Introduction
Breast augmentation (enlargement) is designed to increase the size of the breasts and also improve their shape by the insertion of an implant beneath the breast tissue. Breast augmentation is suitable for women who have naturally small breasts or where there has been shrinkage in size following a pregnancy or weight loss. This operation aims at producing a natural shape which enhances cleavage and will improve your figure by balancing the hips and therefore emphasizing your waist.
Breast implants rely on a silicone shell (the outer part of the implant) and a filling which is usually silicone gel. Mr Grover only uses cohesive silicone gel filled implants which do not leak if. The size of your new breasts depends on your personal choice but it is always recommended to stay within reasonable limits for your height, build and body weight. The decision regarding size will be carefully considered when you visit Mr Grover for a consultation.
before and after photos of patient operated on by Rajiv Grover
What type of breast implants are used & is silicone safe?
Advances in the technology of silicone have lead to cohesive silicone gel which has the consistency of jelly and does not leak even if there is a break in the implant. Mr Grover uses silicone implants as they provide a better shape with a more natural feel than saline implants. When using silicone implants Mr Grover only uses cohesive silicone gel to prevent any leakage.
The safety of silicone implants has been extensively investigated over the past decade and much of the controversy that previously appeared in the media has now been cleared. Silicone breast implants have not been found to cause harmful effects in any scientific study performed to date. An independent review into all published research by the UK Government declared them safe for cosmetic use in 1998 and this has since been confirmed by the European Union and the United States Government (2005).
How long do implants last?
Despite being resistant to extreme pressures breast implants are still susceptible to daily wear and tear. This means that the outer shell or coating of the implant may develop tiny cracks after 12 to 15 years. The body however always produces a thin capsule around all implants from an early stage which acts as a "biological bag" to produce a natural seal. Recent developments in silicone technology have produced cohesive silicone gel which is the most advanced silicone implant available. Rather than being a liquid this is a solid gel which has the same consistency as jelly at a children's party. After many years of wear and tear should any cracks develop these implants would not leak as the silicone is in a solid form. The additional protection provided by the body's natural "biological bag" will prevent harmful leakage outside the implant.
There are many quoted figures as to how long ultimately any implant will last. An average figure is probably in the order of 15-20 years. There are however variations in wear and tear amongst different individuals depending on how much exercise you take and other lifestyle activities. In order to have a proper assessment of the state of your implants it is advised to have your implants examined by a specialist on a regular basis from about 10 years after your operation.
What shape of implant will be used?
One of the more recent choices in breast enlargement involves the option of having either round or teardrop-shaped implants. The importance of the implant shape relates to creating a natural looking breast and in particular the slope of the upper pole of the breast.
Round implants produce a natural looking breast shape in the majority of women undergoing breast enlargement. In a small number of patients who are very slim and have virtually no breast fat there is very little tissue covering the implants and in this selective group a tear-drop shaped implant may provide a more natural shape. Mr Grover feels that in the large majority of women seeking breast enlargement round implants are very successful and produce a natural looking result. However in selected patients the shaped implants may offer some benefits and this will be carefully discussed with you at your consultation.
Where is the implant placed: In front of, or behind the muscle?
Breast implants can be placed in a pocket either in front of the chest muscle (referred to as the subglandular pocket as it lies directly under the breast itself) or behind the chest muscle (referred to as submuscular).
In the U.K. the subglandular placement (in front of the muscle) is the most common method as it allows accurate placement of the implants with the ability to produce a natural looking cleavage. However in some very thin women with little or no breast tissue if the implant is placed in front of the muscle it would only be covered by skin and not much else. In this instance to place the implant behind the muscle will look better as it will have a more natural slope in the upper pole. The exact placement of your implants will be carefully discussed with you at your consultation.
Can breast enlargement help to lift breasts which have dropped?
Although a degree of lifting can be achieved with implants alone, in the event that the skin of the breast has stretched to the point where the nipples have dropped significantly it may be necessary to reposition them upwards by means of an uplift or mastopexy. It is not often that this is required and most women achieve an excellent shape with just implants alone, however if Mr Grover feels that a natural shape can only be achieved with an uplift as well as an implant he will discuss this with you in detail.
Do breast implants cause breast cancer?
There is no evidence that silicone in breast implants causes cancer in women. On the contrary, recent studies have shown that women with implants seem to have up to 30% less breast cancer than the general population although this is really just a reflection of their smaller breast size rather than any influence of the implants themselves.
Will breast implants interfere with breast screening?
Accurate mammograms can still be performed after breast enlargement even though implants are opaque to x rays. A special manoeuvre (Eklund) has been developed to allow the breast tissue to be x-rayed around the implant by assessing it in two directions instead of only one. This allows accurate mammography without loss of accuracy compared to women without implants so please inform the radiographer at the time of your x ray about your implants.
before and after photos of patient operated on by Rajiv Grover
What happens if I get pregnant after I have breast enlargement?
Breast implants do not interfere with breast feeding but care should be taken to maintain the shape achieved by the surgery. If pregnancy should occur particular care should be taken in supporting the breasts in order to maintain the best possible shape subsequently. This is achieved by wearing a supportive bra day and night during pregnancy and also whilst breast feeding to provide constant support. If you can limit breast feeding to three months or less this will also reduce the stretching of your breasts and therefore preserve your shape.
What happens at the consultation?
At your initial consultation, Mr Grover will evaluate your general health and chest, and explain which surgical techniques are most appropriate for you. For instance, if your breasts are sagging, he may also recommend a breast lift although a degree of lifting is achieved by the insertion of a breast implant alone. After discussing the proposed surgery Mr Grover will give you an idea of your new look using sample implants which are helpful in deciding which size will suit you.
How do I prepare for surgery?
It is important to avoid taking any Aspirin or products containing Aspirin for 2 weeks either side of the operation since Aspirin has an adverse effect on bruising. The same is true for non-steroidal anti-inflammatory drugs (such as Brufen and Nurofen). While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days at home, if needed.
Where will my surgery be performed?
The surgery is performed at the King Edward VII Hospital in central London where Mr Grover works as a Consultant Plastic Surgeon. You will usually be admitted on the day of surgery, and stay overnight. It is advisable that a friend or relative accompanies you home when you leave hospital on the day after surgery.
What type of anaesthetic will be used?
Breast enlargement is usually performed under a general anaesthetic, so you'll sleep through the entire operation.
What does the operation involve?
The method of inserting your implant will depend on your anatomy and Mr Grover's recommendation. The incision is usually made in the crease below the breast where it meets the chest as it is well hidden here and allows accurate placement of the implant to create a feminine and natural looking cleavage. Occasionally the incision may be placed in the armpit. Every effort will be made to insure that the incision is placed in such a way that the resulting scars will be as inconspicuous as possible.
Working through the incision, Mr Grover will lift your breast tissue and skin to create a pocket either in front of the chest muscle (the subglandular pocket), or underneath your muscle (the submuscular pocket). The implants are then placed within the pocket and centred beneath your nipples. Following this the incisions are stitched in several layers to protect the implant and external strapping is applied which you will need to keep in place for two weeks as it provides extra support for the breasts during this period. The whole operation takes a little over an hour.
What happens after the operation?
After surgery the breasts will be tender and slightly swollen for a few days and it is advisable to limit arm movements and take the painkillers which you are prescribed. Most women can drive by the fourth or fifth day after surgery and return to work after a week to ten days.
You will need to keep the strapping applied by Mr Grover during the surgery in place for 10 to 14 days and wear a supportive bra over this. After this period the strapping will be removed and your sutures taken out at Mr Grover's clinic. Although by that stage everything will be healed you will need to keep wearing the supportive bra day and night for a further four weeks although it can be removed for showering. As the implants settle in their new pocket it is best to avoid sports for the first 3 to 4 weeks and then build up gently.
There may be changes in the sensation of the nipple and breast which are temporary. It is fairly common for the skin above the incision to feel somewhat numb for 2-3 months but this improves spontaneously. Some patients describe increased sensation or sensitivity which again is a result of the stretching of the breast tissue and its nerves. If this occurs it may last for 2-3 months before returning to normal.
What are the scars like?
The incision for breast enlargement can be placed either in the fold under the breast, or in the arm pit. Mr Grover favours making the incision under the breast so the scar is hidden in the fold as this route allows the most accurate placement of the implant and the creation of a natural looking cleavage. However with all these methods the scar can be kept short (4-5 cm) and is positioned to be as inconspicuous as possible.
before and after photos of patient operated on by Rajiv Grover
What are the risks?
It is important to stress the possibility of risks but in practice these are rare and breast enlargement is one of the most reliable of all cosmetic surgery operations.
Excessive internal bruising (haematoma) occasionally occurs and may require removing some stitches to wash out the bruising from beneath the skin. This has no effect on the long term outcome of surgery.
Infection is rare because routine antibiotics are given following surgery. If infection occurs despite this, then the implant may have to be removed although after the infection is treated a new breast implant can usually be put in.
Changes in the sensation of the nipple and the breast (either an increase or a decrease) can occur following breast augmentation, but these are usually temporary.
Occasionally hardening of the implant may develop due to scar formation. This problem occurs in about 5% of women undergoing breast. The exact cause of this problem is not fully understood but may be due to the body's sensitivity to the otherwise inert breast implant. This hardening can occur months or even years after surgery. If this condition is severe more surgery may be needed in the future to remove the capsule and replace the implants but this is rare before 5 or 10 years.
Summary
Procedure time
60-90 minutes
General / Local anaesthetic
General
No. nights in hospital
1 night
Time off work
7 days
Sensitivity period
10-14 days
Back to normality / sports
3-4 weeks
Breast augmentation is the commonest cosmetic surgery operation in the UK and is extremely successful at improving breast size and producing a natural shape with enhanced cleavage. By balancing the hips it improves a women's figure and emphasizes their waist.
(c) 2005 Rajiv Grover 144 Harley Street London W1G 7LE Tel 020 7486 4301 Fax 020 7486 4327
