Changing your breasts can really change your life. However, breast surgery is major surgery, so you need to be completely confident, happy in the hands of your surgeon and clear about what to expect. We’ve put together a guide to help you from research to recovery – simply select each section to reveal more information.
Prepare and research
Find a surgeon
The first step is finding a surgeon you’re really happy with. Word of mouth can be a great way to find a physician, so we’d strongly recommend asking friends, looking online at forums, and meeting several surgeons before making a decision. Before setting up a consultation, make sure your surgeon is registered with the appropriate professional body, and check reviews online.
Give yourself time to prepare and be ready before making appointments – this isn’t a decision to rush into. Start consultation preparation now, and give it time. List questions you want to ask physician and start searching for photos of breasts that are the look you would like to achieve. No two bodies are the same, so what you would like to achieve may not be possible, but if you bring photos to your consultation, your surgeon will have a better idea of what you’re imagining.
Every consultation is different, but we’d suggest that you prepare a list of questions, and take some photos along to discuss. This will give your surgeon a clearer idea of the size and shape you would like to achieve.
Be totally honest about what you want to achieve from the procedure. Some women want their new breasts to look like they have had surgery and that’s absolutely your prerogative. Equally, you may be keen for a subtle, natural look to restore fullness. A surgeon will guide you through what’s achievable with your frame and existing breast tissue, and make suggestions and recommendations about what he or she thinks will work well for you.
To help you prepare, here are some questions you might consider asking:
- How many operations do you perform?
- How many revisions of your own work, on average, do you perform?
- What product do you use and why?
- Can I see some before-and-after photos?
- How long is recovery? Can I still go to work?
- How quickly can I have the operation?
- How long will I be in hospital?
- How big will the scar be?
- How long will they last?
- What are the dangers and risk?
- What happens if I get pregnant?
- What happens if I want to breastfeed?
Finally, don’t be at all surprised if your physician asks you to strip off. He or she will need to see your natural breasts to decide how to best achieve the look you desire.
Remember, don’t be flustered, take your time, and don’t feel under any pressure to agree anything on the day. It’s your body and your choice – so be sure that you’re 100% happy with your physician, their advice, their approach and their facilities.
Making the decision
It can help to take a friend or family member with you when you go for your consultations for a second opinion. Be sure to consider the costs carefully, and be clear about what’s included and what’s not – for instance, if revision surgery is necessary.
Double check your surgeon’s credentials online, and remember, no one should make this decision but you – don’t let anyone pressure you. Changing your breasts can really change your life, but it’s major surgery, so you need to be sure that it’s what you want.
The week before
Pack your things and practice the route. You may be excited and nervous on the day, so best to prepare well in advance.
Make sure you pack everything to make your short stay in hospital comfortable (slippers, support bra, toiletries etcetera) – and organise having a friend on-call to help you when you get home afterwards.
Double check your time to arrive, and ask for pre-operation guidance about eating and drinking.
On the day
Typically when you arrive you’ll meet the nurse who will look after you. They’ll get you settled in and answer any questions you have. They’ll talk you through what to expect, and ask you to sign the consent form for the operation.
Your anaesthetist will also come and ask you questions about previous operations to ensure they give you the right levels of pain relief and sleep medicine for you.
Finally, your surgeon will review your previous discussion and examine you to make measurement and markings for the operation. Again if you have any last minute questions do not hesitate to ask.
Different physicians have different ways of working, but as a guide, breast enlargement is usually performed under general anesthetic, and takes between one and two hours. Once you’re asleep in theatre, your surgeon will carefully make incisions. This will be, typically, in one of three sites: either in the crease under the breast, in the armpit, or around the nipple. They will have discussed this with you before hand.
After making incisions, your physician will then make a space for the implant. The implant lies under your breast tissue on top of your chest muscle, under the chest muscle, or in some cases, within the chest muscle.
Your surgeon’s decision to place your implant over or under the muscle (or a combination of these) is dependent on your anatomy, the incision type chosen as well as your implant shape and size.
Once the implants are in place, your surgeon will close the incision with stitches (which may be dissolvable), and may wrap your breasts in a supportive dressing or support bra.
When you come round, you may be given painkillers to help relieve any pain as the anaesthetic wears off. You will need to arrange for someone to drive you home, and it’s best to have a friend or relative stay with you for the first 24 hours if possible.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon’s advice.
When you go home, you may be wearing a support bra, and you should follow your surgeon’s advice about when to wear this – different surgeons and procedures mean different recommendations.
At both your initial appointment and before you leave the hospital, your surgeon will talk to you about after care and when you should return to your usual activities.
As a guideline you may need around two weeks off work, you shouldn’t do any heavy lifting or arm or chest exercise for around a month afterwards. You may need to reduce your activity for longer periods, dependent on your surgeon’s advice.
Breast surgery is major surgery, so take it easy, and don’t forget to seek your physician’s advice if you feel you need to take painkillers.
The stitches are usually taken out after about a week, though you may have dissolvable stiches, which will gradually disappear on their own.
Talk to your surgeon about what to expect in terms of scarring and what you can do to improve the appearance of scars. Don’t be afraid to ask a lot of questions – it’s better to be well prepared.
Risks and complications
Breast surgery can really change your life for the better, but like any major surgical procedure, there are complications you need to be aware of…
- Capsular contracture
- Other side effects and complications
- All about anaesthetic
What is it, and what causes it?
In the simplest terms, capsular contracture is breast firmness. As your body heals after the placement of breast implants, it forms a capsule of scar tissue around the implant. However, over time, this scar ‘capsule’ may contract or tighten, which can cause your breasts to look and feel different. These changes are often determined by physicians using the Baker Grade scale:
- Grade I Breast normally soft and looks natural
- Grade II the breast is a little firm and looks normal
- Grade III the breast feels firm and looks abnormal (visible distortion)
- Grade IV the breast is hard, painful and looks abnormal (greater distortion)
It can happen on one side, both sides or not at all.
Can it be corrected?
Your surgeon will assess your progress post surgery. If you do have capsular contracture you may require additional surgery to remove the scar tissue around the implants and/or replace your implant(s).
How often does capsular contracture occur?
It’s unpredictable, and can happen soon after surgery or years later. Medical literature describes capsular contracture rates of less then 5% up to 40%, however, breast implant innovations have reduced the occurrence of this complication significantly.
What about scarring and skin ripples?
All surgery results in scarring – it is nature’s way of healing – and the quality of a scar may vary quite a bit from one person to another. Most scars following breast augmentation are pale thin lines. They may, however, become red, firm and elevated. These scars are called ‘hypertrophic’ scars, and though they usually fade with time, they sometimes leave more visible permanent scarring.
Another type of scar, which occurs in some surgical patients, is called a keloid. This is an enlarged scar that does not fade or flatten with time. A surgical correction of the scar might be necessary.
It’s also possible – though rare – to see some visible rippling. This can happen when an implant pulls on the overlying tissues or when the natural folds in the implant are visible through the skin, or if you lose weight. Rippling may be more noticeable if your implants are in the subglandular position
Other side effects and complications
Is it possible to get an infection – if so, what happens?
Like any surgery, there is a risk of infection. Unfortunately, infection around a breast implant is more difficult to treat than an infection in normal body tissues. Though infection usually responds to antibiotics, in rare cases the implant may have to be removed. Once cleared, a new breast implant can be inserted. In extremely rare instances, life-threatening infections, including toxic shock syndrome can occur.
I’ve read that some women develop pain in their breasts after surgery?
Some women who didn’t have pain prior to surgery may have persistent pain afterwards. These pain symptoms are unpredictable and in some patients no cause can be found. It’s best to talk to your surgeon about complications related to surgery, so you’re fully aware of the risks.
Are there any other risks I should be aware of?
A small number of women with breast implants have reported symptoms similar to those of known diseases of the immune system, such as systemic lupus erythematosis, rheumatoid arthritis, scleroderma, and other auto-immune conditions.
What about cancer and breast implants? Does my risk increase?
There is no scientific evidence that silicone gel-filled breast implants increase the risk of cancer. However, this possibility cannot be completely ruled out, and you should of course continue to regularly feel your breasts for lumps, and carry visiting your physician for a regular routine check up.
What are the different kinds of anaesthetic used in surgical procedures?
Risks of Anaesthesia
There are three types of anaesthesia used during surgery, all of which carry some level of risk.
- Local Anaesthetic:
The lowest level of risk is a local anaesthetic, which involves minimal I.V. sedation with injection of local anaesthetic in the area beneath the breasts. Some patients have an allergic reaction to the local anaesthetic or experience a rapid heart beat due to the epinephrine that is used to reduce bleeding. There may be some discomfort intermittently throughout the procedure with a local anaesthetic.
- I.V. Sedation:
A second method of anaesthesia is I.V. sedation (intravenous medications delivered without a tube in the throat). This carries risks of respiratory distress, reactions to the medications or medication overdose. It is recommended that a professional trained in the use of I.V. sedation be available to monitor and administer the medications. The cost for this type of anaesthesia is generally higher due to the cost of the medication and personnel to administer them.
- General Anaesthesia:
A third option is general anaesthesia in which a patient is asleep during the surgical procedure. The risks of general anaesthesia are the same as those of a general anaesthetic used for other operations and can involve respiratory problems, blood clots in the legs, etc. As a rule, the risk is low because women having implant surgery are generally in good health. The expense of general anaesthesia is higher because of the anaesthesia professional needed and the equipment and medications used.
Are there risks involved in reconstructive surgery?
Unfortunately, every surgical procedure carries some degree of risk, and this includes breast reconstruction.
I’m thinking about immediate breast reconstruction surgery – what are the risks?
Patients who choose immediate breast reconstruction at the time of mastectomy must consider the risks and uncertain outcomes from the mastectomy operation. These include the surgical complications related to the mastectomy, possible need for additional surgery to remove residual breast cancer discovered at the time of the mastectomy, possible need for additional breast cancer treatments (radiation and chemotherapy), and local recurrence of breast cancer. In breast reconstructive surgery the use of a permanent or temporary tissue expander in combination with a silicone gel-filled breast implant has become a normal procedure but also increases the risk of complications due to additional surgery. All of these could adversely affect the outcome of immediate breast reconstruction procedures.
Are there different risks to consider if I have delayed breast reconstruction surgery?
Patients who wish to opt for reconstruction at a later stage (i.e. after radiation therapy) instead of immediate breast reconstruction, are exposed to the same risks as with the immediate breast reconstruction procedure.