Augmentation Mastopexy ( Breast lift + Implants) – for empty droopy breasts (especially post pregnancies)

Experience and extensive studies have shown us that breast implants are safe. However, patients do need to appreciate that breast augmentation may not be a once off procedure and you may need to be operated upon again in future. This may be many years down the line, if you have a problem. There will be scars following the surgery and one has to be accepting of these, but if you can accept this trade off for much more shapely breasts then you would have made the right decision. Most of Mr Mahajan’s patients comment upon how the augmentation mastopexy has helped boost their confidence and changed their lives.

‘Safe’ and ‘beautiful’ results are dependent on ‘experience’ and ‘expertise’ of your plastic surgeon. Mr Mahajan is a highly trained and experienced plastic surgeon who is a Consultant Plastic Surgeon at the Bradford Teaching Hospitals NHS Foundation Trust / Calderdale and Huddersfield NHS Foundation Trust and is the Director of the prestigious Plastic Surgery and Burns Research Unit (PSBRU) at the University of Bradford. He believes in practising “evidence based medicine” by engaging in research activities to help establish a scientific background to his / her clincial practice. He has a specialist interest in Breast surgery having worked in world-renowned centres for breast surgery in Belgium, Sweden and Switzerland in addition to his training in the UK. It obviuolsy helps if your surgeon has travelled the world to enhance his training in premier institutes to learn from leading surgeons in their fields. He is a full member of the British Association of Plastic Surgeons (BAPRAS), British Association of Aesthetic Plastic Surgeons (BAAPS), European Association of Plastic Surgeons (EURAPS), UK Association of Aesthetic Plastic Surgeons (UKAAPS), American Society of Plastic Surgeons (ASPS), Association of Breast Surgeons (ABS) and is on the Specialist register for plastic surgery with the General Medical Council (GMC). Surgeons are only awarded membership of these associations if they are properly qualified and it is a reassurance for you that you are in safe hands.

Cost of breast uplift can be about £7500 depending on the procedure you need. Mr Mahajan will discuss this with you when you meet him. You may find cheaper deals with firms that consider cosmetic procedures as a business, but may end up compromising on safety, quality and convenience.  Although breast uplift is considered as a cosmetic procedure, it is a plastic surgical ‘operation’ and you do need to appreciate this and consider it with all the seriousness that it deserves. Medical tourism has certainly made costs cheaper, but the very fact that you are boarding a long haul flight puts you at risk of blood clots in your legs or lungs that can be life threatening. There are obviously other matters to consider such as qualifications, experience as expertise of your surgeon / anaesthetist apart from the ability to see your surgeon again should there be a problem and you have flown back home.

The breast will have a increased volume with a nice aesthetically pleasing shape to them with appropriately sized areola. The will be proud of your new wardrobe! The breasts will be proportionate to your body. It will help relieve any episodes of rashes under the breasts.  Your self-esteem will be hugely elevated and your breasts will no longer lie in your arm pits when lying down in bed!

Scars are unavoidable following any surgery, but Mr Mahajan aims to make these as neat as possible. You will either have a wise pattern (inverted ‘T’ / Anchor pattern) or vertical (lollipop scar) or periareolar or infra mammary scar.

The standard wise pattern or key hole pattern or inverted ‘T’ or anchor pattern incision results in scars around the circumference of the areola, a scar running along the crease under the breast and a vertical scar extending from the areola to the crease. The scar in the crease tends to be tucked away, the scar around the areola is not very conspicuous as the areolar skin tends to different from the breast skin, part of the vertical scar that is not tucked away under the breast is the most prominent part of the scar. In a vertical scar breast reduction procedure the scar is around the areola and vertical down from it to the breast crease. In a periareolar technique, the scar will only be around the areola. In a minimal scar technique, the scar will only be in your crease and is tucked away under the breasts.

Although patient prefer to have short scar techniques such as the vertical scar or the periareolar scar techniques, the scar can be thicker, crinkled and wider in these procedures as the skin is bunched up when suturing it together to keep the length of the scar down. This can result in a flattened appearance of the breast in the lower or central part of the breast depending on the technique used. A wise pattern scar allows the best possible redraping of your breast tissue, although at the expense of longer scars.

Excess skin will be removed resulting in tightening up of the skin envelope with the enhanced breasts looking more shapely and pert. Your nipples will be lifted up to the appropriate position on your newly shaped breasts.

The nipple is not removed in breast uplift procedures, it is only moved up to where it belongs.

Mr Mahajan uses both silicone gel and saline implants according to the patient’s wishes. However, most patients choose to have silicone gel implants as they tend to feel more natural and maintain a better shape. You can have an anatomical or tear drop shaped implant or a round implant. Details of these will be discussed with you at your consultation. Mr Mahajan only uses implants that have a good track record and has never used PIP implants. The PIP implants contained non-medical grade silicone to be sold at a cheap price and used by some of the clinics that treat cosmetic surgery purely as a business. Mr Mahajan strongly believes that if something is being provided at a significantly reduced cost, there has to be a reason for it that may not necessarily be in the best interest of his patients.

At your consultation, Mr Mahajan will explain the difference between various kinds of implants. You will have the opportunity to see and feel the implants. Together, you can decide the type of implant that is right for you once you have informed knowledge about them. Mr Mahajan will do a detailed examination of your chest and take some measurements. Using the Biodynamic breast analysis system, he will be able to guide you to select implants that are suitable for your chest and you can pick amongst these.

Professor Mahajan uses both textured and smooth wall implants. It is believed that there is a decreased incidence of capsular contracture with textured implants. Moreover, the textured surface helps tissue around the implant to integrate into the surface of the implant and prevents the implant from rotating which can potentially happen in a shaped implant. Textured implants have however been associated with ALCL (Lymphoma – cancer).  There have been some cases of ALCL reported in smooth implants as well, but these may have been associated with use of other implants prior to use of the smooth implant. For detailed information on ALCL, please look at information about ALCL in this section.

Following a detailed examination and consultation, you can discuss with Mr Mahajan and plan as to what size you would like your breasts to be. Whilst it is nice to have larger boobs, it is equally important for them to look as natural as possible. As a general rule, the larger the implant, the harder it is to hide them. The volume of the implant is dictated by your breast base diameter. Ideally your implant should be placed within the confines of your breast base to give you a naturally augmented result. Mr Mahajan can guide you with this after he has examined you and taken detailed measurements. One should also take in to account the weight of the implants. The larger the implants, the heavier they will be and this can stretch down your breast envelope with time and make them droopy again. Ideally your breasts should be of a size that suits your chest.

Implants do not need to be changed unless there is a problem with your augmentation. More often revision surgery is not for changing a ruptured implant. You do not need revision surgery unless, you have a problem with capsular contracture, droopy breasts with time and age, desire for change in size of breasts or other such reason. Even if your implant is ruptured, the silicone is still contained in the capsule that your body forms around the implant. At times you can have extra capsular ruptures that can result in silicone deposits in your breast tissue or lymph nodes in your axilla. This is not supposed to be harmful, but can at times be uncomfortable. If there are obvious signs of a ruptured implant with change in shape of the breast, it is recommended to have them replaced.

There have been extensive studies done on this topic and an Independent review group in the UK (1998) has found silicone breast implants are not associated with a greater health risk when compared to other surgical implants.

Yes you can, it has been shown that cow’s milk and infant formulas contain a higher level of silica than breast milk from women with silicone implants.

When any object foreign to the body is placed inside the body, the body tends to wall it off by forming a envelope around it. This is called a capsule. Everyone one gets a grade one capsule, which is the normal reaction of the body. It is made up of contractile tissue that can potentially contract with time, making the envelope around the implant smaller. This can result in you being able to feel the implant and capsule (grade 2 capsule). If the contraction progresses and the envelope becomes even smaller, then the implant may start to look like a round ball and this can result in change in shape of the augmented breast (grade 3 capsule). With further progression, capsular contraction can start becoming uncomfortable (grade 4 capsule). It is hard to predict the chances of you developing an adverse capsule and this varies greatly amongst patients. There is nothing you can do to prevent this from happening. Meticulous surgical technique does help and Mr Mahajan takes care and time to do the surgery as safe as possible for you. If are unfortunate enough to develop a bad capsule, then you may need revision surgery in future.

With breast augmentation, your implants may end up staying in their pockets where they were placed (first bubble). But with time, age and gravity, your natural breast tissue may sag and droop below the level of your implants, causing the appearance of a second bubble. You may need revision surgery to improve on this appearance in future… should you develop it.

The implant can be placed in a subglandular, submuscular or dual plane pocket. The subglandular plane involves dissecting the pocket for the implant under the gland, but over the muscle. This plane can be used in patients who are not keen on having the implant placed under the muscle as they have a very physical job. Recovery can also be a few days quicker with the approach. However, you need to have a minimum amount of breast tissue to be able to hide the implant (this will be assessed at the time of your consultation with Mr Mahajan). The pocket is dissected under the muscle in a submuscular plane, which results in the muscle giving some added cover over the implant, making it less visible and palpable. There can however be issues with movement of the implant (animation of the implant), with contractions of the muscle. It will also result in some degree of weakening of your pectoral muscle, but there are two pectoral muscles (major and minor) and the implant is placed below the Pectoralis major, leaving the Pectoralis minor intact. Mr Mahajan prefers to use the dual plane technique which is a combination of the placing the implant below the muscle and the gland. In a dual plane technique, the pocket is dissected below the Pectoralis major muscle, but the muscle is released in the lower part, reducing the risk of animation of the implant. A plane is also dissected above the muscle to a varying degree (dual plane 1 to 3) according to the nature of your breasts. This helps redrape the breast envelope appropriately over the newly enhanced volume of your breasts. The implant is covered by both the breast gland and the muscle in the upper part and is less prone to be visible and palpable. The muscle does not cover the lower outer part of the implant, where it is covered by your own breast and subcutaneous tissue. A dual plane breast augmentation tends to give the best possible result as advocated by gurus of breast augmentation surgery, Dr John Tebbets and Dr Per Heden. Mr Mahajan has had the opportunity to train and master his breast surgical skills with Dr Heden during his period in Stockholm.

This depends on your personal choice. If this is the look you would want to acquire, then it can be achieved with the use of round implants or large shaped implants. There is risk that your breasts may look a bit fake. But it is important that you are happy with the outcome of the surgery after having spent all that money and if this the look you want to achieve, then you should clearly express this.

Sensation to the nipple and the skin can be altered following a breast augmentation mastopexy procedure. The sensation may not change, but can be decreased to some extent. At times the nipples can end up being hyper sensitive.

Mammograms are not affected following a breast augmentation procedure. There might be some signs of scarring. A different technique can be used to do mammograms in the presence of an implant and if there is a problem with the mammogram, an MRI scan can be performed.

Some surgeons prefer to do the breast augmentation in the first operation followed by a mastopexy at a second operation or vice versa. Dr Per Heden of Akademikliniken in Stockholm is renowned for his technique of doing breast augmentation mastopexy in a single operation. He conducts master classes for surgeons across the world to teach his technique. Mr Mahajan has had the opportunity to train with him during his period in Stockholm and is happy to do the procedure in a single operation. An augmentation mastopexy can be carried out safely as a single operation by using the right technique, negating the need for a second general anaesthetic and its added costs.

Every effort is made to reduce the risk of complications, but potential risks are bleeding, bruising, swelling, haematoma / seroma, infection, explantation of the implant, delayed wound healing, scars – hypertrophic, stretched, sensitive, not in the inframammary crease, no guarantee of cup size or cleavage, altered sensation – decreased or increased, altered lactation and mammogram, asymmetry, nipple loss, fat necrosis, Implant – visibility, palpability, rippling, rotation, rupture, silicone granuloma / axillary lymphadenopathy, capsular contracture, double bubble appearance, ALCL, risks associated with general anaesthetic, blood clots in legs or lungs.

You will be most comfortable lying on your back immediately after your surgery. After your surgery, the breast implant becomes surrounded by a capsule (or envelope). In the first four to six weeks the position of this capsule can be influenced by outside forces such as activity, sleeping position, and bra support.  I would recommend that you sleep on your back for four to six weeks so that outside forces do not influence the formation of scar tissue around your implants. Sleeping on our side while wearing the support bra is okay, if you are more comfortable sleeping on your side. But I would not recommend sleeping on your tummy for six weeks.