Breast

There are many different techniques of breast reduction and so the position of the resultant scars may vary. There is always a circular scar around the nipple and a second vertical scar running from the nipple to the fold beneath the breast. A transverse scar may also created which runs along the fold beneath the breast. The length of the overall scars reflects the amount of breast skin removed.

Bilateral Breast Augmentation
This operation is designed to increase the size of the breasts and also to improve their shape by the insertion of an implant between the breast tissue and chest wall. The procedure achieves increased breast volume and also produces a more natural shape and symmetry. All breast implants rely on some form of silicone shell within which a silicone gel mimics the consistency of the breast. The implants may differ in consistency, size and shape, and are specifically chosen to suit the individual. The implants can be inserted in front of or behind the chest muscle and the pros and cons of each technique will be discussed with you in full detail at your consultation. A variety of incisions may be used, the most common and highest satisfaction incision is beneath the breast. The size of your new breasts will depend on your personal choice to some extent but we do recommend the appropriate size and shaped implants commensurate with your height, build and your body weight. Breast implants vary in consistency and shape. At LCPCS our preference is for the highest quality silicone implants, with manufacturer guarantees. Either round or anatomical (tear drop) implants will be recommended, and this depends upon individual requirements, the shape of the breast and chest wall, and desired outcome.

The Operation
Breast augmentation is performed under general anaesthetic, takes 1-2 hours, and it is usually recommended that you stay in hospital for 1 night. The most commonly used incision leaves a small scar under the breast to which the implant is inserted. You will wake up comfortable with stabilising dressings and, in most circumstances, a drain from each breast. Drains are not mandatory, but the decision not to use them will be made during surgery. Drains are normally removed at 24 hours, but prolonged drainage may require them to be left in place for longer. It is acceptable practice to be discharged with drain in place to be removed later in outpatients. We do recommend that you wear an unwired post – surgical or support bra soon after surgery for comfort. Patients will normally go home on the first day. Getting used to a new shape may be uncomfortable particularly on arm movement, but is not usually painful. Arm and chest stiffness is common, but is easily overcome with gentle exercise. Appropriate medications are prescribed. Antibiotics are given peri-operatively. Early breast swelling is common, but bruising and bleeding are uncommon.

Recovery Period
The sutures dissolve and do not need removing. Stained dressings may be changed as required. Patients may shower normally but should gently towel dry the suture line, and replace wet dressings as necessary. Initial dressings will be water resistant but will not tolerate prolonged submersion. An unwired bra or close fitting ‘crop – top’ is worn for 6 weeks (day and night) and physical activity is restricted for a month until the implants settle in their new position. The best sleep position is on your back to prevent movement of the implants in position. The return to driving, household chores and professional activity is individually driven, but a return to normality takes approximately 6 weeks.

Follow up period
Patients are seen at intervals of one week, six weeks and 3 months, and then annually at their discretion. Information on breast augmentation and breast implants: DoH advice document: www.doh.gov.uk/bimplants Independent Review Group document: Silicone Gel Breast Implants: www.silicone-review.gov.uk

Breast Reduction and Mastopexy – ‘breast rebalancing’ The female breast is made up of a gland, the nipple and surrounding skin – this may be an obvious statement, but many of the plastic surgery procedures of the breast simply rebalance these components for a cosmetically improved result. The breast can be reduced, reshaped and remodeled, and the skin redraped around it, placing the healthy nipple at the apex of the remodelled breast. Your surgeon may elevate the breast (mastopexy/uplift) in conjunction with a reduction, depending upon your aims. Your surgeon assesses the amount of breast and skin, and the position of the nipple on the breast mound. If the breast is loose in a large excess skin envelope, then there is scope to elevate the breast and tighten the skin around it – re-siting the nipple appropriately. If the breast is large and the skin closely applied, then your surgeon will reshape and remove breast tissue, protecting the nipple and re-siting it on the reshaped breast mound to make a comfortable, proportionate bust. The weight of large or pendulous breasts may cause a variety of medical problems such as back and neck pain, skin irritation and shoulder soreness from tight bra straps. Large breasts can also make a woman or a teenage girl feel extremely self-conscious. Breast reduction surgery aims to reduce the bust size, for an aesthetically improved shape and nipple position. t with time become fine, pale and flat. The Operation The operation is performed under a general anaesthetic and takes two and a half hours. After the operation the breasts are supported with dressings and an unwired bra. Drains are usually placed and removed at 24-48 hours. Usually the patients stay in hospital for one or two nights. Antibiotics and routine pain relief may be prescribed for the immediate peri-operative period. Firm dressings are removed at one week, and replaced with a close fitting sports bra or crop top. Small areas of weeping through the suture line are dressed within the bra if necessary. Underwiring is avoided for 6 weeks. Sutures are usually dissolving and do not require removal. After the surgery It is important to wear an unwired bra for six weeks in order to support the breasts as much as possible whilst they acquire their stable final shape. During the first two weeks following the surgery, the breasts are swollen and feel ‘tight’, bruised and tender. Excessive lifting, carrying and household activities should be avoided. For most occupations two weeks is necessary off work and strenuous exercise should be avoided for six weeks. Driving should be avoided until seat belts can be worn comfortably. In most cases this is possible at three weeks. Nipple and skin sensation returns variably after the surgery. Many women with large breasts have altered nipple sensation before surgery, and in some of these women, nipple sensation will improve post-operatively. Small irregularities in scar and breast skin fade out over time. The bust softens and falls into a natural drop with time. Breast reduction is usually an extremely satisfying procedure, improving the contour size and shape of the bust and restoring body proportion. Many women feel more confident and are relieved of the physical discomfort of large breasts. Possible complications Complications after breast reduction are not common. When they occur they are mostly a temporary nuisance rather than having a long term consequence. Examples of the more worrisome complications are given below, and include but are not limited to - A blood clot may accumulate in the breast after the surgery. This may need evacuation under a general anaesthetic. This has no long term effects on the outcome of surgery. Patients experience altered sensation of the nipple (decreased or occasionally increased sensitivity) especially in the short term. In the vast majority of patients this sensation returns to normal within four to six months of surgery. Wound healing can occasionally be problematic. This can lead to a small area of skin breakdown at the junction of the vertical and the horizontal scars. This problem is usually treated with regular dressings.Occasionally a small area of the nipple can be lost. This is rare and occurs mainly in smokers or in very large breast reductions.