Plastic surgeon, Sheffield
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Breast enlargement (‘Boob job’)

Breast enlargement, Sheffield

Breast augmentation (breast enlargement or a ‘boob job’) involves increasing breast size by inserting implants.  Breasts can also be enlarged with fat injections (lipofilling). ‘Boob jobs’ are the most frequently performed cosmetic surgery procedure in the UK.

Breast enlargement – typical patients

Breast enlargement is most frequently performed to:

  • Increase the size of naturally small breasts
  • Restore lost breast volume following pregnancy, weight loss or ageing
  • Improve breast symmetry (in cases of breast asymmetry)
  • Lift the breasts in women with minor breast drooping who do not want the scars associated with a breast lift (mastopexy)
  • Improve confidence and self esteem related to concerns about small breasts

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).

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The incision 

Mr Morritt inserts breast implants through a small scar in the crease under the breasts (inframammary) incision. Scars in this area tend to heal very well and this incision allows an excellent view inside the breast during surgery so that a good 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 additional scars on the breast.

Under v over the muscle 

Over the muscle (Subglandular or prepectoral)

  • 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
  • Preferred option for patients who already have moderate/large breasts
  • The breasts move more naturally than when implants are placed under the muscle
  • The cleavage gap is often narrower than when implants are placed under the muscle

Under the muscle (Submuscular or ‘Dual plane’)

  • Greater cover over the implant particularly in the cleavage
  • Reduces chance of seeing the implant edge 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
  • The breasts can change shape when the chest muscle contracts (animation)

Breast implants

Mr Morritt generally uses Mentor ® breast implants for breast enlargement. These are high quality implants with good safety records and come with a 10yr replacement warranty in the event of rupture.  Mr Morritt has never used PIP breast implants but regularly removes them.

To learn more about Mentor (R) breast implants – click here

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Modern breast implants comprise a silicone shell filled with either 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 200-400cc. Silicone gel filled implants tend to feel more natural and are more durable than implants filled with saline.

Before and after photos of patients who have had breast augmentation by Mr Morritt

Photos showing appearance before and after breast augmentation breast enlargement boob job by mr andrew morritt plastic surgeon sheffield

Breast augmentation – after surgery

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Bra

Patients are asked to wear a support garment or sports bra 24/7 for 6 weeks following the surgery not when showering. It is useful to have two bras that can be worn in rotation. It is important that the bra is comfortable and provides support without being overly tight. Patients should not wear an underwired bra for approximately 6-8 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 1 week after the surgery to check that you are making good progress and that the wounds are healing well. Mr Morritt uses hidden, self dissolving stitches so there is no need for any stitches to be removed. The dressings are showerproof so you can have short showers following surgery. Please be aware that the wounds are relatively fragile in the first week following surgery and care must be taken when washing/drying the breasts. Patients are advised to avoid submerging their wounds in a bath until 2 weeks after surgery.

Recovery after breast augmentation surgery

Most patient’s skin wounds are fully healed within 2 weeks of breast augmentation surgery but internal wound healing takes a few more weeks.  Patients are advised to avoid strenuous exercise for 6 weeks following surgery. As a general

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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 or fluid accumulation (seroma) 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 1 week 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

Most 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.

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, thick, raised, painful)
  • the scars fade with time and can take up to 18 months to fully settle
  • The scars are never invisible but sometimes heal so well that they are difficult to see

Infection

  • Infections are rare following this surgery
  • Shallow infections (of the skin) can be treated with a course of antibiotics but deeper infections (of the impact itself) are more difficult to treat and sometimes it is necessary to remove the implant. If the implant is removed for infection then it is normal practice to wait 2-3 months for the infection to settle before inserting more implants.

Asymmetry of breasts or nipples

  • almost all women have different sized/shaped breasts
  • Breast augmentation can sometimes make differences between breasts and nipples more noticeable
  • There will always be small 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 if the implant gets exposed to the air

Significant capsule formation (capsular contracture)

  • this causes the breast to harden, change shape (become rounder) and can become painful
  • usually further surgery is necessary to correct this problem

Visible/palpable implant/Rippling

  • This is more common in thin patients or patients with only a small amount of breast tissue
  • Breast implants naturally ripple and this rippling can sometimes be seen as rippling of the breast skin

Permanence of result

  • Breasts appearance changes with ageing, pregnancy, breast feeding and weight change. The appearances created with surgery therefore do not last forever and most patients who have breast enlargement surgery ultimately choose to have further surgery on their breasts later on in their lives.

Lifespan of breast implant

  • breast implants last different amounts of time in different people but at some stage will rupture
  • breast implants last on average between 10 and 20 years
  • Ruptured implants need to be removed or replaced which requires further surgery
  • It is not always possible to remove all the silicone from the body (breast/chest tissue/lymph nodes) in the event that a breast implant ruptures. Sometimes the silicone cannot be seen with the naked eye during surgery to remove the implant and may only become apparent when a lady goes for a mammogram.

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
  • Rarely, the nipples may become hypersensitive

Breast animation for sub pectoral implants

  • When breast implants are placed under the chest muscle it is normal for the breast to change shape to some degree when the muscle contracts
  • Rarely this phenomenon can happen spontaneously when the patient is not actively contracting the muscle

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

  • a very rare type of cancer which has been identified in some patients who have had breast implants
  • Worldwide, approximately 800 cases have been reported (includes 20 disease-related deaths)
  • The lifetime risk for BIA-ALCL ranges from 1:1,000 to 1:30,000 for those with textured implants (for Mentor implants the incidence is 1:24,000)

Breast implant sickness or illness

  • Some patients with silicone breast implants can develop fatigue and general ache/pains
  • In these patients usually no cause can be found to explain their symptoms after extensive investigations
  • Removing the implants can sometimes improve the symptoms
  • Extensive scientific studies have failed to prove the existence of this condition and it is not currently recognised by the World Health Organisation
  • Many doctors think that these patients are actually suffering from fibromyalgia and it is simply a coincidence that the patients have breast implants

Breast feeding

  • approximately 80% of women can breastfeed after breast augmentation

Unhappiness with size or shape of breasts after breast augmentation

  • Mr Morritt cannot promise that inserting breast implants will create a specific breast shape as the effects of breast implants vary between individual patients.
  • Mr Morritt cannot give an exact indication of expected bra size following breast augmentation as bra sizes vary between different manufacturers

General risks of surgery

  • chest infection, DVT, PE

Frequently asked questions – Breast augmentation (Boob job)

Mr Morritt answers FAQs on the Claremont Private Hospital, Sheffield website – click here to read more.

Will I experience any pain after the procedure?

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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?

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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?

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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. Patients are usually seen 6 weeks and 6 months following surgery but are seen more frequently if necessary. 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 on the NHS

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When I first started surgical training in 2000 it was common to see patients having breast augmentation or ‘boob jobs’ on the NHS for purely cosmetic reasons. Patients with common conditions such as hypomastia (small breasts) or postpartum breast changes (breast shrinkage after pregnancy) were entitled to have breast enlargement on the NHS. Fast forward 20 years and it is now very rare for patients to have breast augmentation on the NHS (I undertake approximately 2 breast augmentations per year on the NHS). Breast enlargement for cosmetic reasons on the NHS requires funding approval (IFR) by the Clinical Commisioning Group (CCG) and the criteria are strict. This application must be made by your GP.

In South Yorkshire the criteria (click here for whole policy document) for getting breast augmentation for cosmetic reasons on the NHS are as follows:

  • complete absence of breast tissue either unilaterally or bilaterally or,
  • has suffered trauma to the breast during or after development
  • BMI within the range 18.5 – 27
  • completed puberty as surgery is not routinely commissioned for individuals who are below 19 years of age

Replacement of breast implants on the NHS is generally only available if the breast implants were originally inserted on the NHS.

Breast augmentation (boob job or breast enlargement) links

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