Breast Augmentation
The Operation Depending on the size of the breast, a pocket is surgically created either underneath the breast tissue or underneath the muscle underneath the breast. The surgery is performed under general anaesthesia. Depending on the type of implant used, it can be performed either through a scar around the nipple, a scar underneath the breast, a scar in the armpit or very occasionally, through a scar around the belly button.
Any Alternatives
In the past, silicone itself was directly injected into the breast tissue but this is not something that is recommended at present. There are some external suction devices, which can be applied to the breast, and this has been reported to increase breast size following sustained use. It is not as yet absolutely clear if this is a permanent increase in size. Sterile derivatives of Soya Oil have also been used as 'fillers' for implants but these should no longer be used.
Before the Operation It is important for your surgeon to assess the type of breast augmentation that is requested. It is also important to understand why it is requested, as to whether it is brought about by a change in life circumstances or a problem that has been ongoing for some time. It is also important to try and understand the patient's expectations as to the outcome and size of breast implants. There are a large number of breast implants available and the exact type of implant, whether round, shaped, containing saline sterile solution or silicone jelly, would all need to be discussed in detail with your surgeon prior to the operation. Pre-operative review would also assess how fit you were for surgery. The type of scar and the exact site and placement of the implant would be discussed in combination with a physical examination of your breasts. This will indicate the extent of breast tissue that is available and where the implants should be placed. The size of implants should also be discussed taking into consideration the amount of skin laxity and breast tissue that is present. If the breasts are very droopy, breast augmentation alone may not be sufficient and corrective surgery may be required in order to place the nipples in a different position. The site of the scarring would also be agreed. It is likely that the surgeon may also want to take some photographs prior to surgery. These are kept in your patient records. Your surgeon is likely to have the type of implant available for you to feel and understand how it works. It may also be helpful to get an idea of the type of volume that you require by filling bags of water with various volumes of fluid to gauge the breast size that you might wish for.
After in Hospital
The operation is likely to take around one hour. On return to the ward you will have dressings around your new breasts and these may be in the form of a comfortably fitting bra, or some wrap-around padded dressings. It is also likely that there will be drains in each breast. You may be nursed in a semi-upright position, as this can tend to minimise swelling and hence make you feel more comfortable. Your chest may feel quite sore following your return to the ward. The nurses will be able to give you painkillers for this, either by injection or tablet form. You may also feel your breathing somewhat restricted as the surgery to create the pockets to place the implants can often make the chest feel slightly tight. The nurse will make regular checks and monitor blood pressure, pulse and temperature. The drains are usually taken out on the day following surgery. Should there be more fluid in the drains than expected, you may well be able to be discharged from hospital and then return to have the drains removed a few days later.
After at Home
It is important that you rest on your return home. Excess use of the arms and upper chest area by regular activities which one would normally undertake can cause further irritation and bleeding. It is best to continue to wear a firm tight fitting bra both night and day for a further two weeks. The bra may be removed for washing but one should avoid getting the wounds wet for probably one week following surgery. You should also avoid sleeping face downwards for one month. It is probably best to avoid doing any heavy activities, particularly lifting the elbows above the shoulder level, or any heavy lifting for a further three to four weeks. You may also find that your nipples have altered sensation following the surgery but this is likely to improve as time passes. The scars themselves may be massaged from two weeks following surgery. However, it is not often necessary to massage the breasts themselves. It is probably best for you not to drive for at least a week following surgery. You should then be quite sure that you are able to perform an emergency stop.
Complications
As with any surgical procedure, bleeding can occur but the drains that are left after the operation are usually sufficient to control this. Very occasionally if bleeding continues to be a problem, it may be necessary to return to theatre to stop the bleeding. In making a pocket into which is placed the implant, one of the structures that can occasionally be damaged is the nerve supply to the nipple. This can result in complete loss of sensation to the nipple but more often results in either decreased or very occasionally increased sensitivity. This increased sensitivity can be uncomfortable. Any time an object is placed within the body, the body forms a film around it. This film can occasionally instead of staying nice and loose, increase in thickness, become scarred and occasionally become uncomfortable. This is known as 'capsule formation'. This tends to occur in about 10% of patients who have breast augmentation. It occasionally will only affect one side as opposed to both sides where bilateral breast augmentation has been performed. The type of capsule can vary from a firm feeling to one where the breast becomes very firm and hard, like a tennis ball. In these situations the treatment depends on the ongoing problem. Occasionally it may be necessary to remove the implant entirely and to replace it. Infection can also occur. If the implant becomes infected then it is likely that the best option is to remove it. There has been some controversy as to the use of silicone implants. Many surgeons continue to use silicone implants both for reconstruction and for aesthetic augmentation. There have been a number of studies which indicate that there is no definite evidence that silicone causes any problems within the body. However, there are undoubtedly some people who have had breast implants that do have some unexplained symptoms. Most people benefit from having breast augmentation performed.
General advice
Having a bilateral breast augmentation performed can be somewhat uncomfortable. It is important to avoid driving for about a week following surgery and to be sure that one is able to perform an emergency stop. If the sensitivity of the nipple has been altered by the surgery, this may take some months to recover and indeed may never fully return to normal. It is important that placement of the implants is discussed with the surgeon prior to surgery. The implants will tend to stay where they are placed and will not move around the chest wall, as a normal jelly-like breast would do. The patient would need to have an understanding about this prior to surgery.
Breast Lift (Mastopexy)
A breast lift is a surgical procedure to raise and reshape breasts that have sagged as a result of pregnancy, nursing, and the natural force of gravity. Mastopexy is not permanent – since no surgery can permanently delay the effects of gravity but it can reduce the size of the areola, the darker skin surrounding the nipple.What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility, and takes 1˝ - 3˝ hours, but depending on the extent of the procedure, it can take longer. If you are having more than one procedure, overnight hospitalization may be required.
Breast lift surgery can be performed under local anesthesia, along with intravenous sedation, or general anesthesia depending on your health, the extent of the procedure and whether you are having other procedures at the same time. Techniques vary, but the most common procedure involves an anchor-shaped incision following the natural contour of the breast. The incision outlines the area from which breast skin will be removed and defines the new location for the nipple. When the excess skin has been removed, the nipple and areola are moved to the higher position. The skin surrounding the areola is then brought down and together to reshape the breast. Stitches are usually located around the areola, in a vertical line extending downwards from the nipple area, and along the lower crease of the breast.
Are there risks or potential side effects? As with all surgeries, there is always a possibility of complications including infection, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Should infection occur, your surgeon will prescribe a treatment with antibiotics. Bleeding and infection following a breast lift are uncommon, but can cause scars to widen. You can reduce your risks by closely following your physician's advice both before and after surgery. Be sure to ask your surgeon about all of the risks associated with the procedure your considering before you make any decision.
A breast lift does leave noticeable, permanent scars. They often remain lumpy and red for months, then gradually become less obvious, sometimes eventually fading to thin white lines. Poor healing and wider scars are more common in smokers. The procedure can also leave you with unevenly positioned nipples, or a permanent loss of feeling in your nipples or breasts.
A breast lift will not make breasts firm forever--the effects of gravity, pregnancy, aging, and weight fluctuations will eventually take their toll again. Women who have breast implants along with their breast lift may find the results last longer.
What to expect post-procedure? An elastic bandage or a surgical bra over gauze dressings must be worn after surgery. The breasts will be bruised, swollen, and uncomfortable for a several days, and the level of pain ranges from person to person.
The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily. The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep yourself elevated to limit the amount of swelling. Applying cold compresses, or ice packs can reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with frozen berries or peas. Regular icing is the key to relieving swelling.
Within a few days, a soft support bra will replace the bandages or surgical bra. This bra must be worn constantly for several weeks over a layer of gauze. The stitches will be removed after a week or two.
Breast skin can be very dry following surgery, careful application moisturizer several times a day can alleviate this somewhat. Some loss of feeling in your nipples and breast skin can occur, which is caused by the swelling after surgery. Feeling usually returns as the swelling subsides over the following six weeks. In some patients, however, it may last a year or more, and, occasionally, may be permanent.
As with any surgery, it is also sometimes normal to feel anxious or depressed in the days or weeks following the operation. If there is heavy bleeding or increased pain, be sure to inform your surgeon.
How soon does normal life resume? Healing is individual. Some patients may be up and about in a day or two, but you shouldn’t plan on returning to work for at least two weeks. All patients should avoid lifting anything over your head for three to four weeks.
It is important to follow your surgeons instructions for resuming your normal activities. You may be instructed to avoid sex for a week or more, and to avoid strenuous sports for about a month. After that, you can resume these activities slowly. If you become pregnant, the operation should not affect your ability to breast-feed, since your milk ducts and nipples will be left intact.
Who performs it? A plastic surgeon normally performs a breast lift.
Are you a good candidate? While breast lift surgery can improve a woman's body image and self-esteem, it does not remedy pre-existing psychological and personal problems. As with all elective surgery, good health and realistic expectations are prerequisites, however, if you want to change the look of your breasts then this procedure may be appropriate, but:
How to prepare for this procedure? Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:
Breast Reduction
What is it?Breast reduction is the removal of excess skin and breast tissue with re-positioning of the nipple to a higher situation. It is most frequently performed for heavy breasts that results in physical problems, rather than for cosmetic appearance.
The Operation
The surgery is performed under general anaesthesia. There are different techniques depending on how big the breasts are and how much tissue needs to be removed. The surgery is performed with pre-operative marks as guidelines. In moderate size breasts the nipple is left attached to underlying breast tissue, excess skin and breast tissue is removed and then the nipple is placed in a new higher position. The remaining skin and breast tissue is sutured together. The types of scars that commonly arise are, a scar that goes around the nipple at its new position and a scar that extends from the new nipple position downward underneath the breast. In bigger breasts, there is often a scar that goes underneath the breast from the midline to the side. Drains are usually required and a supportive dressing is placed after surgery.
Any Alternatives Weight loss can occasionally make breasts smaller but this does not usually lead to re-positioning of the nipple in a higher more youthful appearance. Weight loss can also cause empty sagging breasts.
Before the Operation Breast reduction surgery takes between two and three hours to do and therefore is a major operative procedure. It is important that the patient's general health has been assessed and it is advisable to stop smoking. The surgeon will visit pre-operatively and discuss the size the patient wishes. Marks will then be placed on the patient's chest according to the type of operative procedure to be performed. Blood tests may also be taken prior to surgery, as very occasionally a blood transfusion is required. It may also be necessary to take a course of iron tablets following the surgery. As the operation takes some time to do, measures to prevent clots in the legs are undertaken usually along the lines of special stockings, improvement of the blood flow in legs during surgery, or the addition of blood thinning agents prior to surgery.
After - In Hospital You may notice a firm bandage around your chest when you wake up. This may also make your breathing slightly restricted. It is there to provide comfort and also to decrease swelling around the breasts after surgery. It is likely that you will be in a semi-upright position following surgery. Again this helps to decrease swelling and pain. Pain and discomfort following surgery is common and can be treated with pain-killing injections or tablets. Regular painkillers will be needed on return home along the lines of Paracetamol. There will be a drain in each breast to remove excess fluid that can accumulate following surgery. It is also likely that there will be an intravenous drip, which is usually removed when you are able to tolerate diet and fluids comfortably. The nurse will check your blood pressure, temperature and pulse rate following the surgery and in some operations it will be necessary to check the blood supply to the nipple on a regular basis. After the surgery you will be encouraged to gradually increase your mobility and independence. Assistance will be given with shallow bathing and general hygiene until you are able to manage this independently. The dressings usually remain intact for twenty-four to forty-eight hours following surgery at which time the drains are usually removed. The stitch line will then be cleaned as necessary and a new dressing applied. It is often useful at this time to have soft support type bra that can accommodate a small dressing. This gives support to the breast and decreases pain. Your stay in hospital will be variable and will depend on the type of surgery that has been performed and the amount of drainage from the breasts. You may expect to go home within two to three days following surgery.
After - At Home You may experience pain and discomfort in your breasts, which is usually adequately treated with simple painkillers. Should you find increased unexpected pain it will be most important to let the hospital know of your pain and discomfort. As with any major surgical procedure, you may feel tired following the surgery and may need assistance in doing ordinary daily tasks. It is important to avoid getting the suture line wet. It is likely that you will be asked to attend the outpatients if only to review the dressings. It is probably best to also avoid driving at this time as pain and discomfort may prevent adequate control of the steering wheel.
On most occasions, the sutures that are used to close the breast reduction surgery are of a dissolvable type but occasionally some sutures may need to be removed. This usually takes place some two weeks following surgery.
Possible Complications
Breast reduction surgery takes some time to perform and may be considered a major operative procedure. As with any major surgery you may bleed during the surgery and very occasionally a
blood transfusion may be required. The drains are placed in the breasts after surgery as there is often some bleeding that can occur. Very rarely bleeding can continue to such an extent that a return to theatre is required. This is why it is important to have regular post-operative checks on the ward by the nurses.
Infection can occur in the post-operative phase and this is minimised by good surgical technique. Antibiotics are sometimes given around the time of surgery. Regular reviews after surgery indicates if there is evidence of infection and occasionally it is necessary to have a course of antibiotics. Often, due to the extent of the surgery, the skin of the breasts appears red. This is more commonly related to inflammation rather than infection.
There is often some irregularities around the scars immediately following surgery but these tend to settle down and get better as the swelling disperses and the skin tightens. Occasionally there are some areas underneath the breast where the skin does not heal immediately and dressings may be required for up to six to eight weeks afterwards. This is related to the tension that is needed to reshape the new breast, which the skin does not tolerate. Very very occasionally, skin grafting may be required if significant skin breakdown occurs. Personal care and hygiene can be maintained once the wounds have become sealed. This varies from one to two weeks. If dressings are required because of minor wound problems, your doctor may still be happy for you to shower, dab the area dry and have it redressed. Supportive bras, which are not under wired, can keep the breasts comfortable following surgery. It is sometimes necessary to wear them at nighttime as well for comfort.
Return to work can take place from two to three weeks after surgery depending on the physical requirements.
When driving it would important to make sure that there is no interference with turning the wheel or areas of pain which may cause some difficulty with the need to perform an emergency stop.
Direct trauma onto the breast can cause the wounds to split open. However, one should wear a safety belt when driving or a passenger in a car.
It may take some time for the redness of the skin underneath the breast to settle down. If the breasts are very big prior to surgery, the ends of the scars may remain prominent. Should this be the case they may need to be 'tidied up'. This is a procedure that can usually be performed under local anaesthesia.
General Advice
The majority of people who have breast reductions are happy with the size and shape of the breasts following surgery. It can take six to nine months for the swelling to subside entirely. The outcome of the surgery that some people are not so happy with is the scarring. The scars, although they look neat initially, can become red itchy and raised above the level of the surrounding skin. As well as becoming somewhat unsightly they can also give rise to concern. Some techniques are available to try and make the scars more comfortable including local silicone sheet dressings, local massage or the occasional use of laser treatment. The scars may become particularly troublesome close to the midline and most surgeons try and avoid placing scars too close to the midline. This helps with the problems with the scar formation but also avoids putting scars where the patient may want to show their cleavage. The breasts tend to remain in a satisfactory position but as time goes by, droopiness of the breasts can occur again. Excess weight gain or pregnancy can precipitate increased size and therefore droopiness to occur more rapidly.
It is not always possible to match the breast sizes following surgery and this may become more apparent when the swelling has decreased. Depending on the type of breast surgery that has been performed it may be possible to breast-feed if one becomes pregnant.
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