FAQs – Frequently Asked Questions
What Should I Do If I Have PIP Implants?
Mr. Ahmad will fully assess patients with PIP implants and will offer them removal and exchange if required. Mr Ahmad is offering reduced rates to replace uncomplicated PIP implants. Mr Ahmad feels that these implants have doubtful integrity and women should seek to have them removed/replaced.
Mr. Ahmad’s Policy And Opinion About PIP Implants:
In Mr. Ahmad’s experience there is a higher incidence of implant rupture in individuals with PIP implants. Some of these ladies have demonstrated various symptoms, including painful breast and axilla (armpit), tingling in the arm and hand and a general feeling of lethargy. However Mr. Ahmad has not seen any sinister side effects as a consequence of these implants yet.
Mr. Ahmad has extensive experience in cosmetic breast surgery and implant revision surgery with very good cosmetic results. Mr. Ahmad has done innumerable revision implant surgeries, relevant to the recent issue of PIP implants. Mr. Ahmad has been fully involved in the protocol for assessing ladies with PIP implants and has been replacing them when indicated or desired by women over the last two years.
Mr. Ahmad has an extensive experience in breast augmentation using both shaped and round silicone implants made by Allergan and Mentor. Occasionally Mr. Ahmad will use Polyurethane silicone implants on individual request.
What Are The Indications For Implant Use?
Volume enhancement due to aesthetic/medical reasons:
- For personal preference (dissatisfied with the shape and size of breast)
- To replace breast volume lost after having children and breastfeeding
- To correct uneven breast
- To correct mild to moderate ptosis (breast droop)
For complications from previous breast enhancement surgery:
- Capsular contracture
- Rupture/bleeding implant
- Bottoming out
To correct congenital conditions involving the breast:
For breast reconstruction:
- To correct large volume deficit after previous lumpectomy for breast cancer
- After mastectomy
Before Breast Augmentation
What Happens At My First Consultation?
Your consultation is always with Mr. Ahmad. This is a detailed meeting to assess your current situation, medical history, suitability for breast enlargement, and to perform the bio-dimensional assessment. You will have a full breast examination, and comprehensive measurements made of your frame, existing breast size, glandular analysis, tissue characteristics, and anatomical variations in typical dimensions.
The type of breast implants on the market, their safety, and the ones that have the best life span and lowest complication rate will be discussed. Mr. Ahmad will also detail your options and alternatives, the potential complications, any limitations, short and long term breast changes, costs, the need for future surgery, mammography and follow-up.
What Size Can My Breasts Be Increased To?
Mr. Ahmad uses several methods to assess the optimum size of breast implant but mostly bio-dimensional software. The bio-dimensional assessment will enable a choice of size to be made based on your proportions.
This is the safest way of balancing the desire of breast enhancement with reduced detrimental effects. Most ladies desire to be a “C” to “D” cup but some will request a bigger size and although cup size is not absolutely guaranteed, Mr. Ahmad will be able to show you how your breast shape can be augmented, and take into account your desire.
If you ask for a size that is much larger than your assessment suggests then you must be aware that there may be higher risks of complications and detrimental changes: eg breast tissue sag, palpability, less natural appearance, numbness, arms rubbing against side of breasts, ache, and future mal-position. Mr Ahmad assesses ladies for large breast implants and advises them regarding the feasibility of mega-enhancement/enlargement. Some of these mega-enhancements may require two-stage procedures.
Where or in What “Plane” is The Implant Inserted?
The sub-pectoral (under the muscle) dual plane positioning of the implant(s) feels more tender in general than when a sub-glandular (under the breast) position is used. Often one side feels slightly tighter, or more tender initially; implant settling often occurs earlier on one side than the other.
Is It Painful?
The chest area often feels “tight” and tender for a few days. You will be able to move about as normal, but you should avoid using your chest wall muscles forcibly, to avoid discomfort.
When Can I Return To Work?
Usually after one week. Some women return after less time, such as three days, and some longer. Jobs that involve strenuous lifting should be avoided for two weeks.
How Long Will I Be In Hospital?
If you have surgery in the afternoon or evening you will normally stay overnight. Mr. Ahmad will review you the morning after surgery and if everything is satisfactory, Mr. Ahmad will discharge you from the hospital. This normally is always by mid-day.
What Forms Of Sports Activity Can I Do After Surgery After An Augmentation With Anatomical Teardrop Breast Implants?
Anatomical implants (also called teardrops and shaped implants) need time to settle, and for tissue in-growth onto the textured implant surface to reduce future risk of a rotation. Different implant manufacturers have different types of texturing, which has an influence on Mr. Ahmad’s choice of breast implants. Texturing allows tissue in-growth and stops excess movement of the implant and thus helps prevent capsular contracture.
Excess movement early on (first four weeks) will prevent in-growth and encourage a small seroma to form (like blister fluid), further preventing in-growth. Therefore, you will have more restrictions with your recovery programme that must be followed to allow for this. Typical rates of progress that will not hinder your recovery from breast augmentation are as follows: No excessive stretching/movement should be undertaken for 4-weeks. With round breast implants the restriction is much less, especially if the implants have been placed in the sub-glandular position.
If I Lose / Gain Weight Will My Breast Size Reduce / Enlarge?
In general, yes. Breast tissue is composed of thick glandular tissue and soft fatty tissue. Just as when you put on weight you find that it goes onto the bottom/hip area, you will also often find some of it goes onto the breast area. Big shifts in weight are therefore not desirable. Most people have minor weight fluctuations of 2-4 lbs either way, which have negligible effects.
If your starting breast size was very small (A to AA cup size), then losing weight tends not to make the augmented breast smaller, but reduces the thin normal fatty tissue layer under the skin, and in the breast tissue layer – this makes the implant edge more easily palpable (particularly in the outer edge near the arm-pit, and in the skin crease area under your breast).
Implants that are partly under the muscle have the additional coverage of soft tissue that this provides which is particularly helpful in thin individuals, but remember – the pectoralis major muscle does not fully cover the implant, generally just the upper half.
How Can I Prevent Sagging In Future Years?
Some sagging is inevitable but careful choices can modify your risk. Your breasts will always change as you get older, and this is irrespective of whether you have breast implants or not. This is because of biological changes that occur with ageing: loss of elastin, stretching of collagen, atrophy of breast tissue, loss of skin elasticity, sun damage to skin, smoking related damage, effects of weight change on skin and breast tissue, effects of pregnancies and breastfeeding on skin and breast tissue, hormonal changes, weight of breast tissue and implant weight and size.
The bio-dimensional assessment goes some way to reducing excessive implant sizes being chosen by ladies. You should ensure you speak to your specialist breast surgeon / cosmetic breast surgeon about this. The larger the implant the greater the long term detrimental effects. This is because of the additional weight carried, and the compressive force of the implant on the surrounding tissues, which become thinner, and more stretched.
Avoid very large augmentations and implant sizes that exceed your natural dimensions. Sub muscular breast implant augmentation may provide additional support to the implant.
Wearing a well-fitting bra after your recovery is important (usually from four weeks). An under-wire bra is safe and recommended. Wearing a comfortable sports bra at night is also very useful. A shock-absorber type bra should be worn during sport. Keeping the skin over the breasts moisturised helps to maintain the elasticity (bio oil is possibly advantageous here).
Avoid the use of sunbeds and do not smoke at all (both have a very detrimental effect on skin elasticity and quality, as well as micro-vessel blood flow). Maintain your weight in the healthy range for your body mass index.
Are Implants / Surgery Guaranteed For Any Length Of Time?
Each implant manufacturer has slightly different guarantees that relate to implant rupture. No manufacturer or surgeon can offer a guarantee against long term changes, which will always occur, may be subjective, and are biological rather than anything to do with the implant or the initial surgery.
For example: Allergan anatomical implants carry a lifetime guarantee against rupture. If they rupture then Allergan will provide new breast implants free of charge (please check for updated confirmation from your surgeon). The cost of the operation (surgeon’s fee, anaesthetist’s fee and hospital fee) is NOT covered.
If Something Goes Wrong During / After Operation Is Surgery Guaranteed & Will Problems Be Resolved Within Cost?
Complications from breast augmentation surgery under Mr. Ahmad are rare, but he will be unable to give you a categorical guarantee that they won’t occur. The sorts of problems that can occur are haematoma around the implant in the first 24-hours needing evacuation, or implant infection needing implant removal in the first few weeks. If these complications do occur you will be covered by the fixed price package for further surgery.
For example, if you need to have the implants removed because of an infection in the post-operative period, this is covered, as is the subsequent operation to replace new implants. Fixed price packages tend to cover you for complications during the first 3-months after the operation, as this is the time that surgery related complications occur. They do not cover the more long-term changes with implants like: rippling, palpability, breast sag, capsulation, rupture, and malposition. They also do not cover dissatisfaction with the size, or shape.
Mr. Ahmad will always strive to meet your expectations but if there are limitations as to what can be achieved (often related to your starting point) then these will be discussed. It is important to be realistic. Once you have recovered from surgery there is no reason why you shouldn’t go without a bra on occasions. As long as you feel comfortable it will not have a detrimental effect. In the long term, however, breast tissue will be more susceptible to droop if you do not wear a bra most of the time.
Post Operation Questions
How Will I Feel After Breast Augmentation Surgery?
The vast majority of Mr. Ahmad’s ladies feel relaxed and comfortable immediately after surgery. Breast tenderness and a tight feeling usually become apparent in a gradual manner. At this stage Mr. Ahmad is happy for the nursing staff to dispense paracetamol and an anti-inflammatory tablet for pain relief. You will usually need to have a stronger painkiller as well, such as Tramadol or Codeine. This combination is best taken regularly for the first four days. After this, the Tramadol can be just taken at night if required. It is usual to stop the Tramadol after one week.
The anti-inflammatory and paracetamol combination is very effective and can be continued for a few weeks according to how you feel, but should not be taken on an empty stomach. It is quite common for one breast to be more tender, and to swell slightly more (this is often the right side). Similarly one breast will often recover more quickly and this is quite normal.
Although this would be very rare, the gradual appearance of a great discrepancy in size would not be normal and should be assessed. Similarly if you feel unwell, feverish and develop a temperature you would need assessment. If the skin over the breast swells and becomes reddened and tender you would need assessment. Changes like this would be very unusual indeed, but it is important to know that should they occur, a prompt review is required to assess the cause and treat it.
Are There Any Side Effects To The Operation?
The most common one is feeling sleepy for a few hours. Sometimes the anaesthetic or morphine makes you feel sickly, but usually for a short duration only. You may feel slightly bloated for a few days. This is often due to slight constipation caused by morphine, Codeine and Tramadol medication. A gentle laxative (Lactulose, Movicol or Senna) will help resolve this.
What Clothes Should I Bring In To Wear Leaving Hospital After The Operation?
A loose button front shirt is ideal. Avoid clothes that would need pulling on over your head.
Do I Need To Take Time Off Work After Surgery?
Yes. Please check with Mr. Ahmad in relation to what you do. Generally you will require at least one week off. Two weeks or more may be needed if your job involves lifting or heavy manual work. If very sedentary, you can occasionally return after three days, but remember that you will still be taking paracetamol and Voltarol, but should have stopped the Tramadol.
Can I Have Them Removed At A Later Stage If Required & If So What Are The Consequences?
Yes. Implants are easy to remove, even under a local anaesthetic, should it be required. The breasts will of course be empty, devoid of fullness, and the skin will be loose, usually with some wrinkles and sagging. The difference is profound as there will be age related changes that will have occurred and much less native breast tissue.
How Long Is The Scar Tissue Healing Time?
Skin healing occurs in the first 7 days, but continues to mature over 6-12 months. The scars must be cared for and you should avoid touching or feeling along the scar line for the first 8-weeks. Mr. Ahmad gets his ladies to tape the scar for 3-months to keep the scar line like a fine pencil line. The scars gradually fade over the first 12-months to a pale colour. This process can be speeded up by using silicone gel called Dermatix or Cica-care.