Breast Augmentation: A Consultation

By: Katharine Griffiths
Created on 20th September 2011

As well as a full physical assessment of your suitability for a breast enlargement, your consultation is a chance to ask those all important questions before embarking on surgery. Leading breast specialist Mr Philip Turton talks us through some commonly asked questions

What size can my breasts be increased to?

I advise patients strongly against having a large breast augmentation that takes their breast size excessively out of proportion to their frame. The biodimensional assessment will enable a choice of size to be made based on your proportions and this is the safest way to reduce the chance of detrimental changes such as breast tissue sag, palpability, less natural appearance, numbness, arms rubbing against side of breasts, ache, and future malposition.

Can I specify cup size?

It is vitally important not to become fixated on ‘cup size’ as bra size is not standard. It is the look that you want to and can achieve that is important, in relation to your frame.

Bring pictures with you or review your surgeon’s before and after photographs – I provide an extensive gallery of images on my website (www. cosmeticbreastsurgery.co.uk) and encourage patients to take a look for those images that seem closest to their ideal size and shape. This is a useful to get you and your surgeon on the same wavelength.

How can I achieve a natural shape?

Anatomical implants often produce the most natural shape, but not in all patients. Not many patients request a prominent rounded appearance in the upper bust, although this can be achieved if desired. I provide a full range of the latest generation round implants that can be used to produce a natural look.

Is it painful?

The chest area often feels ‘tight’ and tender for a few days. Patients will be able to move about as normal, but should avoid using their chest wall muscles forcibly, to avoid discomfort.

If I lose or gain weight will it affect my breast size?

In general, yes. Breast tissue is composed of thick glandular tissue and soft fatty tissue. Just as when you put on weight you find that it goes onto the bottom and hip area, you will also often find some of it goes onto the breast area, therefore big shifts in weight are not desirable.

If your starting breast size was very small (A to AA cup size), then losing weight tends not to make the augmented breast smaller, but reduces the normally fatty tissue layer under the skin and in the breast tissue layer. This makes the implant edge more easily palpable (particularly in the outer edge and in the skin crease area under your breast).

How can I prevent sagging in future years?

You can’t. However, careful choices can modify your risk. Your breasts will always change as you get older, and this is irrespective of whether you have implants or not.

This is because of the many biological changes that can occur with ageing: loss of elastin, stretching of collagen, atrophy of breast tissue, loss of skin elasticity, sun damage to skin, smoking related damage, effects of weight change, pregnancy and breast feeding on skin and breast tissue, hormonal changes, weight of breast tissue and implant weight and size.

By choosing an appropriate size for your frame then you can reduce the risk of sagging due to the implant.

I advise patients to wear a well-fitting bra after recovery and even wearing a comfortable sports bra at night can be very useful. Other things that can help is to maintain a healthy weight, to keep the breasts moisturised to maintain the elasticity and to avoid sunbeds and smoking, both of which have a very detrimental effect on skin elasticity and quality, as well as micro-vessel blood flow.

Are implants/augmentation surgery guaranteed for any length of time?

Each implant manufacturer has slightly different guarantees that relate to implant rupture. For example, McGhan (now owned by Allergan) anatomical implants carry a lifetime guarantee against rupture and, if they do rupture, then McGhan will provide new breast implants free of charge, although the cost of the operation (surgeon’s fee, anaesthetist’s fee and hospital fee) is not covered.

No manufacturer or surgeon can offer a guarantee against long-term changes which will always occur and are biological rather than anything to do with the implant or the initial surgery. Future surgery must be factored in before undergoing breast augmentation and I would advise patients to beware of anyone offering guarantees, or free follow-up for life, as it may not be worth the paper it is written on.

How will I feel after breast augmentation surgery?

The vast majority of my patients feel relaxed and comfortable immediately after surgery. Breast tenderness and a tight feeling usually become apparent in a gradual manner and appropriate mild pain relief will be dispensed. It is quite common for one breast to be more tender, and to swell slightly more. Similarly one breast will often recover more quickly and this is quite normal.

Is it possible to get larger implants after the first operation?

It is important to avoid unnecessary surgery, as redo breast augmentation carries additional risks and limitations. Further surgery is likely to be needed years down the line and at that point implant size can be increased, but the same criteria and judgments need to be applied as for the first operation.

Can I have them removed at a later stage and what are the consequences?

Implants are easy to remove, even under a local anaesthetic should it be required. The breasts will of course be empty, devoid of fullness, and the skin will be loose, usually with some wrinkles and sagging. The difference can be profound as there will be age-related changes that will have occurred as well.

Will breast augmentation change my life?

Breast augmentation may make you feel more confident within yourself but will not change things if you are dissatisfied with your life. Surgery in itself will not change a life situation, but the confidence and self-assurance which result from it can indeed empower you to make the required changes, allowing you to enjoy your life to the full.

I have an enviable record in patient satisfaction and in my last 1,000 primary breast augmentation operations, I have achieved universal patient satisfaction combined with a zero rate of implant infection.

CS&AG