Breast Augmentation

If you wish to have larger breasts than a breast augmentation (or ‘boob job’) may be suitable for you. The procedure can also improve appearance if you have uneven size breasts and wish to be more symmetrical.

Breast enlargement is carried out under a general anaesthetic as a day case and, after liposuction, is the most commonly performed cosmetic procedure in the UK. A small incision is made under the breast, and a silicone implant is inserted under the breast tissue. In thin patients with very small breasts, the implants may be better hidden under the muscle and breast tissue and Mr. Rayatt can discuss this with you. After surgery a light adhesive dressing will be applied and discomfort is controlled with simple oral medication. Light duties can be resumed in about 1-2 weeks, or as tolerated, and normal activities can be started in about 3-4 weeks.

RICE test - You should be realistic in the breast size that you want to attain. Because of variations in body types and breast shape, it is not possible to guarantee a cup size. Mr. Rayatt will make some chest measurements and try some breast implants within your bra. He may ask you to perform a simple home 'rice test'. Take an old pair of tights, and fill the foot part with uncooked rice and cut off and tie a knot in the other end. Place this home made 'implant' within your bra. Look in the mirror, with and without your everyday and favourite clothing and see how it feels and looks. Add or remove the amount of rice until you are happy with the size. Bring these 'implants' with you to your next appointment and Mr. Rayatt will remove and measure the rice in a measuring jug. This will give a guide to the final implant size.

Summary

Breast Uplift (Mastopexy)

Your breasts can loose shape or sag due to a combination of aging, past pregnancies and breast feeding. In very mild cases this may improved with an implant alone, however most cases will require a breast uplift or mastopexy. The procedure is intended to give the breast an elevated, more youthful breast contour. Some skin has to be removed and the remaining breast tissue is reshaped and the nipple is moved higher. The procedure is performed under a general anaesthetic with an overnight stay. The patient has to accept scars on the breast. In mild cases these will around the nipple only. In most cases there will be additional scars, either ‘lollipop’ shaped (vertical) or ‘anchor’ shaped (going around the nipple, vertically down to the base of the breast and a horizontal scar under the breast). The procedure may be combined with a breast implant. Initial discomfort is easily controlled with oral medication and light duties may be started in 1-2 weeks full activities in 4-6 weeks.

Summary

Inverted Nipple Correction

Nipples come in different shapes and sizes. Any unusual pain or bleeding should prompt a visit to the General practitioner (GP). If you are unhappy with the shape of your nipples or they are inverted than this can be corrected with minor surgery. Scars are very small and usually heal very well. The procedure can be performed under a local anaesthetic as an out patient procedure. You may not be able to breast feed after the procedure.

Summary

Questions About Silicone Implants

What is silicone?

Silicon (without an ‘e’) is the second most common element in the earths crust, and becomes silicone (with an ‘e’), when it is combined with carbon, hydrogen and oxygen. This silicone can be manufactured into many different forms including oils and gels. The oil from is found in common creams and hair sprays. Other forms are used extensively in the medical field, including as coatings for needles, syringes, and pacemakers and heart valves. Solid forms of silicone include artificial joints, catheters, and facial implants. Silicone products have therefore been shown to be reliable and compatible within the human body.

Breast Implants

Concerns have been raised about the safety of silicone breast implants. These are principally about silicon leakage, cancer formation and detection and autoimmune diseases.

Leakage

Silicone leakage probably does occur over time. The leakage is contained within the capsule which is the name given to the soft scar that the body makes around the implant. Rarely, it can travel to the glands in the armpit area.

Capsular Contracture

The body will make a scar around any foreign body placed in the tissues. With breast implants, the body makes a capsule or soft scar around the implant. Sometimes this soft scar can become firm and contract. This condition is called capsule contracture. If this happens, the breasts may feel slightly firmer or become harder. In rare cases the breasts can become mis-shapen and painful. If this occurs than you may require further surgery to remove the capsule. This is through the same scar and usually a new implant can be replaced at the same time. Many studies show that the risk of this is approximately 20% after 10 years with standard implants and 1% with polyurethane implants.

Cancer

There is no evidence that silicone implants cause breast cancer. A number of medical studies have been undertaken.

• A study from University of Southern Calilfornia published in Plastic and Reconstructive journal in 1986 investigated over 3,000 women who received silicone breast implants. There was no increased risk in breast cancer compared with patients with no implants.
• Another paper published in 1992 from the university of Calgary and published in New England Journal of Medicine, looked at 11,000 Canadian women who had breast implants between 1973 and 1986. This study also showed no increased risk of breast cancer.
• A 1996 study published in Plastic and Reconstructive journal, followed 2,000 women with breast implants and found no evidence of a link between breast implants and breast cancer.

There is also no evidence that having breast implants delays detection of cancer by mammaography. Implant patients do need to inform the person performing the scan that they have breast implants and slightly different techniques of taking the mammography scans is employed.

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) 

BIA-ALCL is a rare and highly treatable type of lymphoma that can develop around breast implants. BIA-ALCL occurs most frequently in patients who have breast implants with textured surfaces. This is a cancer of the immune system, not a type of breast cancer. The current lifetime risk of BIA-ALCL is estimated to be 1:3817 - 1:30,000 women with textured implants based upon current confirmed cases and textured implant sales data over the past two decades. The UK risk is estimated to be around 1:24,000, based on implant sales. When caught early, BIA-ALCL is usually curable.

BIA-ALCL has been found with both silicone and saline implants and both breast cancer reconstruction and cosmetic patients. To date, there are not any confirmed BIA-ALCL cases that involve only a smooth implant. Currently, it is not possible to test for who is at risk of this disease. The association with breast implants is likely multifactorial and is currently being extensively studied. Common symptoms include breast enlargement, pain, asymmetry, lump in the breast or armpit, overlying skin rash, hardening of the breast, or a large fluid collection typically developing at least more than one year after receiving an implant, and on average after 8 to 10 years. For any patient experiencing these or any symptoms, they should see their doctor for evaluation.

Connective Tissue Disorders

There was some concern about breast implants causing diseases such as Rheumatoid Arthritis and scleroderma.

• A 1994 Mayo Clinic study published in the New England Journal of Medicine compared 749 women who had breast implant surgery, with 1,498 women who did not have breast implant surgery. The results of the study showed "no association between breast implants and the connective tissue diseases and other disorders that were studied".
• A 1995 Harvard Brigham's Hospital study published in the New England Journal of Medicine, analysed 14 years of follow-up data from the Nurses Health Study Cohort. This involved a survey of over 87,000 women, with and without breast implants. The results showed no "association between silicone breast implants and connective tissue diseases".
• Doctors at the Karolinska Institute in Stockholm, Sweden studied more than 7.000 women who had had breast implants and compared them with a group of more than 3.000 who had undergone breast reduction surgery without implants. They found no meaningful association between women with implants and cases of connective tissue, or immunological, disease. In fact the women with augmented breasts were statistically slightly less likely to have encountered these diseases then the breast reduction group.
• A statement prepared and published by the American College of Rheumatology (ACR) - advises that while there may be a theoretical risk of Connective tissue disease (CTD), especially for a patient who already has a CTD, there is "no reason to discourage women from considering breast [implant surgery] on the basis of acquiring or exacerbating a connective tissue disorder".