In some women, breasts might never fully develop appropriately or sufficiently for a number of reasons, or they can develop asymmetrically or in a distorted fashion. In many other women, breast volume can be lost following pregnancy and/or breast feeding resulting in changes to fullness and shape. There are also occasions when the breast volume (size) might be reduced, but the breast is also significantly droopy with laxity of the breast skin envelope. In these situations, breast augmentation with an implant alone might not be appropriate and a combination of an implant and a mastopexy (lift) is required. This combination surgery can be challenging from a reconstructive perspective, yet is commonly performed by Titus Adams
All options will be explored clearly during the consultation, with photographic and video examples to help illustrate problems and to demonstrate likely outcomes.
In preparation for breast augmentation, all patients undergo a sizing technique in the clinic to assess volume requirements and is an integral part of the consultation.
Different types of breast implants can be used, with different implant shell textures, shapes and dimensions available. A decision about implant pocket placement is also required and importantly, the implications of breast implants will be discussed, including BII, BIA-ALCL and capsular contracture risks and their management.
Before and After Gallery
What You Need to Know
Risks and complications
What Happens When I Leave Hospital?
Following the surgery, the breast will inevitably look and feel tight, and the breasts will look pert for 2-3 weeks before settling, as the swelling is alleviated. There may be a loss of sensation around the scar, but this should return after a few weeks. Nipple sensation is frequently altered; the nipples may become hypersensitive. Regular massage to both the breast and nipples are advised each day. Avoidance of touch or massage to the nipple will only prolong hypersensitivity, should it occur. Occasionally, a few patients notice a reduction in sensation to the nipple. This can often be compared unequally on each side. Again, a return to normal should be expected, but may take several weeks or even months. Rarely, the nipple will lose sensation permanently.
A soft, front-fastening supportive bra, that protects but does not restrict, with no under wire, is expected to be fitted following the operation and be worn day and night for 6 weeks to protect the implants and the pockets in which they sit. The bra is removed for bathing. Wired bras can cause discomfort and irritation to the scar line and is discouraged until after 6 weeks.
Driving should be avoided for the first week. Safety belts should always be worn in any event. Return to work varies, depending on what this might entail. Most patients return to non- manual task at 1-2 weeks. Heavy lifting and stretching out of the arms should be avoided for 4 weeks. Specific advice will be given at consultation. Help will be required for managing babies or toddlers for the initial two weeks. Upper body activities should be avoided for 6 weeks, but a return to lower body gym work may be possible at 4 weeks. Vigorous contact sports should be avoided for 3 months. There are no specific restrictions on sexual activities, but the breasts should be handled with care for several weeks.
One of the extremely rare causes of swelling (or lump) is thought to be due to a breast-implant related lymphoma (called BIA-ALCL). This has only been brought to our attention recently and is entirely treatable by removal of both the implant and its surrounding capsule.
All patients with symptoms of a lump or suggestion of a seroma (fluid around the implant causing it to swell), should undergo a standard breast (triple) assessment of clinical evaluation, ultrasound scan, and a needle biopsy if needed. The fluid can be aspirated for cytology. This should be available on the NHS.
BIA-ALCL is a new disease entity thought to be linked to the surface texturing of some breast implants; however it is extremely uncommon with risks of 1 in 24000 being suggested (range of 1 in 2207 for Allergan implants – 1 in 86,029 for Mentor implants). 573 cases have been reported worldwide (59 confirmed in the UK as of November 2019). Over 90% have involved Allergan textured implants and may be liked to the type of macro-texturing that they had employed. These implants are no longer manufactured. Given that this condition remains very rare at present, the advice is that Allergan implants need not be removed in the absence of any changing symptoms or signs.
Smooth surface implants alone are NOT thought to cause BIA-ALCL (although 26 cases of smooth implants worldwide have been noted in patients in whom they have had previous textured implants or prior implants of unknown texture).
It is also worth noting that smooth implants are only available in round shape – not tear- drop/anatomical shaped. Textured implants are available in both round or tear-drop shaped.
Mr Adams uses micro-textured tear-drop shaped implants for two simple reasons (despite a real but extremely small risk).
- The first reason is that some women often require tear-drop as it suits their shape. Tear- drop shaped implants allow for different widths and heights of their implants to suit their frame. Round implants have fixed diameters so that the width and height have to be the same. The base of one’s natural breast is more horizontally oval and not round.
- The second reason is that texturing of implants reduces the risk of capsular contracture 4- fold. The risk of the commonly presenting capsular contracture is about 10% for textured implants and about 40% in smooth implants. The commonest reason for women to require revision of their implants (whether smooth or textured) is due to the effects of capsular contracture. In the grand scheme of things, BIA-ALCL is extremely rare, and it is worth noting that the overall breast cancer risk for women in the general population is 1 in 9 women.