Pre And Post-operative Information And Care For Breast Augmentation
February 24th, 2013
Pre And Post-operative Information And Care For Breast Augmentation
Breast augmentation is a very personal decision and sometimes it takes prolonged consideration before one decides to finally opt for breast augmentation. It is natural to want to have all your questions answered regarding surgery and to be mentally prepared by having a full picture of your pre and post-operative pathway.
Although most of the issues are addressed in my breast augmentation section, this blog post will answer the most common questions.
Q: What is a silicone implant and what is it made of?
A: It is made of an outer capsule, which is composed of silicone elastomer, and is filled with viscous silicone. The viscosity (thickness) of the internal silicone varies according to the requirement of the augumentee. There are silicone implants which are filled with saline but they are not very popular in the UK.
Q: Are silicone implants safe?
A: Silicone implants used these days are fifth generation implants, so they have gone through many modifications to make sure they are long-lasting, fit for human use and have no negative health implications. They have been subjected to extensive studies both in the US and Sweden and the results of these analyses and studies show that “neurological diseases, or other systemic complaints or conditions, are no more common in women with breast implants, than in women without implants”. Subsequent studies and systemic reviews found no causal link between silicone breast implants and disease. Since the mid-1990s, the fifth generation of silicone breast implant is made of a semi-solid gel that mostly eliminates filler leakage (silicone gel bleed) and silicone migration from the breast to elsewhere in the body. The studies Experience with Anatomical Soft Cohesive Silicone gel Prosthesis in Cosmetic and Reconstructive Breast Implant Surgery (2004) and Cohesive Silicone gel Breast Implants in Aesthetic and Reconstructive Breast Surgery (2005) reported low incidence rates of capsular contracture and of device-shell rupture, improved medical safety and technical efficacy greater than earlier generations of breast implant device.
Q: What are the different shapes of implants?
A: Implants come in two shapes; teardrop (anatomical) and round. Shaped implants tend to give a more natural shape and, generally speaking, require 10% more volume to achieve the same result as round implants, especially regarding cleavage and the upper pole, whereas the round implants will give fullness at the upper pole and will enhance cleavage. The other difference is that teardrop or anatomical implants are firmer than round due to the nature of the silicone used.
Q: Where are these implants placed?
A: Primarily there are three options of placing the implant:
Sub-glandular: A pocket is created just behind the breast and hence the implant is only covered with breast tissue. The advantage of this pocket is that it is less extensive surgery and the post-operative pain is far less. This is suitable for ladies with good tissue coverage. The disadvantages include implant palpability on the upper pole especially if you decide to loose weight. Another disadvantage is substandard mammography. All women are advised to have regular screening mammography after the age of 50. Sub-glandular implants can hamper the quality of the image.
Sub-muscular: This pocket is created behind the pectoralis major muscle without releasing the inferior attachment. This is suitable for women who have very thin breast tissue at the inferior pole. On the plus side it provides tissue coverage to the implant at the inferior pole but at the same time with the risk of causing “window shading”; a condition in which leads to implant displacement every time the pectoralis muscle is contracted, e.g. any upper body movement involving pushing. This can be quite disconcerting to women.
Sub-Pectoral (Dual plane): Is the most common pocket in which to insert the implant deployed by UK breast surgeons. This pocket is created under the pectoralis major muscle but it differs from the sub-muscular pocket as in this approach inferior attachment of pectoralis is released, avoiding the window-shading effect. Another advantage is that mammographic views are not compromised. From a cosmetic outcome point of view, this approach gives the best results. The downside is there may be more post-operative pain, but with strong painkillers, it is very well controlled.
Q: What happens at the first consultation?
A: The first consultation is free. I will go through the basics of breast augmentation and the options available to you. You have your measurements taken and data is fed into the bio- dimensional software, which in turn gives you an idea of optimal implant volume. You are also given the opportunity to try different external implants to give you an idea of your body’s appearance with different volume implants. All your questions are answered to best of my ability.
In the next couple of days you receive a detailed letter with all the information regarding your consultation. At this stage if you decide to proceed with breast augmentation, I book you for surgery but more often than not you take time to consider all the information provided and contact my secretary either to arrange a re-visit or book your surgery.
Q: What is the next step?
A: Once you have decided to go for your augmentation surgery, you are given a date for your operation. A pre-operative MRSA test is done if you are having surgery at the Duchy, Truro hospital but it is not mandatory if your surgery is at Bath BMI. Pre-operative assessment is mostly done on the phone by one of the nurses in the hospital.
Q: What happens on the day of operation?
A: On the day of your operation, you will be admitted a few hours before your operation and will be checked and admitted by the ward nurse. I see you before your operation and go through the consent and pre-operative markings. The anesthetist also sees you and discusses all the operative and post-operative details with you.
After your surgery you are brought back to your room after a period in the recovery room.
You will have one drain on each side, which is removed after approximately 10-12 hours. Your post-operative pain is well controlled with oral analgesia and if required with injectable pain relief. I see you after your operation and then just before your discharge and make sure that everything is in order.
Q: What happens after discharge?
A: You are advised to contact my secretary or me if there is a concern, otherwise I see you in two weeks and your dressings are removed and instructions on wound care are given. You are next seen in approximately 4 months. A newly augmented breast takes four to six months to settle down to its natural position on the chest wall.
All post-operative appointments are inclusive in the price and there is no extra fee for these appointments.
Wound care involves application of Micropore tape for approximately 6 to 8 weeks and massage with bio-oil for 6 weeks. I also ask you to use a well-fitting bra in order to support your breast preferably at all times. My advice is to use a wired bra but I leave this decision to your personal preference.