Heavy breasts? Thinking about breast reduction?
Like some questions answered about surgery?
We asked Cosmetic and Plastic Surgeon experts of the BMI Sloane Hospital in Beckenham, Raj Ragoowansi, Jonathan Britto & Anil Desai of BRAS (Breast Reconstruction & Aesthetic Surgery) to answer some of those questions for you...
How popular is breast reduction surgery compared to, say, breast augmentation?
BRAS: Very popular. It is one of the most common surgeries for remodelling of the breast and is performed for symptomatic as well as aesthetic reasons in both private practice and on the Health Service. The main complaints that woman have from heavy, pendulous breasts are neck and shoulder pain, inability to buy a full choice of clothing and ugly, uncomfortable strap marks on the shoulders. In addition, there can be be great social embarrassment in sporting or swimwear, which can really curb one’s lifestyle.
At what age can women have breast reduction?
BRAS: We see many women of all ages and, as with other forms of breast rebalancing surgery, there is no real exclusion on age terms. Of course, the advice we give to a potential patient does vary with age. Younger patients need to know that there may be a reduction in their ability to breast feed, balanced against the fact that many women may not be able to breast feed for other unrelated reasons. In older patients there is a greater chance of picking up an unanticipated breast cancer, and for this reason we screen the removed tissues for tumours. All patients have the general risks including poor healing and changes in nipple sensation, and these risks are greater in smokers. It must be said though, that many clinical studies indicate that breast reduction surgery delivers a great boost to measured quality of life, and ranks above many other types of surgery.
What is the recovery period and is the process painful?
Breast reduction is a fairly major procedure but extremely safe in the modern era. A one or two night hospital stay is common after the procedure, and a week off work is probably enough depending upon circumstances. Lifting and carrying in that week is a no-no. We advise that mothers of young children bring in the cavalry for support! The procedure itself is not painful; some patients report that if drains are used they can be uncomfortable to remove, otherwise the recovery should be uncomplicated.
Is there a limit to the size of breast that can be safely reduced?
BRAS: Not at all. It is important to choose the correct technique, of course. For the small breast reduction or uplift surgery we prefer minimal scar techniques, using a scar just around the nipple or extending minimally in a vertically
downward direction. These surgeries are aesthetically very satisfying, and can deliver a youthful, pert breast with minimal adverse effects upon nipple sensation or breast feeding ability. For the larger breast reduction (including up to 4-5kg of breast each side) we have to choose techniques that do not compromise the blood supply of the skin or the breast that is left.
Can breast reduction techniques deliver symmetry?
BRAS: Most definitely. The principles that govern breast reduction surgery also govern breast symmetrisation, and for very difficult symmetrisation surgery, they may additionally combine breast augmentation principles. The experienced plastic surgeon will be able to remodel the breast, centralise the nipple, and minimise scar as much as possible.
So what should women reading this article do if they are interested in seeking breast reduction or symmetrisation surgery?
BRAS: As ever, it is important to do the research and go to a reputable surgeon. It is better to go to an experienced plastic surgeon who is or has been an NHS consultant. Plastic surgeons begin their training in breast surgery and have extensive knowledge of multiple techniques.
Don't leave it to chance talk to the experts CALL 08700 418804 NOW.
Make that appointment for a private consultation with Raj, Jonathan or Anil before making that important decision, they are ready to answer your questions.
(GMC accredited, NHS Plastic & Reconstructive Surgeons)
In Great Shape With Millimetre Perfect
In this month’s article from our series unmasking the complexities around plastic and cosmetic surgery, we ask our experts from Millimetre Perfect, Mr Jonathan Britto and Mr Raj Ragoowansi, to unravel some of the myths and mystery surrounding the surgical enhancement of the breast.
In Magazine: We often hear in the sensationalist media of cosmetic surgery procedures that go badly, often accompanied by frightening pictures – how safe is breast enhancement surgery?
JB: Generally extremely safe! Breast enhancement may be achieved by breast uplift, by breast implants, or by a combination of both. Breast augmentation and uplift procedures are the most commonly performed cosmetic plastic surgery procedures in the UK and USA, and, if properly done by fully accredited plastic surgeons, give a complication – free, new lease of life to many women.
In Magazine: Are the scars of breast enhancement disfiguring?
RR: There is no surgery without scar, and the skill of the surgeon aims to minimise the scar, and hide it cosmetically within body creases. Our preferred scar is the breast crease below the breast, as we believe that good implant position can be best achieved this way, and the scars heal excellently. Other access incisions include around the nipple or within an armpit crease. Each approach has its merits and downsides. The scars from breast uplift, around the nipple and a short scar on the breast, are often more than with an implant alone, as the surgeon has to remodel the breast and overlying breast skin. Occasionally for complicated breast asymmetries, breast enhancement may require the introduction of one’s own tissue from the back or abdomen, in techniques modified from breast reconstruction surgery. In these cases scars from the donor sites can also be hidden with good planning.
In Magazine: Do women with breast implants have to worry about breast cancer?
RR: Not above and beyond the risk in the general population. Breast implants, when placed either behind the breast or behind the pectoral muscles and breast, will not hinder a breast examination, mammography, or other breast scans. A woman with breast implants who is undergoing breast screening for cancer risk need only warn the investigating medical team and the appropriate steps can be taken to take the implants into account.
JB: We should add that many studies internationally have confirmed that breast implants do not increase the risk of breast cancer, nor do implants delay the detection of breast cancer in those unfortunate enough to be affected. Silicone implants and expanders are, of course, used in reconstruction of post – mastectomy and partial mastectomy defects in women undergoing follow –up.
In Magazine: You mention silicone, does this carry a health risk to women?
JB: This worry has long been a source of great concern and the subject of much discussion in our consulting rooms. Again there are many studies available to put minds at rest. Medical grade ‘silicon’ used in breast implants has no detrimental effect on general health and there has been no evidence to support previous claims of causation in various bone and joint related diseases. The modern implant designs have also greatly reduced the rates of silicon ‘bleed’ or leak from implants and the risk of silicon dissemination in the breast or elsewhere. All implants have a silicone elastomer shell, and the silicone within varies in consistency and ‘feel’. Using the popular ‘cohesive’ gel implants, one can cut a demonstration implant and the gel within will not ‘run’. After breast augmentation surgery, the female body does make a ‘capsule’ between the implant and the surrounding tissues, but in the vast majority of cases this is symptomless. Hardening of the capsule, so called ‘capsular contracture’, causes a palpable, visible or occasionally painful implant edge. This problem is more likely in smokers, in whom infection of the implant is also a greater risk.
RR: Capsular contracture may necessitate removal of the implant, and some form of removal of any capsule present. Implant removal also usually results from infections, although in some cases the implant and cavity can be washed out and the implant immediately replaced. After surgery for capsular contracture, a new implant may be immediately replaced, but the risk of subsequent contracture is undoubtedly increased.
In Magazine: Is there a maximum or minimum age for breast implant surgery?
RR: We would wish to know that teenagers who requested breast enhancement by implant, uplift, or a combination of both had parental support, and that both the proposed patient and the family had a good understanding of the responsibility of breast implant surgery. It is important to understand that a subsequent pregnancy would not be affected by the presence of silicon implants, and there is no risk to the newborn child. The implants to not lower the ability or safety of subsequent breast feeding, in fact there is more silicone transfer in a teat on bottle feeding than via breast feeding from a breast with implants behind it! The presence of implants does, however, impose responsibility. The British Association of Plastic Surgeons recommends that we offer a yearly review for patients with implants in, and although it is true to say that the modern generation implants will probably last a lifetime, we do quote a figure of 12 – 15 years for implant exchange.
JB: We should point out that the relationship of the breast to the implant will change with time and subsequent pregnancy. As the breast becomes more ptotic, or droopy, it will sit lower on the implant and may reveal it. The option then would be to either tighten up the breast over the implant or exchange the implant for an alternative design or shape to support the changed breast.
In Magazine: What advice to you give about time in hospital and time off work?
RR: Both very frequent questions! Time in hospital is usually overnight, and home the following day. The operation is usually straightforward. Postoperative pain can be controlled, and sometimes there is a short period of nausea, again easily controlled. Surgical drains, if used, are removed at one day. The implant position behind the pectoral muscles and the breast is often aesthetically indicated, but more uncomfortable with a longer recovery time as the muscle disruption takes some time to heal. We would recommend two weeks off work if possible, and a month before sporting activity or a return to heavy tasks. The surgery creates a pocket to exactly fit the implant, but there is no doubt that an excessively early return to work or working out can result in a shift in the implant and a loss of symmetry in the result. For this reason we tape the breast and encourage the use of fitted, sports bra wear postoperatively and for four weeks thereafter
JB: I am glad that you mention symmetry. No-one who has two of anything is symmetrical and we, in our practice, do not guarantee symmetry or an exact cup size postoperatively, particularly as there is variation in cup size between the various manufacturers. Often small imperfections of symmetry in the bust preoperatively may be accentuated by augmentation with implants alone.
In Magazine: Would you always be able to tell if a women had undergone previous breast implants?
JB: If those implants had been well chosen for size and shape and well – placed, there is no reason why anyone should know of their existence! A well - placed implant should not reveal an implant edge or rippling of the implant surface, and should not be palpable. The position of the implant should be chosen according to the size of the native breast and the shape of the breast and chest wall. Likewise, the shape of the implant, round or teardrop, and the projection of the implant from the chest wall are chosen with the patients’ height, chest and bust in mind.
RR: In recent years many women have been more obvious about their implants and have requested larger cup sizes. We try and counsel people away from excessively large implants and towards a feminine but discreet and proportionate effect. In the end, however, the individual has to decide how to balance the surgical advice and their own measure of good outcome!
In Magazine: Well, thanks, is there any advice you would further give to women seeking breast enhancement?
RR: I would say to do the research and go to a reputable surgeon! Breast enhancement by augmentation or uplift can be a life – changing event, and should be entered into with both thought and enthusiasm!
JB: Absolutely! Choose a surgeon who is or has been an NHS consultant. Decide what you want, but be prepared to modify your thoughts on the basis of sensible advice at consultation.
Millimetre Perfect is the promotional arm of the London Chambers of Plastic Surgery.
For further advice or to arrange an appointment call: Tel: 08700 418804 http://www.millimetreperfect.com/
lcpcs@juleehughes.wanadoo.co.uk
Unhappy with your Breasts?
Like some questions answered about surgery?
We asked Cosmetic and Plastic Surgeon experts of the BMI Sloane Hospital in Beckenham, Raj Ragoowanso, Jonathan Britto & Anil Desai of BRAS (Breast Reconstruction & Aesthetic Surgery) to answer some of those questions for you...
We often hear in the sensationalist media of cosmetic surgery procedures that go badly, often accompanied by frightening pictures - how safe is breast enhancement surgery?
BRAS: Generally extremely safe! Breast enhancement may be achieved by breast uplift, by breast implants, or by a combination of both. Breast augmentation and uplift procedures are the most commonly performed cosmetic plastic surgery procedures in the UK and, if properly done by fully accredited plastic surgeons, give complication-free, new lease of life to many women.
Are the scars of breast enhancement disfiguring?
BRAS: There is no surgery without scar, and the skill of the surgeon aims to minimise the scar, and hide it cosmetically within body creases. Our preferred scar is the breast crease below the breast and the scars heal excellently. Other access incisions include around the nipple or within an armpit crease.
Do women with breast implants have to worry about breast cancer?
BRAS: Not above and beyond the risk in the general population. Breast implants, when placed either behind the breast or behind the pectoral muscles and breast will not hinder a breast examination, mammography, or other breast scans. Many studies internationally have confirmed that breast implants do not increase the risk of breast cancer, nor do implants delay the detection of breast cancer in those unfortunate to be affected.
You mention silicone, does this carry a health risk to women?
BRAS: Medical grade ‘silicon; used in breast implants has no detrimental effect on general health and there has been no evidence to support previous claims causation in various bone and joint related diseases. The modern implant designs have also greatly reduced the rates of silicon ‘bleed’ or leak from implants.
Is there a maximum or minimum age for breast implant surgery?
BRAS: We would wish to know that teenagers who requested breast enhancement by implant, uplift, or a combination of both had parental support. It is important to understand that a subsequent pregnancy would not be affected by the presence of silicon implants, there is no risk to the newborn child and the implants do not lower the ability or safety of subsequent breastfeeding. The British Association of Plastic Surgeons recommends that we offer a yearly review for patients with implants in.
What advice do you give about time in hospital and time off work?
BRAS: Both very frequent questions! Time in hospital is usually overnight and home the following day. We would recommend two weeks off work if possible, and a month before sporting activity or a return to heavy tasks. The surgery creates a pocket to exactly fit the implant, and an excessively early return to work can result in a shift in the implant and a loss of symmetry in the result.
Well, thanks, is there any advice you would further give to women seeking breast enhancement?
BRAS: I would say to do the research and go to a reputable surgeon! Breast enhancement by augmentation or uplift can be a life-changing event, and should be entered into with both thought and enthusiasm! Choose a surgeon who is or has been an NHS consultant.
Don't leave it to chance talk to the experts CALL 08700 418804 NOW.
Make that appointment for a private consultation with Raj, Jonathan or Anil before making that important decision, they are ready to answer your questions. (GMC accredited, NHS plastic & Reconstructive Surgeons)
