to point these out to help you decide.

A good surgeon’s job is not just to insert any size implant, but to carefully counsel you to come to a good halfway ground between patient and surgeon where you get all the benefits of your augmentation whilst minimising problems. You want your augmentation to last more than a few photos immediately after surgery, as do I.

Also consider that you may want your implant to look good both in and out of clothes.

In many cases, a smaller more subtle implant will give you a result that will be longer lasting and elegant.

We will come to an agreement of a range of potential sizes in clinic and then I would ask for some artistic license to use my experience and judgement as to which of these works best for you during the operation.

Over or under muscle

Overs:

Here the implant is placed under the breast tissue but over the pec major bench press muscle.
This is the commonest in the UK.
There is less surgical dissection, less pain, less risk of bleeding and less risk of dancing breasts i.e if you bench press at the gym your implant does not move around.
This option is only appropriate if you have a thick amount of breast tissue in the upper breast to cover and hide the implant.
A bigger over-muscle implant might cause the decolletage to be more right angled giving a more augmented look which may not look as good out of clothes but gives a “better” cleavage in clothes.
Teardrop implants really only have a potential benefit if placed over muscle.

Unders:

If your upper breast is thin, placing the implant under your pec major means the muscle will cover the upper implant giving a better decolletage and less risk of the implant being visible or feelable.
However, this involves surgical manipulation of your pec major muscle causing potential issues such as muscle size and strength reduction; this is a problem in physically active women. Conversely, physically active women might have a thinner upper pole which makes unders more appropriate.
Unders may have more risk of dancing breast which is movement of the breast when the muscle contracts.
I do use modern dual plane techniques to help anticipate and correct some of these potential problems in women in whom unders is the only option.

Smooth or textured

Smooth:

This is the default implant.
Texturing was added to better integrate into the body and reduce the capsular contracture scar that forms around all implants but as you read above, some problems have appeared related to texturing.
Smooth implants can rotate within the pocket but if the pocket is accurate and tight, this shouldn’t cause visible or feelable change.
They can be placed both over and under the muscle.
They have less risk of causing the rare blood cancer called ALCL which is mostly related to textured implants.

Textured:

Texturing reduces the risk of capsular contracture scar which all patients form but in some it can become feelable, visible or even painful enough to need implant removal.
Texturing helps reduce swivelling in implants that need to stay in a particular orientation such as anatomical teardrop implants.
The advantage in reducing capsular contracture is only really in overs and therefore, I only use teardrop implants over the muscle.
Texturing increases the risk of ALCL, although this is still an exceedingly rare event.

What does a boob job correct.

Breast augmentation will increase breast size but to maintain shape the breast tissue needs to be firm.

It therefore requires a young breast ie. a breast that has high amount of breast tissue compared to fat tissue for the best and longer lasting result.

What is not corrected with a boobjob.

The breast naturally increases fat content, reduces firmness with age and also after children and breastfeeding. These are called involution changes.

Implant augmentation alone may not be appropriate in women with softer and fattier breast tissue as the breast tissue will just slide over the implant causing the so called waterfall or snoopy breast deformity where the implants sits higher on the chest wall, the lower breasts sags and the nipple points downwards.

Here an augmentation-mastopexy or uplifting boob job is a better option as it both makes the breast bigger and places the lower breast and nipple higher on the chest wall to avoid snoopy deformity.

In breasts with mild involution changes, a bigger implant alone might suffice but the problems of bigger implants are discussed above.

Potential complications

The hallmark of a good surgeon is in honestly discussing complications with patients.

My philosophy is to run a boutique practice with few, well informed and selected patients than a production line approach.

All surgeons suffer complications even if the operation is performed to the highest standard.

Anaesthetic complications will be discussed with you by a Consultant Anaesthetist.

The complications of breast augmentation can be minor including wound infections, temporary bruising and swelling which everyone gets to a varying degree, pain and temporary numbness around the scar.

All scars are red and thick to begin with and then mature over a period of 6-18 months. In some people, pathological scarring can be genetic causing hypertrophic and/or keloid scars. If you have had one of these scar types, any cosmetic surgery risks these happening again.

Implant infections are serious and require implant removal.

Bleeds under the skin can cause blood collections called haematoma which must be drained quickly as they can cause skin necrosis and infections.

A collection of wound fluid called a seroma can result but it harmless and usually absorbed by the body or may need draining.

There may be mild asymmetry between right and left but most people do not have perfectly symmetrical breasts.

Your nipple sensation might change becoming over or undersensative.

The implant will form a scar around it and if the scar becomes visible, feelable or painful it is called capsular contracture and may require removal or changing.

The implant may leak, rupture, swivel or deflate over time.

There may also be cosmetic imperfections including visibility of the implant, rippling, and snoopy deformity.

Textured implants can cause the extremely rare blood cancer called ALCL. This might present as random-onset breast swelling long after the operation. Early treatment by removing the implant and capsule around the implant can cure this condition.

Revision surgery may be required to correct imperfections and complications.

This list gives the worst case scenario but most people do not experience any issues at all with their implants.

Importantly, most complications are treatable and staying in touch means I can help you through should you suffer any of these complications.

Downtime and recovery

Breast augmentation takes about 60-70 minutes to perform.

You can usually go home the same day with good pain killers.

You will be reauired to wear a surgical bra for 6 weeks to help the breast heal around the implant and keep the position design at surgery.

Initial swelling and bruising will subside within the first week but overall it might be 3-6 months before the full result becomes apparent.

Week 1 is all about healing and therefore being at home, stress free to reduce blood pressure, with good nutrition and support from loved ones is encouraged.

A wound check will be performed at the hospital after 1 week after which you can drive again.

You might need to be off work for 7-10 days depending on your job, earlier if you are comfortable and your job can be done at home relatively stress free.

Lifting, such as a small child after 4-6 weeks is usually appropriate.

Heavy lifting and gym is usually allowed after 6 weeks.

These guidelines are meant to reduce risks of complications so it is crucial to follow them.

They are also general and your particular regimen will be discussed with you.

You will also have access to my team to guide you through.

Do I qualify for breast augmentation?

The consultation is the crucial point at which I will gather your medical history perform a comprehensive body and breast analysis and discuss your suitability.

We will also have a detailed discussion of the points discussed above to ensure that you are fully informed and that I am the appropriate surgeon for your particular needs.

I believe with informed counselling, your aesthetic needs and my surgical know-how can benefit you in achieving the body you desire.

I will still be honest with you if I feel your needs are not ones I can meet and help suggesting other surgeons who may be able to offer you a better result.

What to do next

If considering breast augmentation surgery, get in touch using the contact forms below and I’d be delighted to help you.