Breast enlargement surgery (or breast augmentation) is a popular and effective procedure that can enlarge or alter the shape of a woman's breasts using silicone or saline implants. This procedure can be undertaken in conjunction with a breast uplift surgery (mastopexy) which corrects drooping breasts. There are many different kinds of implants available and a range of techniques with which they can be used to improve the shape of the breasts.
Why Choose Breast Enlargement?
There are few issues more personal to a woman than the shape and size of her breasts. Many women feel that their breasts are too small, either naturally, or following pregnancy or weight loss. Other women are concerned that their breasts are not symmetrical or not as firm as they once were. These issues can have a real effect on self confidence and self esteem, and many women feel a loss of femininity. Breast enlargement is a way of regaining confidence and achieving a new and more satisfying body shape, but the decision must not be taken lightly, and must always be done for the right reasons.
Is Breast Enlargement Surgery Right for me?
If you are considering breast enlargement or implants then it's imperative to book a consultation with an accredited and experienced cosmetic surgeon. At the consultation the surgeon will assess your personal needs, discuss the surgical options available to you, help you form realistic goals, and inform you of the potential side effects of breast implants. He or she may also check that you are undertaking the surgery for personal reasons, and not to please or satisfying another party.
The options that will be discussed are: whether to have saline or silicone implants; round or teardrop shaped (anatomical) implants; the implant's size, and whether it will be placed behind the breast tissue or the chest wall muscle (pectoral). The surgeon will explain the benefits and risks of each choice, and how it relates to your body shape: for instance, very slim women are commonly advised to have anatomical implants in order to create a more natural contour. Round implants, in very lean women, can sometimes show an upper edge which creates a stuck-on appearance. The surgeon may recommend you try various bras with different size fillers to get an idea of what each size implant would eventually look like on your body.
You should only choose to have surgery if you are entirely comfortable with the procedure, happy with the breast implant cost, and 100% confident with your surgeon.
What Happens During Surgery?
Breast augmentation surgery takes place under general anaesthetic and normally takes between one and two hours. The surgeon will either make an incision under the breast, around the nipple or by the arm pit. The size of the incision depends on where the implant is being placed. Once the implant has been successfully placed, the incision is closed with stitches. The breasts are then wrapped in a dressing or support bra, and fine plastic tubes are sometimes left in the breasts for a few days to allow sufficient drainage of blood and fluids.
What can I Expect After Surgery?
You may feel discomfort and hardness in the breasts following your operation, including some swelling and bruising. These symptoms can be managed with painkillers, but may last a few weeks. Stitches will be removed after one or two weeks. Scars should fade continuously for the next twelve months.
There are complications that are specific to breast enlargement. UK cosmetic procedures are generally carried out safely and effectively, but there are inherent risks and limitations with all surgery, and it's important to be fully aware of the possible risks and side effects you may encounter before you go ahead.
- Capsular contracture. This one of the more commonly occurring complications caused by the formation of fibrous scar tissue around your implant. Depending on the severity, or grade, of the contracture you may require surgery to either release the capsule or to reposition the implant.
- Haematoma and Seroma. Haematoma is a pool of blood that has collected within a bodily cavity. Seroma is tissue fluid that has collected around the site of the operation. These can sometimes make capsular contracture or infection more likely and often require drainage, potentially surgical.
- Implant displacement. Rarely, implants can move or displace after surgery. Sometimes it is unnoticeable, but large displacements need to be repositioned surgically.
- Infection. This is very rare, less than 1% of cases result in infection, but if infection does occur it necessitates removal of the implants and reinsertion at a later date.
- Necrosis. Necrosis is dead tissue that can occur at the operative site and impair the healing process, which could require corrective surgery. Sometimes skin necrosis can lead to permanent undesirable scarring.
- Galactorrhoea. This is the production of breast milk, which is very rare, but can occur after surgery. The production usually ceases spontaneously, but in certain rare instances requires removal of the implants.
- Mammography. Breast implants can sometimes affect mammography readings as they obscure some of breast tissue. This is most commonly associated with implants placed under the breast tissue as opposed to those placed beneath the pectoral. Implants do not interfere with ultrasound examination, self examination or MRI breast scanning. There is no evidence linking breast implants with cancer, but if you have a history of breast cancer, it's advisable to avoid implants because of the possible impairment of the mammography process.
- Nerve damage. Numbness or loss of sensation around the nipples and incision sites may occur temporarily and sometimes permanently. This is more likely with implants above the chest wall muscle and where incisions were made around the areola.
- Implant rupture/leak. Silicone implants may leak due to age, injury, or capsular contracture. Often women notice breast reduction, lumpiness, asymmetry, and pain or tingling. Implant rupture often requires removal by surgery.
In the ideal breast, the nipple is level with the centre of the upper arm. Pregnancy, breast feeding, weight loss and the passage of time can all cause breasts to droop, with associated loss of volume and elasticity. If you feel that your breasts have begun to droop you could consider breast uplift surgery.
Unlike reduction surgery, breast uplift does not aim to change the size of the breasts, but to restore a more youthful and attractive shape to the breasts. This is done by removing sections of slack and redundant skin and reshaping the breast tissue. Some stretch marks may be removed, but most will remain.
Uplift surgery may also be combined with breast enlargement surgery, but it is important to remember that a sensible breast size will last longer. An uplift will not prevent your breasts from drooping again from the same causes that caused them to droop originally.
Depending on the technique used, breast uplift should not interfere with breast-feeding, making it an option for women who have not finished childbearing.
During your consultation, your surgeon should take a medical history and ask for details of any breast surgery you may have had. He should also inform you about the scarring that can result and explain the various options available.
Breast uplift typically produces scars around the areolas. In addition, you may have scars down to and along the breast crease. The amount of scarring can vary depending on your initial shape. Your surgeon should explain the extent of scarring to expect.
• If your breasts have not drooped significantly and an increase in their size would be acceptable to you, breast augmentation alone may be a better way of lifting and firming them.
• In other cases where breast droop is minimal, your surgeon may suggest a technique that causes less scarring, or he may advise against having surgery at all.
What to expect from your operation
Also known as breast ptosis correction, breast uplift surgery usually takes about 2 hours. It is done under general anaesthesia and usually requires an overnight stay in hospital.
During the procedure, skin is cut away above, below and around the nipple and areola. The breast tissue is reshaped in order to achieve a better contour and enhanced projection. The remaining skin is then stretched taut, rejoined and the nipple is repositioned. Because this type of surgery interferes less with the nerve supply to the nipple areola, sensation is usually preserved
As a routine precaution against blood clotting you should be advised to wear anti-embolism (TED) stockings until you are discharged. Expect to get out of bed and move around as soon as possible after surgery.
Immediately after surgery the shape of your new breasts should be apparent, with less drooping and the nipples in a higher position. It will take around 6 months for your breasts to settle into their final shape. During your recovery there are several things you should expect.
• Following surgery your breasts will probably be uncomfortable and possibly painful. You should be provided with sufficient pain relief by your surgeon. After your discharge a mild pain killer such as paracetamol can be used. Aspirin must be avoided because it can promote bleeding. If you experience a prolonged period of pain, you should seek advice from your surgeon.
• Drainage tubes may have been inserted at the end of the operation to remove fluid or blood after surgery. These are removed once any oozing has stopped. New, light tape dressings should be applied before you go home. These should be kept dry and in place and your wounds should be checked about 7 days after surgery.
• Showers and shallow baths are possible, however it is important to keep your tapes dry.
• You may begin wearing a soft, comfortable bra immediately after surgery.
• Bruising is to be expected, but should subside in 2 to 3 weeks. To speed the resolution of bruising and swelling you may take arnica for 1 week before surgery and 2 weeks afterwards.
• As with any surgery, there is a possibility of infection after breast uplift. This is can be treated with antibiotics and/or dressings.
• If you are a smoker your healing may be delayed. Likewise drinking alcohol to excess after surgery could increase your risk of bruising and bleeding.
• You may feel somewhat tired for about 2 weeks after your surgery. If you tend to be anaemic or have heavy periods consider taking some iron and folic acid supplements. You may drive after 3 or 4 days, but avoid vigorous exercise for 2 weeks. If you wish to fly within 4 weeks after surgery, consult your surgeon.
• Immediately after your surgery, the skin around your incisions may appear slightly folded and your scars may be hard, red, raised and lumpy. It can take up to 18 months for your scars to flatten and resolve depending on your particular healing characteristics. Moisturising and massaging the scars can help them to soften more quickly.
• Your scars will eventually return to a normal skin colour but will always remain visible
Male Breast Reduction
What is male breast reduction?
Male breast reduction surgery is a common and popular procedure that removes excess fat and tissue from male breasts, and flattens skin to improve shape and contours, leading to a more pleasing and masculine appearance for men with enlarged breasts.
Why choose male breast reduction?
For a number of men, having enlarged breasts (gynaecomastia) can cause embarrassment, distress, and a loss of confidence. When men have large breasts it is often linked with obesity, but this is not always the cause. In certain cases, men can have abnormal glandular breast tissue growth, often associated with a hormone imbalance, possibly heightened levels of the female hormone oestrogen. Other potential causes of enlarged breasts may be: excess alcohol consumption, drugs such as anabolic steroids, or a big loss of weight resulting in sagging skin. Male breast surgery for gynaecomastia presents a good option for men who wish to change the appearance of their breasts, but must be weighed up against other options.
Is male breast reduction right for me?
If you are considering male chest reduction surgery, then you need to book a consultation with an experienced and accredited surgeon. This procedure is not recommended for everyone, and has best results for fit, mentally stable men with good skin elasticity and firm skin. Obese men are advised to pursue a regime of healthy eating and exercise, and there are other non-surgical options available such as male breast reduction creams.
At your consultation, the surgeon will assess your individual needs and decide what course of treatment presents the best way forward. He or she will help you formulate a realistic and achievable goal, and give you a breakdown of the costs involved.
What is involved in male breast reduction surgery?
Surgery is performed either with sedatives and local anaesthetic, or under general anaesthetic, and takes between one and three hours depending on the individual.
If the condition is caused mainly by excess fatty tissue (pseudo-gynaecomastia) then liposuction will be probably be used. This is a technique where fat cells are broken down and then sucked out via a hollow tube (cannula). Small incisions are made at the areola to allow the cannula to enter, and after the process is finished the incision is stitched. The scars usually heal very well and are not too noticeable.
If the condition is caused by excess glandular tissue (gynaecomastia), liposuction is sometimes not adequate. Small incisions are made at the edge of the areola or at the armpit, and glandular tissue is then cut away using a scalpel. In certain cases liposuction may be used in conjunction with this technique. If a large amount of tissue is removed, this may necessitate larger incisions and the removal of excess skin.
What happens after male breast reduction surgery?
After male breast reduction surgery, a drain is put in place to ensure that excess fluids or blood does not build up in the body. A pressure garment should be worn for around one to four weeks, and for this time the chest will remain tender. Painkillers can be used to alleviate any discomfort, but aspirin needs to be avoided as this can promote bleeding.
Male chest reduction surgery is usually performed as either a day case, but sometimes the patient is required to stay in hospital overnight. It’s recommended that you take two to three weeks off work, and that you don’t do anything strenuous or play sport for up to six weeks.
Are there any risks involved in male breast reduction surgery?
No surgery is one hundred percent safe, and this procedure is no exception. There are inherent risks associated with procedures carried out under general anaesthetic such as lung or heart problems, but with modern medical techniques, these are very rare. Sometimes there can be bleeding or infection after surgery, but these can usually be dealt with by using antibiotics and drains. You may find that there is hypersensitivity or loss of sensitivity in the nipple area, but this is usually temporary, although it has been known to be permanent in some cases. Scars may be bumpy or red for a while, but over time these should fade and begin to match you natural skin colour.
Breast reduction can bring significant relief to women with large, heavy breasts, which can be uncomfortable both physically and psychologically. The excess weight of large breasts may cause back and neck pain, skin irritation and in extreme conditions, skeletal deformities and even breathing difficulties. Many teenage girls and women are also extremely self conscious about the size of their breasts.
Breast reduction surgery (reduction mammoplasty) removes fat, glandular tissue and skin from the breasts and should leave them smaller, lighter, more lifted and firmer. The size of the areola (the darker skin surrounding the nipple) can also be reduced to bring it into proportion with the new, smaller breasts.
Your goal should be attractive breasts that are in proportion to the rest of your body.
During your consultation, your surgeon should take a medical history and ask for details of any previous breast surgery you may have had. He should examine you and show you what your after surgery effect may be, by defining the area of breast to be removed and the new position of the nipple.
Your surgeon should also explain the procedure itself and ask what sort of results you would like to achieve. If you are suffering from significant neck and shoulder pain you may think that very much smaller breasts are desirable, but your aim should be for attractive breasts that are in proportion to the rest of your body. In addition, your surgeon should:-
- Explain that it is normal for most women to have breasts that are slightly uneven (asymmetric). Whilst he may attempt to make your breasts as symmetrical as possible they will never be truly identical.
- Explain that scarring will take place and although in time these will return to skin colour, they will remain visible.
- Tell you that after breast reduction surgery, breast-feeding can be unpredictable. If this is of concern to you, you may wish to delay surgery until you have completed your family.
What to expect from your operation
Breast reduction surgery should be carried out under general anaesthesia and will require 1 or 2 nights' stay in hospital. The procedure will normally take around 2 hours.
- Having marked the incision site pre-operatively, the surgeon will remove excess skin and glandular tissue from the breast, leaving the nipple on a stalk (pedicle). The nipple is then repositioned in a lifted position.
- The suture line is anchor-shaped and extends around the new position of the nipple, downwards to the crease under your breast (intramammary fold) and outward toward the underarm area. In some cases, depending on the amount of tissue removed, it is possible that you would have only a single vertical scar.
- Dissolvable sutures, which do not need removing, are used. Dressings should be applied and you should receive intravenous fluids for several hours.
Drainage tubes should be inserted at the end of the operation to remove fluid or blood after surgery, which are removed once any oozing has stopped. New dressings should be applied before you go home.
Blood clotting can sometimes be a problem with this procedure, so you should be told to wear anti-embolism stockings (TEDs) as a precautionary measure. These should not be removed until you are advised to do so. Expect to get out of bed and move around as soon as possible.
Immediately after surgery your new breast size will be apparent. It will take up to 6 months for your breasts to settle into their final shape.
During your recovery there are several things you should expect.
- Following surgery your breasts will probably be uncomfortable, possibly painful. Your surgeon should provide you with sufficient pain relief. After returning home mild painkillers can be taken, such as paracetamol. Aspirin must be avoided as it can promote bleeding.
- Your dressings should be kept clean and dry for 1 to 2 weeks following surgery to allow healing to occur. You should wear a soft, well-fitted bra for 6 weeks after surgery.
- You may experience bruising and swelling and this will cause your new breasts to appear larger than anticipated. This should improve markedly in 2 or 3 weeks and settle within 2 to 3 months. To help decrease swelling and bruising, you may be advised to take arnica for 1 week prior to surgery and 2 weeks afterwards.
- Bleeding. If you are a smoker your healing may be delayed. Likewise drinking alcohol to excess after surgery could increase your risk of bruising.
- Your scars may initially be hard, red, raised and lumpy and can take up to 18 months to become pale and flat. This will depend on your individual healing qualities. Moisturising and massaging the scars can help them to soften more quickly.
- You may experience numbness of your nipples and the surrounding skin in the early stages after surgery. This is not uncommon and sensation should return.
- The blood supply to the nipple stalk may be inadequate and part or even all of the nipple may die. In this case you may wish to consider reconstruction of your nipple in a secondary procedure.
- Although your surgeon is careful to stop any bleeding points, occasionally a blood vessel may leak, causing a significant collection of blood (haematoma) and may necessitate a return to theatre. If a haematoma is very minor, natural re-absorption takes place.
- As with any surgery, there is a possibility of infection, which can be treated with antibiotics and/or dressings as required.
- You may feel tired for up to 2 weeks after surgery. If you tend to be anaemic or have heavy periods consider taking some iron and folic acid supplements.
- You can commence driving after the first week, but avoid vigorous exercise for at least 3 to 4 weeks. If you wish to fly within 4 weeks after surgery, consult your surgeon.
List of possible complications
Bleeding, infection, asymmetry, haematoma (3-4% risk), seroma (collection of tissue fluid), heavy scarring, nerve damage-may result in permanent numbness to the nipple, sensory change to the breast as a whole, nipple loss (1% risk), dissatisfaction with breast size/position, adverse reaction to medications, slow healing, skin loss, fat necrosis (breakdown) skin irregularities, visible scars, and interference with future lactation.
Some minor discrepancy in breast size is not uncommon following a mastopexy or breast reduction, although major discrepancy is very rare. One should remember that breasts naturally exhibit minor variations in size and shape.
Fat necrosis, or fat breakdown, can be seen following a mastopexy and breast reduction. It is usually a minor problem that does not require intervention, but larger areas of necrosis may require corrective surgery. The risk of fat necrosis occurring increases with the size of the surgical resection. The overall risk of fat necrosis has been reported as 0.8% in a study including over 370 patients.
Most patients will experience some initial temporary alteration in nipple sensation following a mastopexy or breast reduction. The altered sensation usually spontaneously resolves in a number of weeks but for a small number of women may be permanent.
Occasionally there are problems with wound breakdown that require further dressings, or sometimes, further surgery.
Breast reduction by liposuction
Liposuction removes excess fat and if there is enough elasticity in the skin it will retract producing a lift of the breast. Liposuction may be advantageous as is produces less trauma, has a faster recovery, has smaller scars, and has fewer post-operative complications. Not everyone is suitable for breast reduction by liposuction; suitable candidates are those with firm, elastic skin with an underlying breast that has a large proportion of fat. Your surgeon will be able to advise you if you are suitable for this kind of surgery. Groups of women that may be more likely to be suitable include:
- Women that do not have very large or pendulous breasts
- Women that are not very thin (very thin individuals have less fatty breasts)
Women past the menopause
Breast liposuction will reduce the size of the breast but will retain a very similar shape to the breasts before surgery. There will be swelling that will subside fully over a period of a few months to reveal the final size of the breasts. Occasionally there may be some "lumpiness" to the breasts following liposuction, this is normal and part of the healing process, it typically resolves after a couple of weeks following surgery.
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