The Operation

Before the operation

You should have had a full discussion about the procedure, its suitability, outcomes, complications and longterm effects with Mr Khandwala. You should be confident of the approximate size of implant you wish to have. You should be clear about the incisions to be used, whether the implants will be placed above or below the muscle, the type of implant, length of stay and the costs of the procedure. If possible you should have bought a sports bra to fit your new size as you will need to wear it straight after the operation. If you are unclear about any aspect of your care or the procedure itself you must contact Mr Khandwala (contact details below) to clarify
the situation before committing to surgery.

In hospital

You will normally be admitted to the hospital on the day of surgery. You will be seen by your anaesthetist and you will have an opportunity to discuss your anaesthetic with him/her. Mr Khandwala will review you before your operation and go over the procedure again. You will sign a consent form confirming that you are aware of the risks, complications and benefits of the operation. If you have any last minute questions please make sure that you ask them at this stage. You will be dressed in a gown before you go to theatre. You will have a general anaesthetic i.e. you will be asleep and unaware of the procedure. After the operation you will be looked after in the recovery area until you are awake enough to go back to the ward. You will have dressings on your chest and usually a drain coming out of each breast to collect any blood that may accumulate around the breast implant. You may be sore at this point and the nursing staff will ensure you get enough painkillers to make you comfortable.

After the operation

Overnight you will be checked regularly to ensure you have no problems. This will include checking your drains. As soon as it is comfortable to do so you should put on your sports bra to help support your new breasts. The following day you will be reviewed by Mr Khandwala and usually plans will be made to remove your drains after which you will be allowed to go home. Plans for follow-up will be made before you leave. You will be given painkillers to take home with you.

Follow up & Aftercare

Mr Khandwala will make arrangements for a dressing change a week after your operation and for a formal review at 2 weeks. You should keep the dressings intact until your dressing change. Although it is OK to shower you should avoid baths or soaking your wounds. It is important that you wear your sports bra/binder all the time (even when asleep) for the first two weeks. You should not drive or perform any strenuous activity until you are seen by Mr Khandwala. However should you have any concerns before or in between appointments please contact Mr Khandwala.

Your expectations

Breast appearance and size

Everybody is different and each person wanting breast augmentation surgery will have different desires. It is very important to have discussed your specific expectations with Mr Khandwala to be able to get a realistic idea of what is possible and the pro’s and con’s associated with them. The results of breast augmentation surgery can be very different from individual to individual and so seeing the results of such surgery in others may not give an indication of how things will look in your particular case. You should spend some time confirming the size you would like to be by buying a larger bra (approximately the cup size you wish to be) and then using bags of rice of various sizes in the bra to decide which you like best. It is essential that you measure out the rice as if it were a liquid (i.e. in millilitres) and as accurately as possible. Please make a note of the size you like best. Mr Khandwala will use this as a baseline for the size of implant to use but occasionally may use a different size if it is felt, during the operation, that it would give a better more proportioned breast size and shape. If your breasts are different sizes you should use different volumes of rice to get the breasts as equal as possible in your bra. Again during the operation Mr Khandwala may have to make adjustments to get the best result.

Long term

All women notice a change in their breasts as they get older and this may be exacerbated by pregnancies and changes in weight. It is no different for those women who have had breast implants. However the increased weight of the new breasts may accelerate this process.

Further operations

Breast augmentation is not to be considered a one off operation. It is a long term commitment and you may require further operations over time. This may be to change implants, to uplift the breasts or for revision surgery (e.g. if there is a complication which has affected the breast appearance).

Complications

General

Although general anaesthesia is a safe procedure it is not completely risk free. Rarely patients may get an abnormal reaction to the anaesthetic. More often patients may feel sick after the operation. This is treated much more effectively than before and is usually well controlled.

Bleeding

In a small number of cases (about 2%) there may be bleeding in the space created for the new implant which is too much for the drains to cope with. The affected breast may become larger after the operation. If this should occur then one may have to return to theatre to stop the bleeding.

Scars

Usually patients have thin flat pale scars which continue to improve over time. However in a small group of people there is a tendency to produce thick, red and itchy scars. This may occur even if all goes well. These scars might need further treatment and may never fully return to normal. This may also be the case if a wound gets infected or takes a long time to heal.

Wound infection

The incision used for breast augmentation usually heals within two weeks. In a very small number of patients the wound may get infected and may require antibiotic treatment and dressings for a longer period. If this should occur the resulting scar may become raised, red and itchy.

Implant infection

Although wound infections can usually be successfully treated without any long term effect on breast shape this is not the case if there is an infection that develops around the breast implant. This is a rare complication but one that often requires removal of the affected implant to treat it. Should this occur a new implant should not be re-inserted for at least 3 months.

Palpable implant/rippling

In some patients it may be possible to feel the edge of the implant. Mr Khandwala usually highlights the possibility of this occurring in a specific case. Often the specific technique employed will have been recommended to avoid this. Even so it may not be possible to eliminate the risk of this occurring. It is more likely in thinner patients than those having larger implants. Rippling, an appearance of the breasts where there is a slight irregularity of the breast shape, is also more likely in these situations.

Numbness

All patients will experience loss of normal feeling of the breasts after their operation. This usually returns over several weeks but sometimes there can be small areas where the feeling remains poor. This may be permanent.

Change in Nipple Sensation

This may ↑ or ↓ but usually improves over time, but can be permanent.

Symmetry (size and/or shape)

Most women have a slight difference between their breasts. Breast augmentation surgery will not necessarily be able to fully correct this difference. There is a risk that an implant might move thus affecting the shape of the breast. It is essential therefore to avoid strenuous activity and keep a sports bra on continuously to prevent this from happening. If there is a significant difference between the right and left breasts then usually different sized implants will need to be used. Again it is very difficult to achieve breasts which are exactly the same size and shape in this situation – though one should expect a significant improvement compared to the pre-operative appearance.

Capsular contracture

In about 5% of patients the scar tissue that surrounds every implant becomes much thicker than normal. This tissue then contracts and may alter the breast shape. This can be associated with tenderness of the breasts. If this should occur then, depending on the severity, one may need to have the implant and scar tissue removed and a new implant inserted.

Implant rupture

The outer coating of breast implants can weaken over time (10-20 years) and this may result in the inner part of the implant (the filler) leaking out. This may result in a change of breast shape. It is less likely with the newer cohesive silicone gel implants. If this should occur the old implants would need to be replaced.

Change over time

Breasts do change over time whether they have been augmented or not. However the effects of gravity and age may be greater in those who have had breast implants. This can result in breast droop and may need a breast uplift operation (mastopexy) to correct this.

Breast feeding

There is no good evidence to show breast feeding after breast augmentation is unsafe. However until there is good evidence to prove that it is completely safe Mr Khandwala recommends that one should not breast feed after breast implant surgery.

Breast Implant Registry

Mr Khandwala would like all his patients to be on the breast implant registry. You may be contacted in case of a manufacturing problem or for research.

What to look out for

Early

If you notice increasing pain, redness or swelling soon after your operation contact Mr Khandwala as soon as possible. You may need to be seen earlier than your scheduled appointment. Please also contact Mr Khandwala if you have any problems with the dressing.

Late

In the first 3-6 months after your operation you will notice a change in the feeling of the breasts and a change in the shape (they look less tight and relax a little). This is normal. If you notice them looking tighter or becoming painful please arrange an appointment with Mr Khandwala as soon as possible.

Information

To view online the Department of Health literature regarding breast implants, please go tohttp://www.dh.gov.uk/assetRoot/04/01/45/74/04014574.pdf

For more information about breast lift, contact Mr Khandwala.

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Asit Khandwala - Cosmetic Surgeon

Find answers to the most common questions about cosmetic surgery on the Q&A page.

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Asit Khandwala - Cosmetic Surgeon

Mr Khandwala is available in Sussex, Surrey, Kent and the London area. Send a request for a consultation in person.

www.plasticsurgeon.org.uk     email: info@plasticsurgeon.org.uk    tel: 01342 776 463    fax: 01342 770 575