Breast Augmentation

Breast implants come in different shapes and sizes and surface characteristics. They consist of an outer silicone layer and different types of fluid inside them. There are different implant companies in the UK and in the rest of the world. Dr Vourvachis will examine you and discuss with you the type of implant that suits you best, depending on your preference and your overall chest and body shape.  Different patients require different implant types and sizes, so each patient is treated separately, in order to match the patient’s needs and expectations. You will try different implant sizes before you decide which one is best for you and Dr Vourvachis will help you in making that decision.Nowadays, round silicone implants are the most commonly used type of implants. This is due to the fact that they produce a fuller upper pole and cleavage, they feel natural to touch and they are relatively robust. The silicone that fills the implant has a different viscosity which ranges from liquid to gel-like (cohesive or gummy bear). Implants can also be filled with normal saline (sterile water). Round implants can also have a textured (rough) surface. They have the advantage of being associated with a lower risk of scar tissue formation, known as capsular contracture. Any round implant consists of a round outline, a flat base that is attached to the chest wall and a projection (how much the implants sticks out from the chest when looking at it from the side) the degree of which varies. In addition, the width of the implant varies according to the natural width of the breast. Dr Vourvachis will show you different implant types, sizes and projections to help you decide the one that suits you best. Another type of less commonly used implant is the so-called Anatomical or Tear-drop implant and is generally used in slim patients who have the desire of achieving a natural looking breast with less pronounced upper pole fullness. Anatomical implants are associated with a higher risk of displacement and/or rotation and a higher incidence of revision surgery (a second operation to further improve the overall appearance of the breasts. Dr Vourvachis will discuss with you the type of implant that will give you a result that matches your needs and expectations.

TDr Vourvachis will obtain a full history and will discuss with you about how you want your breasts to look like following this procedure. You will then undergo a detailed examination that will give Dr Vourvachis more information about the size, shape, width and projection of your breasts, in relation to your chest wall. This will give Dr Vourvachis more information regarding the range of implant sizes that would be most suitable for you. You will try different size implants in a bra to help you decide which one is most suitable for you. Dr Vourvachis will ask you about your current cup size and what you would like your cup size to be following surgery. This is of course not very accurate as the cup size is just a letter and varies between different bra companies however, it can be used as a starting point in order to identify how much bigger you wish your breasts to be, following surgery.  As part of the pre-operative assessment, photos of the breast will be taken as they are very useful in planning the surgery. It is not uncommon for Dr Vourvachis to see you for a second consultation, before the treatment plan is finalised and the appropriate implant volume and projection is chosen.  Dr Vourvachis will then choose several implant sizes lower and higher than the recommended implant volume, in order to choose the one that fits you best. The implants that will not be used during the operation, will be returned back to the company at no extra charge.

There is evidence to suggest that textured implants reduce the incidence of scar tissue formation around the implant (capsular contracture) requiring another operation. They appear to be beneficial in cases of revision breast surgery due to capsular contracture. There is however, evidence to suggest that the textured implants are associated with a rare form of breast cancer known as Anaplastic large-cell lymphoma (ALCL). In the majority of the cases the treatment involves surgery alone. The risk appears to be very small and about 1 in 3000 to 1 in 30000 although the numbers in the literature vary. Dr Vourvachis will discuss with you the type of implant that he recommends in your case and why.There is ongoing research in smooth and textured implants and new information is likely to become available in the future.

There are many different implant companies available in the market. Dr Vourvachis will tell you which implant companies he recommends in his practice and why. Most implant companies offer either a time-limited or a lifelong guarantee. These guarantees however, have limitations and do not cover the cost of Dr Vourvachis, anaesthetist or hospital in case a breast revision surgery is needed. The implants will be supplied by the clinic where the actual operation will take place.

Breast implants are placed in a subglandular position (between the breast tissue and the chest wall muscle), in a submuscular position (beneath the chest wall muscle) or partly sub muscular and partly suubglandular (Dual_plane technique). The choice depends on the breast volume, the skin thickness and quality as well as the patient’s choice.  Placing the implant over the muscle provides superior upper pole fullness and cleavage, as the skin envelope and breast tissue stretch more. However, the risk of rippling and scar tissue formation (capsular contracture is slightly higher with this technique. Placing the implant under the muscle creates a more natural breast upper pole because the implant is covered by thicker tissue. In addition, the risk of capsular contracture is lower with this technique. However, the implant is likely to not adequately stretch the skin envelope because the muscle will prevent its full expansion . Another disadvantage of submuscular implant placement is the development of breast animation (also known as ‘Dancing Breasts’), as a result of muscle movement (contraction).  Another option is to place the upper part of the implant under the muscle and the lower part over the muscle, a technique known as ‘Dual plane’. Dr Vourvachis will explain to you where the implants should be placed and why and will help you decide which techniques most suitable for you.

The most widely used incision is 3-4 cm along and close to the inframammary fold (breast fold). This allows the scar to heal well and be well hidden. Less commonly, incisions can be performed in the armit or around the nipple. Each option has advantages and disadvantages. All incisions heal with scars, which usually settle well within months. Sometimes the scars can become red, raised and itchy and are known as hypertrophic scars. Their treatment can be challenging and can lead to a widened scar. Another type of scar is the keloid scar and appears to be larger and treatment is even more challenging but these scars are rare following breast augmentation.

You will be asked to have routine blood tests and a few other tests, depending on your medical background. If you are taking any regular medications such as blood thinners, you should stop them at least 10 days before the surgery. You might have to discuss this with your GP if it is safe to discontinue the medication(s) prior to the surgery.If you smoke and/or Vape regularly you should stop for a minimum of four weeks before and four weeks after the surgery to reduce the risk of wound healing complications as well as anaesthetic complications. The operation is usually performed as a Day case which means that you will be able to go home after the surgery however, someone will have to escort you back home. Alternatively, you might have to stay at the clinic for one night. Dr Vourvachis will discuss this with you. Please bring with you pyjamas and anything else you might require during your stay at the clinic. Avoid bringing any jewelleries. You should take a shower the morning of the surgery, before you go to the hospital. If you are unwell before the operation, the surgery will have to be postponed. On the day of the surgery you will meet the anaesthetist who will explain to you about the anaesthetic procedure. Dr Vourvachis will again discuss with you about your surgery and you will sign the consent form which will confirm that you have discussed the operation with Dr Vourvachis and the anaesthetic procedure with the anaesthetist.

You will be required to wear a Sports bra day and night for a minimum of six weeks following surgery. Dr Vourvachis will advise you which bra to buy. The bra will be fitted at the end of the surgery before you wake up from the anaesthetic. After this time, you can start wearing your normal bra.

The operation usually lasts for one to two hours. You will then wake up in the recovery area before going back to your room. It is usual to feel spaced out and a little disorientated for a short period. If you have pain or feel sick, you should tell the nursing staff and they will provide you with the appropriate medication. The breasts will feel sore after surgery especially while moving your arms however, this feeling will improve within a few days time.

Tubes (drains) are rarely used in breast augmentation however, they might be used in some revision surgeries. They come out through a very small cut on the side of the chest.When drains are used, they usually come out the next day. If however, a large amount of fluid is produced, then the drains will have to be kept for several days until the amount of fluid has significantly reduced.

You will normally go home on the same day or on the day after surgery with some painkillers and someone will have to escort you home.

You will be discharged with post-operative instruction and a follow-up plan. Dr Vourvachis and the nurse will see you at the clinic one week after the surgery for a change of dressings and a routine wound check. You can shower the next day or the day after surgery but avoid having a bath for at least three to four weeks. The stitches are usually dissolvable. After one to two weeks you may go back to work and resume driving a car, but first check with your insurance company as some do vary.

Three weeks after your operation you may begin gentle exercise, but strenuous exercise and work should be avoided for six weeks. You can sleep on your back or side but not on your front for up to six weeks. You can start driving after 2 weeks however, also check with your insurance to be sure. You should be back to your normal daily life activities at six weeks following the operation.

Based on the current literature, there is no evidence to suggest that silicone from breast implants causes cancer or has any effect on the developing embryo in pregnant women.

The current evidence shows that breast implants do not increase the risk of breast cancer. In addition, breast cancer in women with implants has the same prognosis as breast cancer in women without implants has.

The implant can create diagnostic difficulties by interfering with routine mammography. An experienced radiographer will use different mammographic views to overcome this problem. If you are over thirty years old and have a strong family history of breast cancer or you already have screening mammograms, it may be beneficial to have a mammogram prior to the surgery and six months following the surgery as a ‘baseline’, in case of future changes to the breast.

The insertion of a breast implant does not routinely interrupt the ducts that connect the breast tissue to the nipple and breast feeding should therefore be unaffected. The present state of knowledge also shows that silicone does not affect breast milk and that it is quite safe to breast feed. If the nerve supply to the breast and nipple has been damaged (see below) then this may affect the ability of the milk to be produced although this is extremely rare.

Following surgery and with time, a scar will develop around the implant. If the scar is thin, the breast will feel normal to touch. If however, the scar becomes thick, the breast will feel hard to touch the shape of the breast might change and there might be an associated discomfort to the breast. This condition is called ‘’capsular contracture’’. The risk of capsular contracture is about 10% in the first five years however, it can occur at any stage following breast augmentation, even after 15 to 20 years form the surgery. It requires an operation to remove the thick capsule and to exchange the implants. The cause is not fully understood however, in most cases the cause is an implant infection during insertion, or as a result of a blood-born infection later in life. The causative organism settles on the surface of the implant and remains dormant. As a result, the classic signs of infection such as feeling unwell, pain, redness, fever will not develop and the patient will not be aware of the infection. The infection will then cause thickening of the capsule surrounding the implant.There are ways of significantly reducing the risk of bacterial infection in breast augmentation such as covering the nipples at the time of surgery with ‘nipple shields’ and also by using an implant delivery device (Keller Funnel®) for the implant to avoid contact with the skin, and by washing the implant with an antiseptic solution. In addition, placing the implant below the muscle, reduces the risk of capsular contracture. This is more likely to be due to the increased soft tissue coverage making a mild encapsulation less obvious rather than an actual reduction in capsular contracture rate. Textured (Polyurethane) implants also reduce the risk of capsular contracture (scar thickening).

The risks associated with Breast augmentation occur in less than 10% of the population and include discomfort, infection, haematoma (blood clot), reduced or increased nipple sensitivity, wound breakdown, delayed wound healing, thick lumpy scar (Hypertrophic or Keloid scar), breast asymmetry, rippling, implant displacement, rotation, rupture, capsular contracture, need for further surgery. Dr Vourvachis will discuss with you in detail about the risks so that you are fully informed, even though it does not mean that any of those risk will occur from this surgery.

Breast implants do not last forever and removal or replacement might be required at any time. In most of the cases, they last between 10 to 15 years, although there are patients in whom the implants lasted more than 20 years. If however, a revision surgery is needed, it may have financial implications.