All breast surgery needs recovery and as your breast augmentation surgery will probably be performed under general anaesthetic and you will probably stay in hospital overnight but certainly until you are comfortable enough to go home. When you do go home you will need to take pain killers for a few days until the discomfort settles down. The first day of the operation is the worst and you may well need help with day to day activities for a few days. Some women still feel some twinges of discomfort for a few weeks after the operation, but most women are back to normal tasks within a few days. If you are taking time off work, you may be able to go back after a week and you can go back to high impact activities after 4-6 weeks. Most women are back to doing most of their normal day to day tasks within a couple of days, in my practice.
For the first few days after the operation, take it easy. You should try and keep your wounds dry and clean, though it is sometimes impossible to keep them away from water completely. If you have an absorbent dressing, then this should be changed if it gets wet. After a bath or shower, you may want to dry your wounds with a hairdryer on a cool setting (so as not to burn your delicate healing skin) before applying any more dressings, if still required.
If we have told you to wear a bra, then you should wear it constantly for the time period advised (often 4-6 weeks). You can take off your bra for an hour at a time once or twice during the day, but you should really wear it constantly at night time.
We may insert drains after the procedure and we may ask you to wear a supporting bra for a while after your operation. Your support bra should be wireless with firm supporting cups - something like a shockabsorber sports bra is usually fine. Wired bras are very supportive, but they can sometimes press against the bottom of the implant or the site of the surgical wound, and be more uncomfortable than non-wired bras.
You should buy a couple of sizes, as the breast size changes over the course of a few months after the operation. The bra may be needed so that the implants can be supported in place while the bruising and swelling gets better. The implants will drop down over time and a well supporting bra will help prevent this. You might only want to buy one bra of each size in the first instance, and only buy more once you know you are filling a particular manufacturer's size.
Occasionally we will tell you not to wear a bra for a few weeks. This may be because the implants have been placed behind the muscle and muscle appears to be quite strong - wanting to push the implants upwards and outwards. Sometimes we will apply an upside down bra to the top of the implant or place a pressure dressing at the top of the implant to help keep the implants from riding upwards. This is more commonly done after placing the implants behind the muscle.
If we have placed drains into the chest at the end of the operation, these will be removed, usually the following day, before you go home. They can help reduce bruising and help remove some of the excess air and fluid in the implant pocket. Not all patients will need drains and many surgeons will only use drains for the operation if there seems to be a little excessive bleeding during the operation.
BREAST SURGERY RISKS - WHAT YOU NEED TO KNOW ABOUT BREAST AUGMENTATION SURGERY
The majority of people who have breast augmentation are very happy with the results. However, there are risks with any procedure and there are specific problems you should be aware of with breast augmentations and these include (but are not limited to):
- Blood clots
- Wound healing delays
- Nipple hypersensitivity
- Nerve injury leading to sensory reductions at the nipple
- Size issues - some women feel they should have been made bigger or smaller after their augmentation procedure
- Implant palpability
- Implant wrinkling
- Implant deflation (in cases of saline implants)
- Implant migration and movement
- Implant extrusion
- Implant rotation (in cases of anatomic implants)
- Difficulty with mammogram interpretation
- Changes in the way breast lumps are investigated and treated
- Capsular contraction (the formation of a hard painful or distorting area of scar tissue around the breast implant)
- Silicone leakage (in cases of non cohesive silicone gel implants)
- Galactorrhoea (the inadvertent production of milk)
- Further surgery: all implants have a life-span that is limited and finite. In many cases, the patient lives longer than the implant. All women with breast implants should therefore prepare themselves for further surgery during the course of their life.
- All the natural effects of having larger breasts - bra strap marks, drooping of the breast tissue with time, development of prominent veins, etc.
This is the most important long term complication that you need to know about, and you may need another operation several years later because of this. Whenever we insert a foreign material into your body, your body recognises that implant as being foreign. Your body then creates a wall of scar tissue around the implant and this is perfectly normal. This happens with all types of implants - for example hip replacements, plates and screws for broken bones and, of course, breast implants.
What is not normal is for this wall of scar tissue to thicken as the years go by. The thickness of the scar tissue increases and increases and then it starts to contract. Eventually it becomes hard and round. This changes the shape of the implant and you can sometimes start feeling the wall of scar tissue. When this happens, we call this capsular contraction. Because it can feel uncomfortable and look different you may want to have another operation to remove and free up the capsule and replace the implants.
Capsulectomy and implant replacement
If a capsule forms and is sufficiently severe enough to warrant treatment, an operation is performed called a capsulectomy and implant replacement. This is where the scar tissue around the implant along with the implant itself is removed and the implant is replaced. Sometimes it is necessary to make a new pocket or change the size or type of the implant when replacing it. It is a more complex operation than simply inserting a breast implant and the recovery time is a little longer.
Although infections after breast augmentation surgery are rare, when they do occur it can be very troublesome. The early signs are redness and discharge around the wound site and feeling unwell with flu like symptoms. If caught early, then infection can sometimes be treated with antibiotics, but if the infection cannot be treated with antibiotics, then the worst case scenario is that the implant will need to be removed and the infection allowed to settle. Several months later, another implant can be inserted.
Often a surgeon will ask you to attend the hospital or clinic around a week after the operation, for a quick wound check to make sure that any early signs of trouble can be dealt with promptly.
Blood clots can occur after any surgery. If a blood clot forms within the breast where the implant has been inserted, this is usually spotted in the first 24 hours after the operation. If this happens, you may need to go back to the operating theatre to remove the blood clot; the implant itself is not affected by this. A different type of blood clot can form in the legs after any operation (or indeed any period of prolonged immobility, such as an aeroplane journey, or prolonged operation). These blood clots in the legs can break off and fly into the lungs causing breathing problems. Although rare, if this does happen it can happen around a week or so after the operation and you should seek emergency treatment for this. Drink plenty of fluids and keep your legs mobile after any operation to reduce the risk of blood clots in the legs (also known as DVTs, or deep venous thrombosis).
Any operation or any cut in the skin leads to scarring. Most scarring after a breast augmentation is well hidden within natural crease lines and tends to heal very well. Rarely, scarring can be a problem and in these cases, it will be a problem a few months after the operation. If you do have scar problems, then you might want to apply creams or ointments recommended by your surgeon, or he may want to give you injections into the scar to help reduce some of the itch and pain associated with some of the more abnormal scars. Scars may also darken if exposed to too much sun or tanning booths after an operation, so you should protect your scars from these after such an operation. You can also develop scars within the blood vessels below the breast and these can sometimes present as painful cords (these are called Mondor's cords); treatment of these is with anti-inflammatory medication and you should speak to your surgeon before starting these.
Everyone is a little different on each side before the operation, and these differences are often accentuated after the operation. For those women who have a considerable degree of asymmetry between the left and right breast before the operation, we can often insert implants of different sizes to compensate for some of the differences. Your left and right sides will always be a little different but these differences can be more noticeable after a breast augmentation. Also, whenever we do an operation on two sides, the rate of healing varies, even though we do the same operation using the same techniques on both sides. As a result, sometimes the two sides can heal at different rates over the course of time. We generally will see the final result six months after the operation.
Wound Healing Delays
Rarely, the wound may unzip, leading to infection and implant exposure. Your surgeon may choose to resuture the wound or to allow the wound to heal with dressings. The implant may also need to be removed in rare circumstances.
After an augmentation, the nipples can increase in their sensitivity. It may be uncomfortable to touch the nipples or they may become quite prominent. This usually settles over a few weeks, and during this time, nipple protection may help reduce the discomfort. Nipples can also become less sensitive.
The nerves that supply the skin of the breast and the nipple run close to where some incisions are made and where the pockets are made. These nerves can often be irritated during the operation, which can sometimes lead to reduced sensation around the nipple and the skin of the breast. This is often a temporary problem, but can take up to six months to return. In rare cases, the loss of sensation around the nipple can be permanent.
Breast Implants - Size Issues
Some women feel they should have been made bigger or smaller after their augmentation procedure. Often this can be avoided by discussing size issues in detail with your surgeon beforehand. However, sometimes it can be difficult to know exactly what size you will be after the augmentation, because implants don't come in cup sizes and all bra manufacturers are different. The vast majority of women, however, are absolutely delighted with their appearance afterwards. There is also a balance between maintaining a natural look and the augmented look, with larger implants looking more augmented than natural.
There is always a risk of being able to feel a breast implant. Even though we can use various methods to try and make sure we reduce the chance as best as possible, there will be times when you will be able to feel the implants in some parts of your breast at some times. Feeling a firmness may either be the implant or the beginnings of a capsular contraction. If you are unsure about something that you are feeling, you should ask your plastic surgeon.
There is always a risk of being able to see a breast implant. Even though we can use various methods to try and make sure we reduce the chance as best as possible, there will be times when you will be able to see the implants in some parts of your breast at some times. This is, of course, very similar to being able to feel an implant, and so you should expect to either feel or see your implants at some stage.
Breast Implant Deflation
Saline implants are filled with salt water (saline). Although they have protective mechanisms to prevent the saline from leaking out of the implant, if this does occur, then the implant will deflate over the course of the next few days and your breast size will shrink. You will need another operation to fix things, and many women take the opportunity to have an operation to change both breasts at the same time. The risk of a saline implant deflating is around 5%.
Breast Implant Migration
Breast implants need a few months to settle into their final position. During this time they move around inside the body by a small amount. Occasionally, they can move into the wrong position, and they can be lower, higher, more outwards or more inwards than desired. In these situations, you may need another operation, though your surgeon will probably want to wait several months for the implants to settle into their final position before considering another operation to readjust the implant pocket.
Breast Implant Extrusion
Very rarely, the stitch line will open up and you will be able to see the implants. This is extremely rare, but in these situations, the implants need to be removed, and reinserted around 6-12 months later.
Breast Implant Rotation
Anatomical breast implants are shaped like a tear drop. They need to be placed in a pocket which is exactly the right size so that the implants can stick down into their position as quickly as possible. Your surgeon may also use a drain to help remove some of the excess space that may need to be created to insert such an implant. Although anatomical implants (in some women) may produce a more natural looking appearance, they will not look natural if they rotate.
What You Need To Know About Mammograms
A mammogram is an X-ray which is taken to look for breast cancer. Although putting in implants doesn't increase your risk of getting breast cancer it can make it harder to detect. You should know that a mammogram will not see the whole of the breast if you have implants. When you are having a mammogram you should tell your radiographer that you have breast implants (if they don't already ask you), as they will use special views to have a better look at your breasts with the X-rays; they may also take two pictures rather than just one. The only way to completely see your breast tissue is by performing an MRI scan on the breast, but this is not something that is routinely performed for breast cancer screening, and there may be a cost associated with this if you are wanting a full screening to be performed. Women with breast implants are not at any greater risk of getting breast cancer.
What You Need To Know About Breast Lumps
If you do ever get a breast lump, the tests you have may be different because you have implants. In particular, you may not have tests which risk rupturing or piercing the implants and you may have a different type of scan to find out more about the lump. Women with breast implants are not at any greater risk of getting breast cancer.
There are different forms of silicone that can be used to fill a breast implant. Cohesive silicone is a more solid silicone, and non-cohesive silicone is a more liquid silicone.
Cohesive gel implants do not leak silicone, but non-cohesive implants can leak silicone into the surrounding tissue. Also, some women have gone abroad for treatment and have returned with liquid silicone within their breasts, which causes problems and needs to be removed. If you have non-cohesive silicone breast implants, then these may leak silicone and if you have problems with firmness inside the breast because of this, you may need another operation to fix this.
Galactorrhoea is the inadvertent production of milk and is quite a rare complication. Usually it is temporary but occasionally treatment with hormones may be needed to suppress milk production.
The Need For Further Surgery
All implants have a life-span that is limited and finite. All women with breast implants should therefore prepare themselves for further surgery during the course of their life. Also some women may want to have another operation a few years after having one breast augmentation (for example, a further enlargement or a breast uplifting operation, or treatment for prominent breast veins, etc)
The Effect Of Larger Breasts
After making your breasts larger, you may start suffering all the natural effects of having larger breasts - bra strap marks, drooping of the breast tissue with time, development of prominent veins, etc. Wearing a well supportive bra will help reduce this, but nothing completely stops the effects of gravity and time.
Since the operation is usually performed under general anaesthesia, there are also risks of a short general anaesthetic. Modern anaesthesia techniques are safer than ever before and it is very safe indeed to have a short anaesthetic, particularly when your anaesthetist is an experienced hospital consultant with an excellent safety track record. It also helps if you are as fit as possible, and you should stop smoking if you are smoker.
BREAST IMPLANTS SURGERY - EXPLANTATION
Some women want their breast implants removed and not replaced. In these cases we would remove the implant along with all of the surrounding capsule of the implant to remove all elements associated with implant insertion. At the same time it is sometimes necessary to remove some of the skin of the breast to prevent too much drooping but even when this is done, a second operation is often required a few months later to remove some of the skin excess that develops after an implant has been inserted. Recovery from breast implants surgery is very important and the risks involved are minimal but are something all patients need to be aware of beforehand. Contact us today for a consultation.