Scope
Breast aesthetics is not a single operation but a group of procedures with differing aims. Among the reasons for consulting there are functional complaints as well as appearance: back and neck pain, grooving of the shoulder from the bra strap, recurrent irritation within the skin folds.
| Procedure | Principal aim | Points of attention |
|---|---|---|
| Augmentation | An increase in volume; loss of fullness after pregnancy or weight loss | Choice and placement of the implant; thickness of the tissue |
| Reduction | Relief of the pain and the skin problems caused by excessive volume | Preservation of the blood supply and the sensation of the nipple |
| Uplift (mastopexy) | Correction of sagging; where volume is sufficient no implant is needed | Planning of the excess skin and of the position of the nipple |
| Correction of asymmetry | A marked difference between the two breasts | A different procedure may be required on each side |
| Gynaecomastia (breast enlargement in men) | Reduction of breast tissue and of excess fat | Investigation of underlying hormonal or drug-related causes |
Where several changes coincide after pregnancy and breastfeeding, the procedures may be combined in a single session; this decision is made according to the state of the tissue.
Assessment and planning
At examination the volume and symmetry of the breasts, the quality and elasticity of the skin, the position of the nipple, the structure of the chest wall and the posture of the spine are assessed; the measurements are recorded.
Breast health screening is an inseparable part of planning. Ultrasound or mammography is requested according to age and family history. In patients with a family history of breast cancer the assessment is carried out in greater detail. An aesthetic procedure does not take precedence over the investigation of a problem that is already present.
Smoking, blood-thinning medication and uncontrolled chronic illness affect planning.
What needs to be known about procedures using implants
- Size and shape are determined together, according to the measurements of the person’s chest wall, the thickness of the tissue and their expectations. A volume greater than the tissue can carry leads in the long term to sagging and thinning.
- Placement (beneath the muscle, above the muscle, or in the planes between) is chosen according to the thickness of the tissue.
- Implants are not guaranteed for life. Replacement may become necessary with time; regular review and imaging follow-up are advised.
- Capsular contracture is the thickening and hardening of the membrane the body forms around the implant; it can cause firmness, a change in shape and pain, and may call for a further procedure.
Surgery and recovery
The procedures are carried out under general anaesthesia. The duration varies with the procedure.
- Pain and a feeling of tightness occur in the first few days; a supportive bra is advised.
- In reduction and uplift a drain may be used for a period.
- Return to daily life is in most cases 1-2 weeks; 4-6 weeks are awaited before heavy exercise and upper-body work.
- Resolution of the oedema and settling of the shape take months. Scars are red and conspicuous in the first months and grow paler with time, but they are permanent.
Frequently raised topics
Breastfeeding. In reduction and uplift an effort is made to preserve the connection between the nipple and the tissue; even so, the possibility that breastfeeding capacity may be affected is discussed from the outset. Where pregnancy is planned in the near future, the timing is considered together.
Cancer screening. Previous breast surgery does not prevent screening from being continued. When imaging is carried out, information about the earlier operation and about any implant needs to be shared.
Change in sensation. Temporary reduction of sensation in and around the nipple is common; the greater part of it recovers within months, and a permanent change is also possible.
Risks
Bleeding and collection of blood beneath the tissue, infection, delay in wound healing, scar problems, asymmetry, change in sensation; in procedures using implants, capsular contracture, displacement of the implant or loss of its integrity. The frequency of the risks varies with the procedure and with the person’s state of health, and is discussed in detail before a decision is made.
Assessment
In breast aesthetics the appropriate procedure is determined by the source of the complaint: sagging and loss of volume call for different solutions, and in some patients no implant at all is needed.
You are welcome to book an appointment for assessment and to discuss the options; bringing your most recent breast ultrasound or mammography result, if you have one, speeds up planning.