Breast Augmentation Mastopexy

A breast mastopexy-augmentation is performed under a general anaesthetic (you will be fully unconscious). Providing all is well, you can expect to go home the same day.

Incisions are necessary to sculpt the breasts into a smaller and perter shape. The incisions are made around the areolar, vertically down from the areola to the breast crease and horizontally in the breast crease under the breast. The implant is inserted through the same incision so there are no additional scars.

The implant is inserted first, followed by removal of the excess skin, and the entire breast is reshaped with the nipples moved to a higher and more youthful position. The implants are placed either in front or behind the muscle, or a combination of the two (dual plane).

The incisions are closed with sutures that are hidden under the skin and dissolve. There will not be any visible sutures, thus keeping scarring to a minimum. The surgery takes approximately 3 hours to complete.

I use a long-acting local anaesthetic block during the surgery, which is used to temporarily stop pain from the nerves that supply the breast. This lasts for 72 hours and should provide pain relief making surgery as comfortable as it can be. Usually only simple analgesia such as Tylenol and ibuprofen are needed in the initial post-operative period.

Breast implants are available in a variety of types, with different shapes and sizes. Some are round and some are teardrop shape (anatomical). Implants are made of an outer casing of silicone or polyurethane and filled with a silicone gel. For more information, please see my guide below on implant selection.

Selection of the correct size and shape of implant will be done with you at your first appointment. Using Crisalix, or similar simulation software, we can create a 3D image of your chest, and you can see yourself to compare simulations of what you may look like after surgery. This allows you to compare how the different implant sizes and shapes of implants will look on you. You can also use the sizing kit to confirm this.

It is important that you take your time in deciding what shape and size of implant you would like. I will help guide you with this decision, but ultimately the final choice is very personal.

Breast implants are not lifetime devices. The older implants are, the more likely they need replacing. The U.S. Food and Drug Administration (FDA) current advice is that implants are changed every 10 years to reduce the risk of implant rupture with time. It is recommended that you have imaging 5 years after implantation and every 2 years after that. Fortunately, the risk for implant rupture is now as low as 1-2% per year, given the advances in silicone implant technology over the last decade. Thanks to their improved cohesiveness, in the event of a rupture, a silicone implant´s filling material may bulge out of its shell but will remain contained within the breast capsule.

I only use implants that carry a guarantee from the manufacturer. However, should the implants require replacement in the future, this guarantee only covers the cost of the replacement implants but not the cost of surgery.

Complications are infrequent and usually minor. However, no surgery is without risk, and it is important that you are aware of the possible complications. All the risks will be discussed in detail with you at your consultation. However, if you have further questions or concerns, please do not hesitate to discuss them with me. Decisions about cosmetic surgery should never be rushed.

These risks can be divided into those specific to the surgery and those that relate to the anaesthesia.

General Anaesthetic risks: An anaesthetic is very safe, however, should a complication arise, the relevant medical expertise is immediately available to deal with this.

The risks increase if you have certain medical problems, which will be discussed at length during the consultation. The risks include:

• Unintended intraoperative awareness, which is very rare.
• Dizziness and nausea.
• Sore throat.
• Damage to teeth or mouth.
• Nerve injury due to body positioning.
• Allergic reaction or anaphylaxis.
• Malignant hyperthermia, which is a rare life-threatening condition.

The anaesthetist will go through these risks in more detail prior to your surgery.

Scars: The scars are usually hidden in the crease under the breast, around the areola and vertically down the middle of the breast, from the lower areola border to the crease under the breast. They normally settle remarkably well, so that the scars are barely perceptible. However, some patients heal with thick, thin or stretched scars, which can be noticeable.The scars are usually hidden in the crease under the breast, around the areola and vertically down the middle of the breast, from the lower areola border to the crease under the breast. They normally settle remarkably well, so that the scars are barely perceptible. However, some patients heal with thick, thin or stretched scars, which can be noticeable.

Bruising and swelling: A degree of swelling and bruising is normal, and this may take approximately 3 weeks to settle.

Haematoma: This is a collection of blood in the pocket created by the implant. It does occur in between 1% to 4% of women who undergo a breast augmentation procedure. It tends to occur within 1 to 3 days post-surgery.

Any increase in swelling or pain should be reported immediately for assessment. Should the haematoma be significant, it will have to be washed out in theatre and any bleeding vessel(s) identified and cauterised. This does not normally delay your recovery or change the cosmetic result.

Infection: The risk of infection is inherent with any surgical procedure; this can be either:

• Superficial (does not involve the implant) and should respond to oral antibiotics.
• Deep (involves the implant) and requires temporary removal of the implant.

The deep infection risk is less than 1% but on the rare occasion, when infection occurs, the breast implant may have to be removed to allow the antibiotics to work effectively for the infection to settle. The implant will be replaced once the infection has resolved.

I use a no touch technique during surgery with Keller funnels to introduce the implant and minimise any possible infection risk.

You will also be given antibiotics when you are put to sleep and post-operatively to reduce the risk of infection.

Numbness, reduced sensation or oversensitivity:  A reduction in nipple sensation may occur, which may improve to some degree with time. However, this may never completely return to normal. Occasionally patients feel that nipples become more sensitive.

Wound healing problems:

These are rare, but can happen around the nipple or at the T junction (where the horizontal and vertical scars meet). These healing difficulties can range from minor problems, such as small scabs or areas of wound separation, to major issues, such as skin or nipple loss. Although very rare, this situation may require a skin graft to close the wound, meaning more surgery.

Patients who have diabetes, smoke, are obese or elderly are at an increased risk of delayed healing.

Asymmetry: Each breast is slightly different and will continue to be so following surgery; remember, “they are sisters and not twins”. However, if you have noticeable asymmetry prior to your surgery, then this can be corrected as part of the surgery as discussed with you.

Stretching of your breast tissue:  The larger the implant you choose, the more likely it is that your skin will stretch with time, and you may require an uplift at a later stage. Occasionally breast augmentation is associated with stretch marks, which are permanent but fade with time.

Rotation/displacement: Occasionally implants can sit in the wrong position or may move in the post-operative period. A further procedure may be required to correct this.

Implant rippling or wrinkling:  This can be more prevalent in very slim patients or those with very little breast tissue. This is reduced if the implant is placed behind the chest muscles, or a fat graft is performed to increase the soft tissue cover.

Rupture:  I use Sebbin and Motiva breast implants and are all guaranteed. However, as a medical product, they can still fail. If an implant is known to have ruptured, then it should be removed. The ruptured implant is contained within the capsule of scar tissue so it will not ‘spill out’ into your breast tissue.

Sebbin Implants have a rupture rate of 0% at 5 years and the risk of rupture of Sebbin implants is 1.7% after 5 years.

Motiva have similarly low rates for implant-related complications with a rupture rate of less than 1% after 5 years.

Capsular contracture: Following breast augmentation, the body makes a capsule of scar tissue around the implant. Sometimes this tissue can shrink and contract (capsular contracture). If this happens, it can make the breasts feel abnormally hard and may require further surgery to remove the capsule.

Many studies show that the risk of this is approximately 20% after 10 years with silicone implants.

Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE): Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and travel to your lungs. If the blood clot is large enough, it could prove fatal.

The overall risk for cosmetic surgery is less than 1%, but to reduce any risks of a DVT/PE, you will be provided with special stockings to wear in bed together with a blood thinning injection, if you are not mobile or have previously had a DVT or PE.

Fat necrosis:  Sometimes areas of fat within the breast scar form hard lumps called fat necrosis. Usually, no specific treatment is required, and the problem settles down over a 12-month period.

Breastfeeding: Not all patients will be able to breastfeed after breast surgery, reduction or mastopexy. If you have further family plans and wish to breastfeed then this procedure should be delayed.

Anaplastic Large Cell Lymphoma (ALCL):  In January 2016, the United States FDA announced a possible association between breast implants and the development of ALCL, a rare type of non-Hodgkin’s lymphoma.

According to the World Health Organization, BI-ALCL (or ALCL) is not a breast cancer or cancer of the breast tissue; it is a lymphoma, which is a cancer of immune cells.

Women with breast implants have a very low, but increased risk of developing ALCL. In women with breast implants, ALCL is generally found next to the implant itself and is usually contained within the fibrous capsule that the body forms around the implant.   The exact risk of ALCL is unknown and health organisations from around the world are pooling data to try and establish this risk.

An observation of reported cases indicates a predominance of textured device involvement. The association with breast implants is likely multifactorial and is currently being extensively studied. There are only 2 cases reported with the Sebbin microtextured implants and they were both in patients who had previously had Allergan textured implants, and they are likely to have been caused by the Allergan implants.

Most of the breast implant patients found to have ALCL were diagnosed after they sought medical treatment for implant-related symptoms such as pain, lumps, swelling, or asymmetry that developed after their initial surgical sites had fully healed. In most cases, the ALCL was treated with surgery to remove the implant and surrounding scar tissue. Some patients also received radiation therapy, chemotherapy or both and 36 patients worldwide have died of the condition The condition has a very good prognosis and a high probability of cure if it is treated appropriately.

I recommend that you seek medical help if you notice swelling, fluid collection or sudden and unexpected changes in breast shape either from myself or another suitably qualified healthcare professional. If you require more information, then please feel free to contact me at any stage.

For more information on what is known about BI-ALCL please visit these useful links from the American Society of Plastic Surgeons or the FDA website.

FDA Patient Information - Breast Implant Complications

Joint ASPS ASAPS Statement On Breast Implant Associated ALCL

Breast Cancer: There is no evidence linking silicone or saline filled implants to breast cancer. You will still be able to examine your breasts, with the implants in place and have a mammogram/ultrasound as normal. Breastfeeding is still possible with implants, as the implant sits behind the breast tissue, leaving all the milk ducts untouched.

Your incisions will be closed with dissolvable sutures that do not need to be removed. I use a glue and tape dressing (Prineo®), which is waterproof and can be peeled off 2 to 3 weeks after surgery, when it starts to lift at the corners. You can shower as soon as you like after surgery and do not require any dressing changes.

I recommend that you wear a support bra for 6 weeks and that you purchase 2 bras, so you have one to wear and one in the wash. These are worn day and night for approximately 6 weeks post-surgery, before returning to any bra of your choice. You will need to purchase these prior to your surgery, and I will provide the relevant details in clinic. Details can also be found in the compression garment guide below.

Before you leave the hospital, you will be given a follow up appointment to see the nurses at one week to check your incisions and an appointment to see me in 2 weeks. You will not be able to drive yourself home from hospital and, ideally, you should have someone to stay with you for a few days to assist you. If you have any concerns during this period, do contact the clinic for advice.

Scar advice
Once the dressings are removed, I recommend that you massage the incisions, using small circular motions at least twice a day for 5 minutes. You can use any moisturising cream of your choice and apply firm pressure until it blanches.

The scars will also benefit from Silicone scar gel (ScarAway® or Kelo-Cote®) twice a day, which will soften and fade them, as well as applying sunblock for 12 months to provide sun protection.

The ScarAway® can be purchased from Healthcare Pharmacy at Governors Square in Grand Cayman.

When you get home, you should take things easy for the first week or so. Most people take approximately 2 weeks off from work. You should be able to drive from 2 weeks, return to the gym for lower body work at 4 weeks and begin upper body exercises at 6 weeks.

You must wear your support bra day and night for 6 weeks to help shape and support the breasts as they settle.

For self-funding patients, surgical fees are a combination of the Hospital costs, the surgeon, anaesthetic fees and any consumables. I do not charge additional fees for post-op appointments. The fees are based on the surgical time taken to perform the surgery, rather than procedure itself. This means that the costs are calculated fairly.

You will be given a quotation for surgery approximately 48 hours following your consultation.

Breast Augmentation Mastopexy - Nicotine and Surgery

Breast Implant Selection Guide

Sebbin Warranty

Breast Augmentation Mastopexy - Post-Op Bras

Breast Augmentation Mastopexy - Pre-Op Instructions

Breast Augmentation Mastopexy - Post-Op Instructions

Dermabond™ Prineo™