Breast Implants
Bilateral Breast Augmentation
Who would benefit from this procedure?
Women who would like larger breasts but do not have any breast
droop are the most common group to have this procedure. Others
who may benefit include those with very mild droop, tuberous breasts or breast asymmetry. Some women may benefit from a combination of breast augmentation and breast uplift.
How is it done?
You will have a general anaesthetic i.e. you will be asleep and unaware of the procedure. Once fully anaesthetised Mr Dheansa will insert a breast implant sizer through the planned incision above or below the muscle (depending on the decision made with Mr Dheansa) to gauge how your chosen size of implant will look. At this stage Mr Dheansa may make adjustments to improve the appearance of your breasts resulting in using implants that may be a slightly different size from your chosen ones. Once the permanent implants are in place the wounds are closed with dissolving sutures and a shower resistant dressing applied.
What happens before the surgery?
You should have had a full discussion about the procedure, its suitability, outcomes, complications and long-term effects with Mr Dheansa. You should be confident of the approximate size of implant you wish to have. You should be clear about the incisions to be used, whether the implants will be placed above or below the muscle, the type of implant, length of stay and the costs of the procedure. Knowledge of your general health will allow pre-assessment of fitness for anaesthetic.
You will normally be admitted to the hospital on the day of surgery. Your anaesthetist will see you and you will have an opportunity to discuss your anaesthetic with him/her. Mr Dheansa will review you before your operation, go over the procedure again and mark the breasts for your new implants.
You will sign a consent form confirming that you are aware of the risks, complications and benefits of the operation. If you have any last minute questions please make sure that you ask them at this stage.
If possible you should have bought a sports bra to fit your new size as you will need to wear it straight after the operation. This needs to be easy to put on, unpadded, non-wired and not be tight around the chest. If you are unclear about any aspect of your care or the procedure itself you must contact Mr Dheansa (contact details below) to clarify the situation before committing to surgery.
Breast appearance and size
Everybody is different and each person wanting breast augmentation surgery will have different desires. It is very important to have discussed your specific expectations with Mr Dheansa to be able to get a realistic idea of what is possible and the pro's and con's associated with them.
The results of breast augmentation surgery can be very different from individual to individual and so seeing the results of such surgery in others may not give an indication of how things will look in your particular case. You should spend some time confirming the size you would like to be by buying a larger bra (approximately the cup size you wish to be) and then rice in pop socks (or similar) of various sizes in the bra to decide which you like best.
It is essential that you measure out the rice as if it were a liquid (ie. in millilitres) and as accurately as possible. Please make a note of the size you like best. As a guide, try 150ml, 200, 250, 300 and 350ml of rice in pop socks and then once you have an idea of what you like go up and down by 25ml at a time so that you have a minimum, an ideal and maximum size. Mr Dheansa will use this as a baseline for the size of implant to use but occasionally may use a different size if it is felt, during the operation, that it would give a better more proportioned breast size and shape.
If your breasts are different sizes you should use different volumes of rice to get the breasts as equal as possible in your bra. Again during the operation Mr Dheansa may have to make adjustments to get the best result.
After the Surgery
What happens after the surgery?
After the operation you will be looked after in the recovery area until you are awake enough to go back to the ward. You may have a drain coming out of each breast to collect any blood that may accumulate around the breast implant. You may be sore at this point and the nursing staff will ensure you get enough painkillers to make you comfortable. Overnight you will be checked regularly to ensure you have no problems. This will include checking your drains.
As soon as it is comfortable to do so you should put on your sports bra to help support your new breasts. The following day you will be reviewed by Mr Dheansa and usually plans will be made to remove your drains after which you will be allowed to go home. Plans for follow-up will be made before you leave. You will be given painkillers to take home with you.
Mr Dheansa will make arrangements for a review at 1- 2 weeks after the operation. You should keep the dressings intact until your dressing change.
You will be reviewed until everything is stable. This is usually at about 3 months after the operation.
What should I expect post-op?
You should massage and moisturise the breasts with a circular movement from outside to in at least twice a day for 6 weeks after the first week. Once everything has healed it is best to apply Micropore tape to the scar for 6 weeks. If the paper tapes from the original surgery are intact Mr Dheansa may leave these until they separate. Tape can then be applied to the scar. This will help the scar mature. After this time moisturise the scar with a simple cream such as E45. Apply it along the scar twice a day using firm strokes to help it mature.
Post Operative Care
These advice pages give general guidance on care after your surgery. Mr Dheansa will have discussed any specific do’s and don’ts with you before your surgery but if you are not sure please ensure you check these pages or contact us.
Long Term Care
All women notice a change in their breasts as they get older and this may be exacerbated by pregnancies and changes in weight. It is no different for those women who have had breast implants. However the increased weight of the new breasts may accelerate this process.
What can I do and not do at home?
You should take your pain killers regularly. Make sure you have enough support to help you at home. Try to eat and drink healthily to help healing.
Although it is ok to shower, you should avoid baths or soaking your wounds. It is important that you wear your sports bra all the times (even when asleep) for the first two weeks. You should not drive or perform any strenuous activity until you are seen by Mr Dheansa. After two weeks you need not wear a bra at night.
Generally it is ok to drive after two weeks and you can slowly increase your activity so that by 4 weeks you can start doing more such as light gym work. You shouldn't do any really strenuous activity until after 6 weeks. However should you have any concerns before or in between appointments please contact Mr Dheansa.
Will my scars change?
All scars go through a maturing process and go through a series of changes before settling down. This process varies from person to person as well as from site to site on the same person. Generally once a wound has healed the scar will be a thin pale line. Over the ensuing 6-12 weeks the scar may become raised, pink and wider. It often becomes itchy too. It then stabilises before slowly becoming flatter, paler and less itchy. This can take up to a further 12-18 months. Even after this time scars continue to improve but at a much slower rate.
Avoid sunlight on the scar for the first year to avoid it getting burnt and then subsequently dark. It is very hard to make it pale again. Mr Dheansa will advise you of any further precautions or actions if required.
Applying tape for the first 6 weeks may help reduce the scarring and in Mr Dheansa’s opinion more effective than cream, oils or silicon.
Things to Consider
It is important to be prepared before and after your surgery. Here are a few things to consider about this operation.
Further Operations
Breast augmentation is not to be considered a one-off operation. It is a long term commitment and you may require further operations over time. This may be to change implants, to uplift the breasts or for revision surgery (e.g. if there is a complication which has affected the breast appearance). Most people are likely to have between 3-5 operations over their lifetime.
Numbness
All patients will experience loss of normal feeling of the breasts after their operation. This usually returns over several weeks but sometimes there can be small areas where the feeling remains poor. This may be permanent.
Small Bumps
Occasionally you may be able to feel (or rarely, see) small bumps at the site where the bones have had to be reset. This is more likely if you have thin skin. These often resolve but in a few people they persist and may require a minor operation to improve them.
Change over time
Breasts do change over time whether they have been augmented or not. However the effects of gravity and age may be greater in those who have had breast implants. This can result in breast droop and may need a breast uplift operation (mastopexy) to correct this.
Abnormal Scars
Sometimes even if all heals well a patient may develop abnormal scars (pink, wide, raised and itchy). Patients may already have noticed such a tendency from previous scars. Such scars take a very long time to settle (up to 18 months) and may be difficult to treat.
DVT/PE/Chest Infection
Clots in the leg (DVT) or lung (PE) or chest infection are uncommon with this operation.
Asymmetry
Most women have a slight difference between their breasts. Breast augmentation surgery will not necessarily be able to fully correct this difference. If there is a significant difference between the right and left breasts then usually different sized implants will need to be used. Again it is very difficult to achieve breasts which are exactly the same size and shape in this situation – though one should expect a significant improvement compared to the pre-operative appearance.
Bruising/Swelling
Some patients may experience some bruising. This often results in increased swelling and some tenderness. The skin may become discoloured and take a few weeks to settle down.
Cancer Screening
Many women will have breast screening at some point. It is important to inform the screening team that you have implants so that they can take extra views. Some evidence suggests that it may be harder to detect early breast cancers if you have implants but at the moment there is no definitive evidence.
Nipple and Areola
The nipple/areola may increase in diameter after augmentation as it may be stretched by the implant. It is difficult to predict if this will occur or by how much but is more likely with larger implants. Sometimes the nipple/areola can become sensitive. If this is the case, regular massage & touching/desensitising the area will help. If this is not done, the sensitivity will increase.
Breast Feeding
There is no good evidence to show breast feeding after breast augmentation is unsafe. However until there is good evidence to prove that it is completely safe Mr Dheansa recommends that one should not breast feed after breast implant surgery.
Are there any potential risks?
There are potential risks and complications with any operation and it is important to be aware of them before committing to any surgery. You may also have particular circumstances that affect the final outcome and these will be discussed with you at your consultation.
Capsular Contracture
In about 10% of patients the scar tissue that surrounds every implant becomes much thicker than normal. This tissue then contracts and may alter the breast shape. This can be associated with tenderness of the breasts. If this should occur then depending on the severity, one may need to have the implant and scar tissue removed and a new implant inserted.
Bleeding
Rarely there may be significant bleeding under the skin that does not settle. Should this occur you may have to return to theatre to control the bleeding. This should not have any long term effect should it occur.
Implant rupture
The outer coating of breast implants may weaken over time (10-20 years) and this may result in the inner part of the implant (the filler) leaking out. This may result in a change of breast shape. It is less likely with the newer cohesive silicone gel implants and some manufacturers think they can last a lifetime. If rupture should occur the old implants would need to be replaced.
Anaesthetic
You will be assessed for fitness for anaesthetic and providing this is appropriate the risks from general anaesthetic are low. Anaesthetic can sometimes cause a reaction though this is very rare.
Implant shift
There is a risk that an implant might move thus affecting the shape of the breast. It is essential therefore to avoid strenuous activity and keep a sports bra on continuously to prevent this from happening.
Delayed Wound Healing
Sometimes if there is a lot of swelling, bruising or infection the wound may open up. In such circumstances you may need to have dressings for a few weeks and the resulting scar may be less than perfect.
Seroma (Fluid Collection)
Rarely, patients can notice a small amount of fluid accumulate around their implant. This fluid often settles after a few weeks. Very rarely, it may need to be drained.
Important things to look out for:
Early on
If you notice increasing pain, redness or swelling soon after your operation contact Mr Dheansa as soon as possible. You may need to be seen earlier than your scheduled appointment. Please also contact Mr Dheansa if you have any problems with the dressing.
Later on
In the first 3-6 months after your operation you will notice a change in the feeling of the breasts and a change in the shape (they look less tight and relax a little). This is normal. However, if you notice them looking tighter or becoming painful, please arrange an appointment with Mr Dheansa as soon as possible.
Download Procedure Information
Download Consent Form
Frequently Asked Questions
How long is the operation?
The operation should take about 90 minutes to complete.
When can I shower?
Straight away as you will have a water resistant dressing.
How long until the final result?
It takes about 3 months for your breasts to settle.
How long should I keep taking pain killers?
You will often need pain killers for at least a week but everyone is different you may need to take them for longer.
When can I go to the gym?
You should avoid the gym till about 4 weeks after the operation but check with Mr Dheansa first.
When can I fly?
Generally it is ok to fly 2-3 weeks after the surgery but this depends on length of flight and your recovery. Check with Mr Dheansa before flying.
Download Further Information
Click here to check out these handy information packs that you can download
