Breast Augmentation (Enlargement)

A breast augmentation is an operation to increase the size of your breasts, usually by using silicone implants. This procedure has become increasingly popular over the years and is one of the most common cosmetic surgery procedures with 5000-10000 cases annually in the UK.

Breast Augmentation surgery does not alter your chest measurement, but will alter your cup size. 

Mr Sharma will not be able to guarantee a cup size, but your breast size is likely to be appropriate to your height and body structure.

You may be having or benefit from this operation because you:

• Are not happy with the size and shape of your breasts.
• Your breasts have become smaller or lost their shape after pregnancy or losing a lot of weight
• Wish to correct uneven breasts (asymmetry).

In breast augmentation Breast implants can be placed:

1.  Under the native breast tissue (Sub-glandular or Sub-mammary)

2. Under the pectoralis major muscle (sub- pectoral or sub-muscular) 

3. Under both (Dual Plane)

The determining factors for which plane to have your implants placed will be discussed in your consultation with Mr Sharma but is usually dependent upon your own anatomy and the amount of breast tissue you have. 

• Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) Recent studies have shown that women with breast implants have a small risk of developing this rare tumour (latest incidence estimated to be around 1:15000 as of November 2021) in the breast tissues surrounding the implant. The main symptoms of this disease are persistent swelling, presence of a mass or pain in the area of the breast implant. The association of this rare tumour has been linked primarily with textured silicone breast implants, however, worldwide research is still investigating the exact cause which is currently not known. In most patients, it is treated successfully with surgery to remove the implant and surrounding scar tissue, and in some cases also treatment with chemotherapy and radiation therapy.
  Mr Sharma uses smooth (nanotextured) implants which to date worldwide have not had any primary cases of BIA-ALCL
• Breast Implant Illness A group of women report a spectrum of symptoms that they attribute to having silicone breast implants and in some cases these go away when the implants are removed. Currently there is no scientific evidence to support this disease as some of these symptoms also occur in women of similar age who do not have silicone breast implants. However, science about this condition is likely to evolve and develop.
• PIP Implant Scandal In 2010 PIP Implants withdrawn from the UK as they were reportedly manufactured with unapproved silicone gel and were therefore more prone to rupture than other silicone implants. Mr Sharma has never used PIP implants but has removed and replaced them with new non PIP implants for women who have had them put in somewhere else. For more information see link: www.nhs.uk/conditions/pip-implants
• The life expectancy of a silicone implant may vary and can range on average from 7-12 years, see above.

In the majority of cases this operation is carried out very successfully with good cosmetic results, however as with any surgical procedure there is a small chance of side effects or complications. This is a list of potential complications that you need to be aware of:

• Bleeding You may have excessive bleeding from within the breast envelope, which may result in a collection of blood (haematoma) beneath the wound site.  If this occurs you could experience excessive pain and swelling in the breast tissue. The collected blood may need to be removed in the operating theatre; this may necessitate another operation.
• Wound infection There is a risk of wound infection, which can occur at any time following surgery. Symptoms of infection may include increased swelling, redness, fluid leakage, which may smell offensive, and increased pain at the site of the operation. If your wound becomes infected you may need treatment with antibiotics, occasionally this may mean admission to hospital for antibiotics to be given through a drip. After a wound infection, healing may be delayed and you may need dressings for a longer period than normal. If the implant is infected it will have to be removed, the wound be allowed to settle for a few months and then if all well consideration of putting a new implant in.
• Wound breakdown Wound breakdown may occasionally occur following surgery. It may happen if the stitch line does not heal properly and the wound may breakdown or gape. If this happens you will require dressings for a longer period of time; rarely, a further operation may be needed as your breast implant may have to be removed as a result of the wound breakdown and or infection. After wound breakdown your scar may not have as good a cosmetic result than if your wound had healed without problems.
• Scarring You will have permanent, visible scars on your skin. Scars tend to improve over a period of 18 months following surgery.  In some people, for unknown reasons, scars can become raised, red and lumpy; unfortunately this is largely beyond surgical control. The risk of this occurring on the breast is greater if you have already developed thickened scars following accidents or operations elsewhere. The way a scar develops depends as much on how your body heals as it does on your surgeon’s skills. Mr Sharma has been trained in and uses a technique of minimal scar suturing to help achieve the best scars for his patients. He also has a regimen of scar management that he advises his patients to follow to achieve the best results.
• Difference in size or shape of one breast compared to the other (asymmetry) After augmentation, some degree of asymmetry of shape and size of the breast and of the scarring may be evident. It is not always possible to produce a natural cleavage, and your implant may not drop to the side when you lie down. Your implanted breasts may feel firmer than your natural breasts.
• Nipple and skin sensation You may have reduced or permanent loss of sensation to your nipple or breast skin after this operation. Hypersensitivity may occur to the nipple areola, which maybe self-limiting.
• Capsular contracture Over time your body may form a wall of scar tissue known as a fibrous capsule around your breast implant. This capsule contracture is noticeable as an apparent hardening of your breast. When this happens you may need a further operation to remove the capsule or release the scar tissue, and if appropriate, to replace the implant
• Rupture of a silicone implant Rupture means the development of a split or hole in the implant. Breast implants are thought to have a life expectancy of 7 –12 years, however this does not mean an automatic replacement at this time. If your implant ruptures you may need a simple operation to remove or exchange it.
• Leakage of silicone If your implant ruptures, the silicone gel will usually remain within the capsule that the body forms, and can be removed if the ruptured implant is removed.  Occasionally the silicone can spread outside the capsule and into the breast, surrounding tissues or into the armpit, where it can form small lumps known as siliconomas or silicone granulomas.  In this case some breast tissue may be lost when the implant is removed.
• Creasing and folding of the implant As you develop a capsule around your implant you may notice kinking, rippling and visible or palpable folds in the implant.  These are most often seen in women with very little breast tissue.
• Breast feeding Primary breast augmentation surgery does not usually interfere with your ability to breast-feed, though there is some evidence indicating that the amount of milk produced by some women with breast implants is reduced.
• Mammography Breast implants could interfere with the ability of medical imaging to detect the early signs of breast cancer.  Whenever you have a mammogram you should tell your radiographer that you have implants so that the most appropriate method of screening can be used. Mr Sharma recommends that any women aged 40 or over have a recent mammogram prior to undertaking any cosmetic breast surgery procedures.
• 'The silicone controversy' It has been reported that a number of women have experienced serious illness following silicone gel implant surgery.  The Independent Review Group (IRG) (1998) found no scientific relationship between silicone gel implants and immune reactions, or with any specific or non-specific illness affecting the whole body.
• Stretch marks These are likely to worsen after augmentation and on occasions may develop as a result of the operation.
• Prominent veins The veins under the skin of your breast can become more prominent with implants.
• Cleavage Your cleavage may appear widened following this operation and cannot be guaranteed in its width or narrowness.
• Rotation of implants This may occur in a small number of people when shaped implants are used and may require an operation to correct it.
• Waterfall effect Your breasts go through dynamic changes throughout your life and once you have had breast implant surgery this does not change. Often with age related changes your native breast tissue may start to “droop” in front of the implant. This is more common in implants placed under the muscle as the muscle holds the implants whilst the native breast tissue is susceptible to gravitational changes usually with age. This leads to a “waterfall effect” of the breast appearance.
• Double bubble This is when the breast implant drops inferiorly behind the natural crease (inframammary fold) where the breasts meet the chest.

It is normal to have some bruising, swelling and tenderness around your breasts following the operation. On occasions you may experience self-limiting hypersensitivity of the nipple areola complex. 

Although all operations carry risks, Mr Sharma implements safe techniques and measures to mitigate these risks, though these can still possibly occur.

If you suffer from any of the following symptoms after your discharge from hospital you should telephone the hospital immediately:

• Persistent or increasing levels of pain.
• Fever.
• A feeling of heat in your breasts.
• Redness or swelling of your breasts.
• Tiredness or fatigue that lasts longer than three weeks.
• Shortness of breath or pain when you breathe in deeply.

Recent studies have shown that women with breast implants have a small risk of developing this rare tumour (latest incidence estimated to be around 1:15000 as of November 2021) in the breast tissues surrounding the implant. The main symptoms of this disease are persistent swelling, presence of a mass or pain in the area of the breast implant. The association of this rare tumour has been linked primarily with textured silicone breast implants, however, worldwide research is still investigating the exact cause which is currently not known. In most patients, it is treated successfully with surgery to remove the implant and surrounding scar tissue, and in some cases also treatment with chemotherapy and radiation therapy.

Mr Sharma uses smooth (nanotextured) implants which to date worldwide have not had any primary cases of BIA-ALCL (as of November 2021).

A group of women report a spectrum of symptoms that they attribute to having silicone breast implants and in some cases these go away when the implants are removed. Currently (as of November 2021), there is no scientific evidence to support this disease as some of these symptoms also occur in women of similar age who do not have silicone breast implants. However, science about this condition is likely to evolve and develop.

• You will be given an appointment to return to the dressing clinic for a wound check usually within 7-10 days of your operation
• You will need dressings until your wounds have healed, these may be done at the dressing clinic.
• You will need to wear a well-fitting, supportive bra without wires such as a sports bra, after the surgery and after the dressings are first removed. This bra can be worn over dressings and should be worn day and night for a period of time specified by Mr Sharma.
• A breast band will be worn over the bra to ensure implant stability and prevent swelling following the surgery, the band will be placed on the top part (upper pole) of your breasts, this will be applied in theatre and must be worn, along with the bra, at all times during the first 6 weeks.

Please see below recommended garment purchases in readiness for surgery requirements:

• An underwired bra is not worn until 8 weeks have elapsed
• Once your wounds have healed, massaging your scars regularly may help them to settle down. Massaging your breasts may also be of benefit.
• You will receive an appointment to see Mr Sharma in clinic at approximately 6 weeks following surgery. This follow up regimen may vary.

Recommended bras and breast band

Please purchase the sports bra and breast band, combined or separate garments and bring to the hospital on the day of surgery.  The bra and band can be applied in theatre or when you return to the ward. The bra will be the same measurement around your body, the cup size will generally go up a cup size but this is difficult to gauge. If possible purchase a few bra sizes and seek advice from the company if the bras are not worn can they be returned.

2 web sites to browse will give an idea of what is recommended and bras and bands can be purchased from these companies:

www.eurosurgical.co.uk
Design Veronique – breast wear brochure

www.macom-medical.com
post-surgical-compression-garments/womens/post-surgical-compression-bras

• You should not drive until you can wear a seat belt comfortably and feel able to perform an emergency stop, this could be up to 6 weeks following surgery. Your insurance company may refuse to meet a claim if they feel you have driven too soon. It is also advisable to contact your insurance company with regards to cover following a general anaesthetic.
• You should not go back to work until instructed by Mr Sharma. This could be in the region of 2-6 weeks depending on your job and the exact type of surgery you had.
• Please ask if you need a doctor’s certificate for your work.

You may resume sporting activities approximately 6 to 8 weeks after your surgery, however you should stop if you experience pain or discomfort during the activity.  You should wear a well-fitting sports bra during any sporting activity.  

The following websites have useful information links:

www.plasticsurgery.org/ALCL
www.bapras.org.uk

Download a BAAPS patient information leaflet for breast augmentation by clicking here

This state of the art software is used to generate a high resolution 3D image of what your own body is likely to look like after breast augmentation surgery. 

To find out more click here to visit the Crisalix 3D information page