Breast Augmentation – Breast Enlargement

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• *** Augmentation – Post Operative Questions ***

WHY so popular?

Breast augmentation (also referred to as augmentation mammoplasty) is the medical term for breast enlargement (or boob job). It is the most popular cosmetic surgery procedure that Mr Turton performs, and this is mirrored across the UK and indeed across the world. In fact there are in excess of 10-million women who have had the procedure. The first breast enlargement was carried out in 1962! Mr Turton uses specialist techniques both for the implant planning as well as the surgery.

Statistics show that 94% of women who have had implants recommend the surgery to others. And in fact the MemoryGel Breast Implants have a 97% satisfaction rate for primary augmentation patients and a 99% satisfaction rate for primary reconstruction patients, based on Core study data!

Breast enlargement is a socially accepted operation

Estimates are that up to 1-4% of women have implants. This is perhaps not surprising given that women naturally want to maintain an optimum appearance. Breast implants have evolved significantly and are more quality assured than ever. That does not mean there have not been safety fears, and of course we all remember the PIP breast implant scandal relating to the infamous French manufacturer and the fraud committed by the owner. But as over 56 years have elapsed since the first breast enlargement procedure in America it is inevitable that as science and technology evolve so will materials, quality assurance testing, and medical knowledge. Techniques, implants and safety have all evolved too and we have passed through from the 1st Generation devices of the 60s, to the 4th and 5th Generation devices of the 90’s. The focus on safety has never been higher and there are still elements of uncertainty that require better data, which we hope will evolve through changes to the national breast implants registry, scientists, epidemiologists and safety organisations such as the MHRA and FDA. But it does also require that you see a specialist who really understands their subject and has a quality driven approach to managing their patients. You must also have your surgery by a specialist in the field of breast surgery and opt for the safest hospital environment rather than using stand alone small clinics.

Main reasons to request breast enlargement:

• Never had satisfactory breast development
• Want to look more feminine
• To have breasts that are in proportion with your body
• After childbirth, weight loss; loss of volume or shape with age
• In order to satisfy the desire for a fuller bustline.

Lacking breast shape commonly affects confidence. Getting an attractive breast shape and a reasonable breast size requires a skilled surgeon to create it where that shape has never existed at all before. Or, it might be a case of restoring or improving on shape that used to exist when the patient was younger but has been lost subsequently. This occurs more typically from age related changes or after having children. Some women want very natural looking enlarged breasts and others want their breasts to be bigger and occasionally noticeably bigger. Mr Turton can really help with the planing here and give his advise and recommendations. Above all it is important that women having breast enlargement decide to do so for themselves and never because someone else wants them to have it done. When done correctly, in addition to the positive cosmetic results, data has shown patients often receive a substantial psychological boost. It can improve body image and restore confidence.

How do I choose my implant size?

Most women ask for a natural and proportionate result, and Mr Turton will use his extensive experience to give them exactly that.

Patients may ask to be as full as they can be and achieve a natural appearing breast that is safest for their tissues in the long-term. They leave the choice of implant size under these circumstances entirely to Mr Turton, and will accept the size of breast that he feels is safest for their tissues long-term.

This is done by using a detailed combination of analysing your chest wall and breast measurements, an assessment of your tissue characteristics, and taking into account your height, weight and body shape. It enables Mr Turton to determine what will work and what won’t.

There are hundreds of implant sizes that Mr Turton can choose from to provide you with the optimal result. Using your characteristics, Mr Turton will be able to determine the best base width to the implant, then the implant height (for a round implant, these dimensions are the same), followed by the thickness of the implant at it’s maximum point (this is called projection), and then the lower pole ventral curvature (LVC), and finally the curve in the upper pole of the breast. This will give an optimum volume measurement in cc for your starting point. He will help you choose between textured, microtextured (nano textured) and a smooth shell, taking into account the latest safety data, as well as the potential advantages and disadvantages. And he will recommend any changes to the cohesiveness (gel thickness) and fill properties of the implant.

What if want to go bigger than recommended?

A small increase above optimal size can give a poor result. For example, the nipple position on the breast may look too low just by increasing the implant size by 50cc. A lot depends on your starting characteristics, your nipple position on your current breast in relation to the level of the crease under the breast and how loose your tissues are.

Can I request a specific bra size and certain cc of implant?

Implants do not come in bra sizes and there is no exact formula that a specific implant size translates into a specific bra cup size. There is no universal way of assessing bra size, and there is no easy way of measuring it during surgery. We therefore cannot guarantee a specific bra size as a measure of your outcome- it is simply too crude.  However, women naturally use it in the conversation and I don’t think that is a problem, as it is one way of communicating desires for shape! Where you are wanting to achieve a certain outcome it is best communicated by a detailed consultation in various formats and having further review. We can take 3D images and create a Crisalix 3D simulation to guide you. This enables you to communicate if this outcome is close to the results you are hoping for. However, you need to be realistic and understand that simulations are approximations and not a guarantee. Your tissue charactertistics will determine if your tissue can accommodate an implant of a certain size. Although tissue can stretch, it has limits. Choosing larger implants than is optimal causes more tissue stretch and a greater likelihood of sag and needing future procedures such as mastopexy (uplift), other revisions, or even removal.

Going bigger than the optimum size produces more negative results on the breast tissue. If you choose to have an implant that is larger than Mr Turton feels is optimal for your tissues, you must understand that you may not have a natural appearing breast. You will need to accept the increased risk of re-operations, complications, deformities, and additional costs. Think also of the time off from work and normal activities in the future that may result from selecting an implant that is larger than is ideal for your tissues. You need to remember that no implant regardless of size or shape can guarantee upper breast fullness long-term, and the larger the implant you select, the more likely stretch of the lower breast envelope, which will allow loss of upper fullness.

What does it cost?

• The average total cost is £7500
• If you require breast enlargement and a breast uplift the cost is higher, usually £12,000 -£13,000
• Simple Breast implant exchange costs around £7000 with conventional implants
• The predominant variability in cost relates to the type of implants, additional surgery, and the 20-years of specialty experience provided by Mr Turton
• Beware of low cost set ups in the UK. In a competitive market, achieving cheaper surgery usually means a compromise in quality of surgeon, quality of facility or quality of your implant- it is not worth it! Beware the false or misleading advertising promising lifetime implants- these do not exist- no implant is actually guaranteed to last for life.
• Implant exchange is the renewal of your breast implants. Replacing breast implants might require capsulectomy and this is a higher cost.

Which is the best implant manufacturer?

There are many things to take into account when choosing a specific implant manufacturer and  Mr Turton would suggest you allow him to help you choose.

All of the implants that Mr Turton uses are CE approved (the European regulation) or FDA approved (the American regulation).

Examples:

Mentor: FDA approved and extensively studied. Established implant type, good quality assurance. Choice between micro textured (Siltex) and smooth, anatomical and round. Mr Turton prefers to use the Memory gel and Memory Gel XTRA varieties. The modern generation Mentor implant has the manufacturer’s name imprinted on the back of the implant together with the serial number, lot number, size in cc and the implant style. Mentor offer a good manufacture’s warranty. This has become the most popular UK implant in 2019.

Allergan: These lost their FDA approval in 2019.

Since then just their smooth shell implants were available in Europe pending the manufacturer resubmitting quality assurance data on their textured implants.

 

Sebbin: CE approved. Choice between microtextured and smooth. A smaller company than Mentor but established for many years in France and recently made available in the UK.

Motiva: CE approved. Choice between microtextured, nano textured and smooth. A smaller company than Mentor and available in the UK.

Polytech: This is a German company that has a long history for manufacturing quality breast implants. They have a huge range that includes standard implants as well as micro polyurethane (MPU) coated: CE approved. The MPU coating sticks firmly where it is placed. Some evidence of a lower capsular contraction rate, but needs careful consideration when using as pros and cons. Uncommon risks of BIA-ALCL thought to be higher.

 

What is the Implant Guarantee?

Whichever manufacturer you choose, you will find there is a broadly similar manufacturer’s guarantee. This may state ‘a lifetime guarantee against implant rupture’ – this does not mean the implant will not rupture! It also does not mean the manufacturer will pay for your surgery if they do rupture, as they will not! The guarantee should be caefully read as it relates to each manufacturer to understand it. The manufacturer’s implant warranty for the main implants used in the UK, usually means that in the event that your implant ruptures the manufacturer will provide you with a replacement ‘implant’- the cost of purchasing that implant might then be deducted from the cost the hospital charges you for the operation. It is a small saving. Some manufacturers also reimburse around €1000 towards the cost of the surgery if the rupture has occurred within the first 10-years. Hospitals such as the Nuffield Health Leeds also offer a more robust ‘patient promise’ on aftercare, but even then surgical costs are met by the patient. Fixed price packages for surgery at the Nuffield Health Leeds provide a very comprehensive package so that if you have any significant complications within a year of surgery you do not have to pay for outpatient reviews or further surgery during that year.

Is implant surgery safe?

Breast augmentation is a relatively safe operation in the hands of an experienced specialist but is never risk free, and so it must be carried out to exceptional standards and with patient safety as paramount. Your surgeon needs to spend plenty of time with you at a consultation. Be particularly weary of places that are run by nurses suggesting your choice of implants, that are often underpinned by dubious marketing practices. There are lots of potential risks< from having breast implants and these should be minimised by staying under the care of the best specialists for Breast Enlargement Surgery.

The hospital environment may present a glossy waiting room, but what is it really like behind the scenes? The Care Quality Commission (CQC) is the national body that checks hospitals. The Leeds Nuffield Hospital where Mr Turton holds his specialist clinics and surgery is rated as OUTSTANDING by the regulator. It is one of only six private hospitals to achieve such a high rating. He also works at Spire Hospital Leeds, and this was also highly rated achieving GOOD overall. Check your hospital’s rating 

Are silicone breast implants safe?

• Breast Augmentation with silicone implants has been performed for over 55-years; but it is still not a completely safe operation. There will always be some future uncertainties.
• The manufacturing and quality checks of Silicone Breast Implants have evolved during this time frame
• Consider renewing implants or MRI surveillance to reduce problems such as prolonged rupture and silicone leak. 10 years should be considered even if you have not had any problems.
• The overall safety of silicone breast implants is reasonably established and is published in a number of independent reviews. There have actually been 4 such independent reviews and they essentially reached the same conclusions. Despite this, there are always potential concerns that some systemic disease might be associated in very small numbers of patients, but that it has never shown up in the big studies.
• No obvious increase in breast cancer or autoimmune disorders. The vast majority of patients implanted with medical devices have no adverse reactions. The device works and performs as expected to treat medical conditions or help patients better manage their health. However, a growing body of evidence suggests that a small number of patients may have biological responses to certain types of materials in implantable or insertable devices. For example, they develop inflammatory reactions and tissue changes causing pain and other symptoms that may interfere with their quality of life.
• Rare association of some textured devices to an uncommon type of breast implant lymphoma (ALCL)

How long do implants last?

Mr Turton advises that you should consider and plan for replacement by 10-yrs, or have regular MRI surveillance. Many places and even manufacturers give rupture rates that are not scientifically based and lack validity. The most reliable data came from compulsory 10-year studies and only a few manufacturers undertook these. There is therefore no reliable data to say one manufacturer is better than another, and it it is wise to refer to the robust data from the FDA submission for McGhan and Mentor implants.

Symptomatic rupture is now rare (<5% at 10-yrs) but increases with time. If a cohesive implant ruptures the gel doesn’t “run” initially. The gel in a good quality implant has a consistency like a jelly that has just come out of the fridge. You can push your finger into it and withdraw it slowly with the silicone staying together in the implant. The outer layer of the implant is the strong elasticated shell that holds the silicone gel. This outer shell is made from several layers of a stronger denser silicone that resists stretch and pressure. If it breaks or splits, silicone doesn’t usually immediately escape. In fact it rarely does so and you may have no idea as you would not normally have any symptoms early on. You also have another line of defence – your body forms a strong but thin tissue layer around your implant within a few weeks of surgery – this is called the capsule. It is like a membrane and is an important structure as even with a silent rupture it serves as a further protective layer between your implant and the breast tissue.

Even with no symptoms, and a normal clinical examination, silent ruptures may be detected in about 10% of patients on MRI at 10-years. This was shown in the original FDA data submitted by the manufactures McGhan and Mentor when they applied for the rigorous process of regulatory approval in America. It is robust data and serves as the best guide to current implant behaviour. Having an exchange at the 10-year mark is therefore a good safe practice to follow because of this, even thought the implant manufactures state the lifespan of their implants is 10-20 years, and even though the implant manufactures offer a lifetime guarantee in case of rupture. The guarantee provides a new implant and not the full cost of your revision surgery. Some manufactures now claim rupture rates of <1% at 9 years but the data on which this is based is different to the FDA data that used MRI studies! The patients could have silent ruptures.

If a silent rupture goes on to get worse, the gel in the implant may partially fragment and become more liquid with time; this might cause symptoms of inflammation (might cause discomfort), capsule contraction (the breast implant feels harder, the breast shape may become distorted, the breast may ache), or silicone leakage into the breast tissue, lymph nodes or into the organs in the body. Any changes should always be investigated urgently by an experienced breast specialist. It is harder and more expensive to revise implants once complications occur and cosmetic results may not be as good.

Common Questions

How long does the operation take?

Breast augmentation is a low risk surgical procedure if done with the right specialist surgeon and in the right hospital. Mr Turton uses specialist techniques and the surgery takes around 60 minutes. One of the major goals of Mr Turton’s technique is to perform a near bloodless dissection. It is done under a general anaesthetic with an experienced team.  Mr Turton will always schedule you for an overnight stay when you are under his care, for your enhanced safety and comfort, and this has remained  the preference of his patients for over 15-years.

Is it painful?

Mr Turton injects a long-acting local anaesthetic into the deep tissue before the implant is placed and the incision closed, so when you wake up the breast area often just feels tight straight after surgery. Usually a paracetamol and ibuprofen combination is then all that is required to managed tenderness and an ache.

The operation

We conduct a full preassessment in advance of surgery so that on the day everything is relaxed and un-rushed. You are told when to arrive at the hospital and you will have been instructed when to fast from (no food or drink after this time please). We allow a good amount of time to settle you into your own private room. Most patients  will relax and watch a film or use the complimentary wifi. You can of course bring a friend or your partner. You will have a further check from our nursing team to ensure you are well on the day. You are always seen in person by Mr Turton and the breast care nurse. A series of photographs are taken and your will have markings drawn on your breasts which serve as guidance during the operation. The option for incision will usually have been made in clinic. Although it is possible to use the areola or under-arm area the optimum place to reduce complications is in the crease just under your breast .

When can I drive?

• Individual advice varies
• From 4-days to 2-weeks

When can I return to work?

• Usually after 1-week, but avoid lifting please. If your job involves lifting, you will need 2-weeks minimum.

How do I decide on the size of the implants?

• Take advantage of Mr Turton’s 3D Crisalix simulation of your before and after results. At your consultation a 3D scan will be taken, and the advanced software will show you your body as it is now in 3D and as your surgeon is planning for your results with implants. This is one of the best ways to help you decide.
• Asking for a natural shape and proportionate augmentation is common and advised
• The average natural breast size in the UK is a “B” cup. Most patients desire to be a “C” or “C-D” cup, but as body frame size is variable the actual shape and width of the breasts is more important than any ‘bra size’ measurement.
• Bring pictures with you, & review your surgeon’s album
• Listen to your Mr Turton’s advice about your optimum size implants based on his expertise, very thorough assessment of your tissue characteristics and starting point
• There are specific cosmetic techniques that can be used to give you a proportionate result
• If you have a lot of breast sag (nipples close to the lower breast fold or below), implants on their own do not give a nice result. If one breast has more sag than another you will still notice differences after implant surgery, unless you have a mastopexy (uplift) to correct it. The degree of difference you have prior to surgery is therefore important to understand. Patients with a lot of breast sag (ptosis) may require a mastopexy (uplift) at the same time (mastopexy-augmentation) or if it is severe, doing the mastopexy first, waiting four months then having the augmentation. Some patients may have an augmentation and then decide on a mastopexy to improve the nipple position at a later date. Read my section on mastopexy-augmentation in the Uplift Information Sheet.

To see anonymous pre and post operative photos of patients who have had Breast Augmentation Surgery performed by Mr Turton in his Cosmetic Breast Surgery Leeds practice, please review the images section.

 

Risks and complications

As with any surgery there are associated risks. In general the sort of complications we see are minor swelling, and dull aches during the first week. Bruising is usually very minor or not at all. You can get loss of nipple sensation, although this usually recovers in a few months. Redness around the scar usually settles naturally with scar maturation.

There are some uncommon risks for example haematoma, seroma, and infection which on occasion may require further surgical intervention. You are monitored closely after surgery and have our contact number after discharge if you require assistance after discharge form the hospital. Our hospital remains open 24-hrs per day and 365 days per year.

Uncommon complications include ALCL a type of lymphoma in the tissue capsule around the implant.. Please read Mr Turton’s Augmentation Information Sheet thoroughly. Further detailed information provided by Allergan is very useful to read and can be found here.

Get in touch with us today to find out what will work best for you.