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Breast Augmentation

Click here to see the full section of before and after photos for breast augmentation

Statistics UK 2004-2005:

  • 30% rise in cosmetic procedures
  • 50% rise in breast augmentation
  • 94% of women who have had implants recommend the surgery to others

WHY so popular?

  • Socially accepted
  • Breast implants have evolved
  • High cohesive gels
  • Strong implant shell
  • Comprehensive range
  • Texturing
  • High Confidence
  • Specialist Cosmetic Surgeons
  • Health Care Commission approved hospitals
  • Safety of silicone implants now clearly described

Main reasons to request breast enlargement:

  • Never had satisfactory breast development
  • To have breasts that are in proportion with your body
  • After childbirth, weight loss; loss of volume or shape with age
  • In order to satisfy the desire for a fuller bustline.

In addition to positive cosmetic results, data has shown patients often receive a substantial psychological boost.

What Does it Cost?

  • The average total cost is just over £4000
  • The predominant variability in cost relates to the type of implants!
  • The cost of the latest high cohesive textured anatomical implants is £1200 for two!

Is implant surgery safe?

Breast augmentation is straightforward but must be carried out to exceptional standards and with patient safety as paramount

Is Silicone Safe?

  • Breast Augmentation has been performed for hundreds of years
  • Silicone implants have been used for over 40 years
  • Safety of silicone breast implants is established
  • No increase in cancer or autoimmune disorders

How long do implants last?

Symptomatic rupture is now rare (<5% at 10-yrs) but increases with time

  • If a cohesive implant ruptures the gel doesn't "run"
  • There is no automatic need for exchange of modern implants at 8-yrs

Common Questions

How long does the operation take?

  • 1- 1.5 hrs

Is it painful?

  • The chest area often feels "tight" and tender for a few days

When can I drive?

  • Individual advice varies
  • From 3-days - 3-weeks

When can I return to work

  • Usually after 1 week

How do I decide on the size of the implants?

  • The average breast size in the UK is a "B" cup
  • Most patients desire to be a "C" cup
  • Bring pictures with you or review your surgeon's album
  • Asking for a natural shape augmentation is common
  • There are specific cosmetic techniques that can be used to give you a proportionate result

To see anonymous pre and post operative photos of patients who have had Breast Augmentation Surgery performed by Mr Turton in his Cosmetic Breast Surgery Leeds practice, please review the images section.


High Cohesive Implants

Cohesive gel implants have been designed to feel much more like normal breast tissue and to further improve the aesthetics of breast augmentation.
They provide control over a breast augmenation to change breast size proportionately, to enhance the cleavage area and to provide natural volume to the breast area.

Most patients dislike unnatural upper breast fullness, although a few specifically request this look. I use several techniques which produce a much more natural breast augmentation. This is the type of breast augmentation that I prefer to do as it is intrinsically more satisfying. I call it the proportionate augmentation. The implants are chosen after a detailed consultation and measurement schedule that is referred to as the biodimensional assessment.


How do Cohesive Implants differ from Runny-Gel Implants?

Cohesive gel implants have been in use in England since 1995. Thes are silicone implants that are filled with a thicker material than standard runny gel implants. If you cut into a standard gel implant, the runny silicone escapes like runny hunny. This would be completely undesirable in real life as the silicone gel escapes into the surrounding space. In contrast when you cut into a cohesive gel implant, the implant itself maintains it shape and integrity as the high cohesive gel is rather similar to the inside of a jelly baby (what the American's refer to as a "gummy bear").

Because breast augmentation with cohesive gel implants is designed to focus more on proportions and dimensions rather than volume, it is particularly indicated for women who are looking for a natural-shaped and
proportionate-sized breast augmentation. Cohesive gel implants are not
indicated for women undergoing large breast augmentations who desire a
non-proportionate upper pole fullness.


What are the advantages and disadvantages of cohesive gel implants?

Advantages of cohesive gel implants:

  • proportionate-sized breast augmentation
  • very soft and natural-feeling
  • maintains its shape in an upright position
  • decreases the incidence of folding of the implant shell
  • decreases development of rippling
  • If an accident occurs and the implant is ruptured, the shape and integrity of the implant is usually maintained, and gel leak is minimised
  • very extensive product range: all variations in height, width, projection, volume are catered for

Disadvantage of cohesive gel implants:

  • require a slightly larger incision for insertion (but still well hidden in crease under breast)
  • more expensive than standard runny gel or saline breast implants

Disadvantages of saline implants:

  • many women feel they produce a less natural augmentation
  • there may be a sloshing sensation, or they tend to look more rounded particularly in the upper pole of the breast where this isn't desired
  • more prone to spontaneous deflation causing sudden loss of volume, due to saline leak from the valve (see pictures below)

  • very rarely used in the UK, and decreasingly so in USA due to popularity with newer generation silicone gel implants
  • the membrane is still made of silicone and it is largely regarded as absurd to use saline which is regarded as an inferior filling material now that the Independent Review Groups have so extensively reviewed the studies on the safety of silicone implants


What are the complications associated with cohesive gel implants?

Please review my infomation sheet in the "Support" Section on Breast Augmentation

Potential short and long term complications, future need for revisional surgery and it's limitations, costs and potential permanent deterioration in cosmetic result must be understood. They should be read about and discussed at a detailed consulation.

The type of complications that can occur with cohesive implants are similar to those in any breast augmentation. The largest published study looking at complication rates with cohesive gel implants showed an overall capsular contracture rate of <5%. The majority of these contractures were minor in nature with only 4/600 patients having a severe (Baker IV) contracture. Infections occurred in 2/800 patients and improper implant position was noted in 1.1% of patients. Of note, half of these were in secondary breast augmentations. (Breast augmentation with anatomical cohesive gel implants, Per Heden, MD, PhD, et al, Clinics in Plastic Surgery, Vol. 28, No. 3, July 2001, pp 531-552).


Capsular Contraction

The majority of women have a very nice and long lasting result from breast augmentation. A thin layer of healthy tissue soon forms around your new breast implant to make it part of you. This is called the capsule.

This occurs around any implanted material whether it is a pacemaker or an artificial hip. In some people this tissue may thicken with time and the term for this is "capsulation "or "capsular contraction."

Capsular contracture is the most common complication that occurs with breast augmentation and can happen at any time. It seems to be more common in the first few months after surgery, but the incidence then rises again several years after surgery.


How does Capsular Contraction occur?

At the time of the implant surgery, a pocket is made under the breast for the implant. The capsule that forms is made of fibrous tissue. Some patients lay down more collagen and scar tissue in this capsule, which naturally tends to shrink with time. In most people this may cause a slight increase in firmness of the implant, or it may only be noticed by your specialist. In some people, the capsule will tighten gradually, and squeeze the implant. This makes the breast implant feel hard, and alters the appearance of the breast. In the later stages, the implant feels very firm, and may take on a ball-like look. Capsular contracture like this usually produces pain and discomfort.


How is capsular contraction graded?

  • Grade I
    Breast is soft and looks natural (this means there is no capsulation!)

  • Grade II
    Breast is a little firm but looks normal

  • Grade III
    Breast is firm and looks abnormal

  • Grade IV
    Breast is hard, painful, and looks abnormal


What causes capsular contraction?

There are probably several causes that affect some patients and not others. There are some factors that may increase the risk of capsular contracture.

  1. Smoking
    The rate of capsular contraction is twice as high in smokers. Mr Turton advises all of his patients not to smoke.
  2. Infection
    Capsular contracture is more likely following an infection. It may occur following sub-clinical infection.
  3. Sub glandular placement
    Breast implants placed above the muscle tend to have higher capsular contracture rates, versus breast implants placed behind the muscle, which is also known as submuscular placement. But remember there are other pros and cons to be taken into account in deciding on implant placement, and your specialist will discuss these.
  4. Haematoma
    This is a collection of blood around the implant. It can cause an inflammatory reaction, which can lead to capsular contracture. It is advisable to place a temporary drain at the time of surgery which is removed immediately before your discharge home. This removes even small volumes of blood which otherwise would be left around your implant by those surgeons that don't routinely drain.
  5. Smooth Surface Implants
    The smooth surface implants seem to be associated with a significantly higher capsulation rate than the rough surfaced type. These rough surfaced implants were a new design change introduced over 10 years ago. The process is called "texturing". There are different ways to texture the implant. The textured implants inhibit the capsulation process and do dramatically reduce it's occurence. The textured implants also unite better to the back of the breast tissue reducing risks of a rotation of a shaped implant. Occasionaly you make get some texture-rippling form, if minor capsulation occurs with a textured implant in place.
  6. Previous capsulation
    If you have had previous capsulation it is much more likely to occur again. There may be a genetic reason for this related to wound healing. This is unknown though.


How do you treat capsular contraction of breast implants?

My first advice is to stop smoking if you are a smoker. If there are no symptoms and the cosmetic result remains excellent you do not need to have anything done. It doesn't always progress. It is also important to know that it is not usually associated with any toxic or nasty systemic inflammatory processes.

If it causes discomfort, pain or an unwanted cosmetic result then surgery would be the best way to deal with it.

No one should undergo the previously used but now out-dated technique of closed capsulotomy (the hardened implant is manually squeezed from the outside, to tear the scar envelope, as it can damage the implant).

Open capsulotomy or capsulectomy: This involves a general anaesthetic. The previous incision is usually reopened and the capsule is either incised, or partly or totally excised.

The old implant may sometimes be reinserted. However, I will normally advise for a new implant to be used. After surgery the breasts feel softer and quite often slightly lower (the capsule has acted to keep the breasts artifically high, so after it is removed the breasts drop back to their normal position).


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