Breast Augmentation is a very personal choice. It is critical that we take the time to fully understand what your aims are to achieve the result that you want. However, there it is also important that you understand the realities, both in the short and long term, of having an augmentation. I have set out here some of the things that you must appreciate before contemplating this surgery, and some links to trusted, professional organisations where you can find more, independent opinion on some of the key issues. Each augmentation surgery has to be bespoke, and that can only happen through a face-to-face consultation. I will cover all points below in more detail in person.
Implant and capsules
The implants are made of silicone which the FDA has deemed to be totally inert and safe for insertion in humans. The implants consist of a gel fill (which is solid, like a gummy bear) and a shell. The surface of the shell affects the characteristics of the internal scar (capsule) your body naturally makes to wall off what is, in effect, a foreign body. This capsule gradually tightens over time (capsular contracture) and you should understand that this means you will almost certainly need to have your implants replaced at some point in the future. This occurs on average at a rate of 1% per year, so I recommend that you plan (both mentally and financially) on needing them replaced every ten years. I favour Motiva implants as I feel that they have a proven safety profile, as well as a very good aesthetic result. There is more information on Motiva implants and details of their warranty program here.
scars
I will insert the implant through the fold under the breast and this scar will need to be large enough to admit the implant, usually around 5cm. This scar is well hidden in the infra-mammary fold. All wounds seal in the first few weeks after surgery, but scars themselves take up to a year to mature. To achieve the best possible scars you will be given advice in the post operative period regarding moisturising and massage and sun exposure avoidance.
What implant?
The choice of implant size is determined by the volume and dimensions of your breast. The ratio of breast tissue:implant volume will affect the chances of the implant becoming visible. A large breast can disguise a large implant, a small breast cannot. I am inherently a conservative surgeon and I aim to achieve a natural appearance. As such I will try to help guide you towards a proportional, natural look when we decide on the size of your implant.
Sub-glandular or sub-muscular
The decision on which pocket to place the implant is dependent on the thickness of tissue overlying the upper chest wall. If there is not sufficient glandular tissue to hide an implant then it is better placed under the pectoralis major muscle. This smooths the ‘take-off’ of the increased volume in the cleavage area. There are some aspects to a sub-muscular position that differ from a sub-glandular pocket: lifting the muscle off the ribs tends to make it slightly more uncomfortable in the first few days after surgery, and the cleavage tends to be wider as the muscle has to remain attached to the edge of the sternum (breast-bone).
The implant will be well covered, but any individual undergoing augmentation will be able to contort themselves such that they can “find” their implant. This is usually in the thinner area on the lateral chest under the arm. As such it is possible that where the implant can be made visible here you may experience some rippling. No two breasts are identical, and this is true after augmentation as well.
Bi-ALCL
There is a very rare condition called Bi-ALCL which is a type of inflammatory cancer of the blood which is associated with breast implants. These have almost exclusively been associated with macro-textured implants, and there have been no cases with the smooth Motiva implants that I recommend. There is more information on Bi-ALCL from consensus review of the British Association of Aesthetic Plastic Surgeons (BAAPS) and British Association of Plastic and Reconstructive Surgeons (BAPRAS) here.
Post Surgery
You can go home the same or following day as your surgery. If your implant is placed in a sub-muscular pocket I would recommend an overnight stay to ensure your analgesia is adequate. You will have dressings on and a supportive, non-underwire bra. You will need to wear this bra day-and-night for six weeks and avoid exercise, heavy lifting and driving during this time. My preferred partner in this is Lipoelastic who will help you size your new bra before surgery.
After one week the dressings will be changed, and after two weeks the sutures will be removed. In most cases you will be able to shower after the first dressing change, but you cannot soak in a bath for 2 weeks.