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Breast augmentation (Boob job)

What is breast augmentation?

Breast augmentation is also known as breast enlargement or a boob job and involves increasing breast size by inserting breast implants.  Breast size can also be increased with fat injections (lipofilling). It is the most frequently performed cosmetic surgery procedure in the UK (7732 patients had this surgery in 2016).

 

Breast augmentation – typical patient

  • Patients with small breasts who want to increase the size of their breasts
  • Patients who have lost breast volume following pregnancy or weight loss
  • Patients who have different sized breasts (breast asymmetry) who wish to increase the size of the smaller breast or of both breasts
  • Patients who have a minor amount of drooping of the breasts who do not want the scars on the breast that a breast lift (mastopexy) would produce
  • Patients who have self confidence issues relating to the size of their breasts who wish to improve their self esteem

 

Breast augmentation – procedure

Boob jobs are usually performed under general anaesthesia and involve an overnight stay in hospital. A breast implant is placed under the breast tissue either directly below the breast (subglandular) or under the chest muscle (submuscular). Mr Morritt usually inserts breast implants though an incision in the breast crease (inframammary).  Breast enlargement can also be performed by inserting breast implants through an incision around the areola (peri-areolar) or through an incision in the armpit (transaxillary).

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The incision 

Mr Morritt typically inserts breast implants through an inframammary incision which is a scar in the crease under the breast. Scars in this area tend to heal very well and this type of incision also allows an excellent view inside the breast during surgery so that a nice breast shape can be created. The inframammary incision is also useful because any revision breast surgery in the future such as capsulectomy is also easily performed through this approach without the need to make more scars on the breast. Other incisions for placing breast implants include transaxillary (a scar in armpit) and perioareolar (through an incision around the areolar). The transaxillary incision avoids scarring on the breast but the scar in the armpit takes longer to settle and can sometimes be visible when wearing sleeveless tops/dresses. The periareolar incision is made at the lower edge of the areola and is an option in ladies who have larger areolae but is associated with a slightly higher risk of infection.  Periareolar scars generally heal well but would be conspicuous in the event that a poor scar formed.

 

Under v over the muscle 

Over the muscle (Subglandular)

  • Can fill loose breast skin better than when implants are placed under muscle
  • Less painful and less risk of bleeding following surgery compared with submuscular
  • Sometimes avoids the need for a drain
  • Preferred option for patients who already have moderate/large breasts

Under the muscle (Submuscular)

  • Greater cover over the implant particularly in the cleavage
  • Reduces chance of seeing or feeling the implant
  • Lower capsule formation rate compared with subglandular
  • More uncomfortable than subglandular in healing phase following surgery
  • Slightly greater risk of bleeding following surgery
  • Preferred in thin patients with small breasts and those who have visible ribs

 

Breast implants

Mr Morritt generally uses breast implants made by Mentor which are some of the highest quality breast implants available on the market, have good safety records and come with a lifetime replacement warranty.  Mr Morritt has never used PIP breast implants but has removed them.

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Modern breast implants generally have a silicone shell and are either filled with silicone jelly or saline (salt water). In contrast to the implants used years ago which were filled with runny silicone that could leak if the implant shell broke, modern breast implants are filled with thick silicone called cohesive gel which is similar in consistency to a jelly baby and does not leak to the same degree in the event of implant shell rupture.  Breast implants are either round or shaped (teardrop) and are manufactured in a wide range of sizes which means that different looks can be achieved in different patients and Mr Morritt will discuss the available options with you during your consultation. The most commonly requested breast implant sizes are in the range 200-400g. Silicone gel filled implants tend to feel more natural and are more durable than implants filled with saline.

 

Breast augmentation – risks

Breast augmentation is a commonly performed procedure and for the vast majority of patients the surgery goes very well without significant problems. Mr Morritt has incorporated a number of safety modifications into his practice to reduce the risks for patients having surgery. As with all surgical operations there are potential risks that patients should be aware of before proceeding with breast enlargement.

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Significant bleeding

  • results in a collection of blood in the breast that will make the breast appear swollen and may cause pain.
  • This blood has to be removed in the operating theatre
  • Rare –  affects approximately 2% of patients
  • More frequent when implants are placed under the chest muscle

Scar

  • scars following breast augmentation tend to heal well but will vary between patients and some patients may get poor scars (red, raised, painful)

Infection

  • we take multiple precautions to reduce the chances of wound/implant infection during surgery. Infections do however still sometimes occur.
  • Infections can be treated with a course of antibiotics but in some cases the implant may need to be removed.

Asymmetry of breasts or nipples

  • almost all women have different sized/shaped breasts
  • Breast augmentation can make differences between breasts and nipples more noticeable
  • There will be marginal differences in breast size, shape and nipple position following the surgery

Wound breakdown

  • this is very rare but may require removal of the breast implant.

Capsule formation

Visible/palpable implant/Rippling

Permanence of result

  • changes with time, pregnancy, breast feeding, weight change

Lifespan of implant

  • implants last different amounts of time in different people
  • On average implants last between 10 and 30 years
  • Young patients will need to change their implants at some stage in the future

Nipple sensitivity alterations

  • reduced nipple sensitivity occurs frequently following surgery
  • may affect one or both sides
  • generally improves with time
  • may be permanent in 5% of patients

Breast animation for sub pectoral implants

BIA – ALCL (Breast implant associated – anaplastic large cell lymphoma)

  • a type of cancer which has been identified in some patients who have had breast implants but is very rare
  • Worldwide, nearly 513 unique cases have been reported (includes 16 disease-related deaths)
  • The lifetime risk for BIA-ALCL ranges from 1:1,000 to 1:30,000 for those with textured implants

Breast feeding

  • approximately 80% of women can breastfeed after breast augmentation.

General risks of surgery

  • chest infection, DVT, PE

 

Breast augmentation – after surgery

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Bra

You will need to wear a support garment or sports bra 24 hours a day, 7 days a week to support the breasts while they heal following the surgery (not when showering). It is useful to have two bras that you can wear in rotation. It is important that the bra is comfortable and provides support without being overly tight. You should be able to start wearing underwired bras 6-8 weeks following the surgery.  Patients should not wear an underwired bra for approximately 6 weeks following surgery as the skin under the breast can be numb for some weeks following surgery and can be damaged by pressure from the wiring.

 

Dressings

The wounds will be covered with dressings. You will be seen approximately 3 days after the surgery and also at 7-10 days following the surgery to check that you are making good progress and that the wounds are healing well. Mr Morritt uses dissolving stitches so there is no need for any stitches to be removed. You can shower once the dressings have been removed. The dressings are showerproof so you can have short showers following surgery but the wounds are relatively fragile in the first week following surgery and care must be taken when washing/drying the breasts.

 

Recovery after breast augmentation surgery

Most patients are fully healed within 2 weeks of breast augmentation surgery.  We generally advise all patients to avoid strenuous exercise for 6 weeks following surgery.

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0-7 days following surgery

Mr Morritt recommends taking it very easy in the first week during surgery as this is the most frequent time to encounter problems such as bleeding following surgery if patients overdo things. Patients with young children should therefore organize for help and support with childcare and housework during this period. Your wounds will be checked approximately 3 days following the surgery and again at 7-10 days following the surgery. It is normal for the breasts to seem slightly high and also firm at this stage.

 

7-14 days following surgery

Patient’s should only have low levels of pain at this stage and will be able to gradually increase their activities e.g. walking as their energy levels allow.

 

3-6 weeks following surgery

Patient’s should be able to return to work approximately 2 weeks following surgery. Mr Morritt advises that patient’s should not undertake any heavy lifting before 6 weeks following surgery. Those in active jobs may therefore need to take more time off work or to modify their activities at work until they have fully healed.

 

6 weeks onwards

Patients can undertake all exercises without restriction. The breasts should have softened and look more natural but will continue improve over the next 5 – 6 months.

 

Frequently asked questions – Breast augmentation (Boob job)

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Will I experience any pain after the procedure?

Patients differ in how much pain they experience following breast augmentation surgery. Some patients may be free of pain within 3-4 days following surgery whereas others may have discomfort for 2-3 weeks. Most patients find that the pain following breast augmentation surgery can usually be well controlled with tablet medication. Severe pain following breast augmentation is less common. Younger patients sometimes experience more pain following surgery than older patients and submuscular breast implant placement can also be more painful than when the breast implant is placed over the muscle (subglandular).

 

How long will I need off work?  What is the recovery time?

People heal at different rates following breast enlargement. Furthermore, physical activity requirements do vary between different jobs. While some patients may feel ready to return to work one week following breast augmentation surgery, others may not feel ready to return until two weeks after the surgery. Those with particularly strenuous jobs will need to take a bit longer off work or to restrict their duties to light activities during the first six weeks following surgery. Usually all patients are fully healed and are able to return to normal activities including exercising at six weeks following surgery. We advise that patients avoid driving until they are completely pain free and can perform an emergency stop confidently so that they are covered by their insurance policies.

 

Can I come back and see you anytime if I’m worried about anything?

We aim to provide excellent aftercare following surgery. You will be given a follow-up appointment before you leave the hospital following the surgery (this is usually 5-7 days following surgery). You will then have a number of further follow-up appointments to check that you are progressing well following the surgery and to answer any questions and address any concerns that you may have. You will also be provided with contact details so that you can contact the team at any time following the surgery for advice or review if you have any concerns.

 

Breast augmentation (boob job or breast enlargement) links

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