Breast Augmentation / Boob job / Breast Implants

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. Most of Mr Mahajan’s patients comment upon how the augmentation has helped boost their confidence and changed their lives.

MB BS, MB BCh or MB ChB is the basic medical degree of any doctor. Your plastic ‘surgeon’ should at least be a ‘surgeon’. Doctors who receive adequate ‘basic’ surgical training in the UK are awarded Fellowship (FRCSI, FRCS, FRCS Ed, FRCS Gl – in the older generation of surgeons) or Membership (MRCS – in the younger generation of surgeons) of the Royal Colleges in the UK. Doctors or Surgeons, who believe in having a scientific foundation to their practice, spend further years doing research in their fields and are awarded Research degrees such as MSc, MMedSc, MPhil, MD or PhD.  Surgeons who ‘train specifically in the field of Plastic surgery’ are awarded FRCS (Plast). These surgeons are then entitled to be on the “Specialist register for Plastic Surgery” with the General Medical Council (GMC).

‘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 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. 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. In addition to this, it obviously helps if your surgeon has travelled the world to enhance his training in premier institutes to learn from leading surgeons in their fields. It also helps if your surgeon believes in practicing “evidence based medicine” by engaging in research activities to help establish a scientific background to his / her clinical practice.

Cost of breast augmentation can be about £4500 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 augmentation 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.

Mr Mahajan uses both silicone gel and saline breast implants according to the patient’s wishes. However, most patients choose to have silicone gel breast implants as they tend to feel more natural and maintain a better shape. You can have an anatomical or tear drop shaped breast implant or a round breast implant. Details of these will be discussed with you at your consultation. Mr Mahajan only uses breast 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 breast implants. You will have the opportunity to see and feel the breast implants. Together, you can decide the type of breast implant that is right for you once you have informed knowledge about them. There are well over 750 breast implants to choose from! 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 breast 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.

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 have adverse effects on your breast envelope. The breast can end up being droopy with a stretched skin envelope in future if the implants are heavy. This may necessitate reducing the volume of the implant and doing a breast uplift procedure in future.

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.

Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma (NHL), a cancer involving the cells of the immune system. ALCL in the breast is rare.

Textured implants have been preferred over the years to reduce incidence of capsular contracture and to prevent the implant from rotation in anatomical (tea drop shaped) implants. Shaped implants are better in providing as natural (anatomical) shape as possible to the augmented breast especially in patients who have very little of their own breast / subcutaneous tissue.

Patients do need to be fully aware that there is a risk of ALCL associated with any breast implant but the risk is low. Although most cases are associated with textured implants, there are cases associated with smooth implants too, but some of these cases have a history of previous textured implants. Cases have been reported from most manufacturers and not a particular brand of implant. Although ALCL is a type of cancer (lymphoma), it  is not breast cancer and is mostly treatable. Patients who have breast implants do not have to have them removed, but they do need to be vigilant of signs and symptoms that may reflect underlying problems.

 

For details please refer to the following credible sources.

 

BAAPS

//baaps.org.uk/patients/safety_in_surgery/breast_implant_safety.aspx

“The British Association of Aesthetic Plastic Surgeons advises that concerned patients need not take any action at this stage. They should continue their routine follow up with their healthcare professional and discuss any questions they have about their breast implants. There is no need to remove or exchange any current implants based on the most up-to-date scientific data available. Indeed, unnecessary surgery may cause additional harm in a small number of patients.”

Breast implants safety – statement issued by

The Association of Breast Surgery (ABS)

The British Association of Aesthetic Plastic Surgeons (BAAPS)

The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)

“The consortium of journalists has highlighted the known link between breast implants that have a textured surface and the condition Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). BIA-ALCL is rare and, usually, eminently treatable. (Statement available here) Current research suggests the risk of developing this condition in the UK is approximately 1 in 24,000 breast implants sold. Not all textured surfaces are manufactured in the same way and they appear to convey different levels of risk, hence it is difficult to draw definite conclusions about the type of texturing at this time. Texturing of an implant surface however conveys advantages over smooth implants, particularly with more naturally shaped implants. Hence many surgeons in the UK still advocate the use of textured implants for their patients. It is vital however, that the risks of using textured or smooth surfaced implants are fully discussed with all patients before surgery so that they are able to make fully informed choices.”

 

BAPRAS

//www.bapras.org.uk/professionals/clinical-guidance/alcl-risk-from-breast-implants

“BIA-ALCL appears to be related to textured breast implants and it appears to have occurred with textured implants made by every manufacturer.”

“BIA-ALCL is a lymphoma and not cancer of the breast tissue. When breast implants are placed in the body, they are inserted behind the breast tissue or under the chest muscle. Over time, a fibrous scar called a capsule develops around the implant, separating it from the rest of the breast. In women with breast implants, the ALCL was generally found adjacent to the implant itself and contained within the fibrous capsule.”

 

MRHA

//www.gov.uk/guidance/breast-implants-and-anaplastic-large-cell-lymphoma-alcl

“In the UK, the estimated risk of BIA-ALCL, based on the reported confirmed cases is 1 per 24,000 implants sold. This estimate is based on data for all types of breast implants known to be sold in the UK and reported cases of BIA-ALCL confirmed to meet the WHO criteria until July 2018.”

 

FDA

//www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm

“risk of developing BIA-ALCL for a woman with textured implants is 1:3,817 to 1:30,000”

“Most confirmed cases of BIA-ALCL have occurred in patients with textured-surface implants, although there are known cases in patients with only smooth-surface implants.”

“The FDA update calls for no changes in recommendations regarding breast implants. For patients with breast implants, the FDA states there is no need to change routine medical care and follow- up, and there is no need to test asymptomatic patients.”

 

ASPS

//www.plasticsurgery.org/for-medical-professionals/health-policy/bia-alcl-physician-resources

“Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon 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.

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. Since the initial case report in 1996, ASPS now recognizes approximately 265 cases in the US and a total of 688 worldwide as of February 8, 2019.

Most of the patients who have developed BIA-ALCL receive an excellent prognosis following surgical removal of the breast implants and the surrounding scar tissue capsule. Continued follow-up after any breast implant surgery is suggested and important for patient health, but patients who notice pain, lumps, swelling, fluid collections or unexpected changes in breast shape, including asymmetry, should contact their plastic surgeon. In most cases, women diagnosed with BIA-ALCL observed changes in the look or feel of the area surrounding the implant greater than one year after their initial surgical sites were fully healed, and on average eight to ten years after receiving textured implants.”

Some patients experience symptoms such as tiredness, “brain fog”, joint aches, immune-related symptoms, sleep disturbance, depression, hormonal issues, headaches, hair loss, chills, rash and neurological issues which may be associated with breast implants. To date there is no scientific explanation for this and there is no proven link between developing these symptoms and having breast implants, but we cannot ignore the fact that some patients have claimed that their symptoms have got better on removal of their implants. Patients opting to have breast implants need to aware of the risks of Breast Implant Illness (BII).

For further information about breast implant illness (BII) please refer to the following websites.

//www.gov.uk/guidance/symptoms-sometimes-referred-to-as-breast-implant-illness

//baaps.org.uk/_userfiles/pages/files/bii_information.pdf

//www.fda.gov/medical-devices/breast-implants/risks-and-complications-breast-implants

//www.surgery.org/sites/default/files/downloads/BII-Talking-Points-FINAL-1.15.19.pdf

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.

Your breasts will have a naturally augmented look if you select the right implant (with guidance from Mr Mahajan). A natural aesthetic breast tends to have a gentle slope in the upper part, peaking at the nipple and a rounded lower part of the breast. This can be achieved by using a natural shaped or anatomical shaped or tear drop shaped implant. It is important to select an implant that sits within the confines of the foot print of your breast and suits your chest wall. Generally speaking, the larger the implant, the more the risk of an unnatural result. A large implant can result in a rounded appearance in the upper pole, rather than a gentle slope. But if this is what you desire, then this is what you may need to go for.

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.

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.

Not necessarily. During a breast augmentation procedure, the implant is placed under your breast gland (either under the gland itself or under the muscle, which is under the gland). This does not disrupt the milk ducts from the gland to the nipple, unless a trans areolar approach is used.  However, larger implants can put pressure on the breast gland and result in pressure atrophy or reduction of the breast gland, which can potentially affect the amount of milk produced.

If you are on the oral contraceptive pill, you will need to stop these 4 weeks before the procedure to reduce your risks of blood clots in legs or lungs. Also, you will need to stop any blood thinning drugs. Aspirin and Clopidogrel will need to be stopped a week prior to surgery.  Warfarin, Dabigatran etexilate, Rivaroxaban and Apixaban need to be stopped 4 days prior to surgery. Mr Mahajan will discuss this with you in the pre operative consultation.

Yes, you will need a general anaesthetic to undergo the procedure. It will take about 1 to 1.5 hours to do the operation for you. Your anaesthetist will be fully qualified and a member of the Royal college of Anaesthetists. He will ensure that you have a smooth anaesthetic procedure and are comfortable during your recovery.

Every effort is made to reduce the risk of complications, but potential risks are Bleeding, bruising, swelling, haematoma / seroma, infection, explantation of 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, 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 may need to stay in hospital over night, but if you are comfortable enough, you can go home the same day.

It takes about two weeks for the wounds to heal up. You will need dressings until the wounds are healed in two weeks.

You can shower when you are comfortable to do so. You will have a shower proof dressing, but will need to wait for two weeks until your wounds are healed and dressing are removed before you have a bath.

Although you will only be discharged from the hospital when Mr Mahajan is satisfied that you doing well following your surgery, you do need to look out for sudden increase in swelling of the breast, disproportionate pain, any signs of infection such as feeling unwell, temperature, redness around the scars, discharge or foul odour from the wounds. Your nipples can be a bit bruised after the procedure, but should their colour change to purple or pale, it could be sign of compromised circulation and you should return to see Mr Mahajan.

You will need to wear a lycra sports support bra that is not underwired following the procedure. You can get comfortable post op bra from

//www.theyahealthcare.com/products/peony-zip-front-fastening-bamboo-post-surgery-bra-black?variant=17060320837675

My Mahajan will discuss the potential bra size with you during your preoperative consultation. It would be ideal to wear this for about eight to twelve weeks following the procedure. As the swelling goes down after this period you can invest in a new wardrobe of lingerie.

Mr Mahajan does not advocate massaging the breasts as this may cause the implants to displace or rotate. You are however advised to massage the scars once your wounds have healed in two weeks time.

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.

​Sensation to the nipple and the skin can be altered following a breast augmentation procedure. The sensation can be decreased to some extent. At times the nipples can end up being hyper sensitive. Preserving the nerve supply to be the nipple can be technique dependent and you are better off choosing an experienced board certified plastic surgeon.

In most patients (93%), the nipple is supplied by the lateral cutaneous branch of the 4th intercoastal nerve. This nerve runs in or below a thin layer of fascia covering the pectoral muscle up to the midclavicular line (almost middle of the breast) and then turns at right angles towards the nipple through the breast gland. In view of this, dissecting the pocket for the implant under the muscle minimises the risks of the sensation being affected as the nerves to the nipples are above the muscle.

You will need to wait until your wounds have fully healed and you are comfortable to under take any labour intensive work. This could take 4 to 6 weeks following your surgery.  You could however return to light cardiac exercises sooner in about 2 to 3 weeks.

There is no issue with having a social drink after the procedure. However, smoking tends to reduce the circulation of blood, which is vital for wound healing. It is advisable to refrain from smoking to help your wounds heal without any complications.