Breast Enlargement

Introduction
Breast augmentation (enlargement) is designed to increase the size of the breasts and also improve their shape by the insertion of an implant beneath the breast tissue. Breast augmentation is suitable for women who have naturally small breasts or where there has been shrinkage in size following a pregnancy or weight loss. This operation aims to produce a natural shape which enhances cleavage and will improve your figure by balancing the hips to emphasize your waist.

Breast implants rely on an outer shell and a filling which is usually silicone gel. Mr Grover only uses “cohesive silicone gel” filled implants which do not leak because the silicone is actually a solid material (like jelly) rather than a liquid. One of the chief aims is to achieve a natural look and Mr Grover specialises in the use of “tear drop” implants which avoids the stuck on appearance. He also uses round implants in some patients but will advise you carefully at the time of consultation which will be best for you both surgically and also from the artistic perspective of producing a natural and attractive breast. The size of your new breasts depends on your personal choice but it is always recommended to stay within reasonable limits for your height, build and body weight. The decision regarding size will be carefully considered when you visit Mr Grover for a consultation and you will get the opportunity to wear trial implants in a special bra to simulate the result of your surgery so you have some idea of the outcome.

Breast enlargement is certainly NOT an operation where one size fits all and Mr Grover provides a very individual approach to try and achieve a bespoke result for each patient. He is particularly known for his artistic approach to achieving a natural look and has lectured on the importance of an artistic element to surgical technique and how this can improve surgical outcome at the Louvre in Paris. He will also be honest in informing you if he feels you are not a good candidate for surgery and carefully explain why this is so.

Before and after photos of patient operated on by Rajiv Grover

What type of breast implants are used & is silicone safe?
How long do implants last?
What shape of implant will be used?
Where is the implant placed: In front of, or behind the muscle?
Can breast enlargement help to lift breasts which have dropped?
Do breast implants cause breast cancer?
Will breast implants interfere with breast screening?
What happens if I get pregnant after I have breast enlargement?
What happens at the consultation?
How do I prepare for surgery?
Where will my surgery be performed?
What type of anaesthetic will be used?
What does the operation involve?
What happens after the operation?
What are the scars like?
What are the risks?
Summary

What type of breast implants are used & is silicone safe?
Advances in the technology of silicone have lead to cohesive silicone gel which has the consistency of jelly and does not leak even if there is a break in the implant. Mr Grover uses silicone implants rather than saline (salt water containing) as they provide a better shape with a more natural feel and can also provide some degree of lift to the breast. When using silicone Mr Grover only uses cohesive silicone gel implants which do not leak. His preferred manufacturers are Silimed, Mentor or Allergan all of which provide a lifetime guarantee against rupture.

The safety of silicone implants has been extensively investigated over the past two decades and much of the controversy that previously appeared in the media has now been cleared. Silicone breast implants have not been found to cause harmful effects in any scientific study performed to date. An independent review into all published research by the UK Government declared them safe for cosmetic use in 1998 and this has since been confirmed by the European Union and the United States Government (2005).

How long do implants last?
Despite being resistant to extreme pressures breast implants are still susceptible to daily wear and tear. This means that the outer shell or coating of the implant may develop tiny cracks after 12 to 15 years. The body however always produces a thin covering around all implants from an early stage which acts as a “biological bag”. Recent developments in silicone technology have produced cohesive silicone gel which is the most advanced silicone implant available. Rather than being a liquid this is a solid gel which has the same consistency as jelly at a children’s party. After many years of wear and tear should any cracks develop these implants would not leak as the silicone is in a solid form. The additional protection provided by the body’s natural “biological bag” will prevent harmful leakage outside the implant.

There are many quoted figures as to how long ultimately any implant will last. An average figure is probably in the order of 12-15 years. There are however variations in wear and tear amongst different individuals depending on how much exercise you take and other lifestyle activities. In order to have a proper assessment of the state of your implants it is advised to have your implants examined by a specialist on a regular basis from about 10 years after your operation.

How do you know when implants need replacing?
After 12-15 years the shell of the silicone implant develops tiny cracks which are not visible to the naked eye but only with the microscope. The implant is still physically intact but these microscopic cracks allow the body to come in biological contact with the silicone inside. As a result the thin membrane which the body made to surround the implant (its “biological bag”) develops some scar tissue and thickens creating a capsule around the implant which gives the breast a firmer feel. Firmness after 10 to 12 years is therefore the first sign an implant may need replacing

Before and after photos of patient operated on by Rajiv Grover

What shape of implant will be used?
One of the more recent choices in breast enlargement involves the option of having either round or teardrop-shaped implants (also called anatomical implants as they resemble the anatomy of the breast). The importance of the tear drop or anatomical implant shape relates to creating a natural looking breast and in particular the slope of the upper pole of the breast. In patients who are slim, have little breast fat or in whom there has been some droop following children or weight loss the tear drop (anatomical implant) produces a more natural look which also gives more lift to the nipple. Round implants can be used but they suit patients who are younger and have little or no droop in the breast and who also have a reasonable amount of breast tissue to start with (at least b or c cup).

Mr Grover will advise you which will suit you best at your consultation although as most of his patients want a natural look he uses the tear drop (anatomical) implants most frequently and has a very large experience of their use in over 500 patients. He has lectured internationally on the use of tear drop implants and has refined techniques to improve outcome and reduce risk (Results presented at the IMCAS meeting–International Master Class in Aesthetic Surgery Paris 2009).

Before and after photos of patient operated on by Rajiv Grover

Where is the implant placed: In front of, or behind the muscle?
Breast implants can be placed in a pocket either in front of the chest muscle (referred to as the subglandular pocket as it lies directly under the breast itself) or behind the chest muscle (referred to as submuscular). The pocket in which the implant is placed is created by either lifting the breast tissue away from the underlying chest muscle (pectoral muscle) as in the case of the “subglandular” (above the muscle) approach or placing the implant behind the chest muscle as in the “submuscular” approach. It is important to understand that the majority of the chest muscle is floating as it is attached to the ribs only near the centre of the chest. Placing the implant behind the muscle therefore does not require “cutting into muscle” to create the cavity as a potential space already exists there and the implant is placed under the floating part of the muscle.

The subglandular approach (above the muscle) suits women who have a fuller breast which allows the implant to be covered adequately so that it is not visible or palpable through the skin. In thin patients who have either very little breast tissue, the implant will look more natural placed under the muscle as this gives better coverage of the upper pole and therefore does not look “stuck on”. The decision whether to go over or under the muscle will be discussed very carefully with you by Mr Grover at the consultation but is usually a decision made by your body’s anatomy rather than by surgeon or patient.

Before and after photos of patient operated on by Rajiv Grover

What is dual plane breast augmentation?
The dual plane technique is a method of enlarging the breast but at the same time lifting the breast and nipple without the need for a full uplift which would leave visible scars round the nipple. It is a variation of the submuscular technique but which allows a greater degree of lifting to the nipple and is usually combined with the use of a tear drop implant. It is ideally suited to thinner women over 30 years of age who have either had children or perhaps lost weight and therefore have a little droop on the breast. Because this technique suits thinner women the implant is placed under the chest muscle which gives a smoother contour for the upper pole of the breast. However, if this was all that was done the droop might still be apparent so the second and essential part of the operation requires lifting the breast tissue off the muscle in the lower half of the breast so it can slide over the muscle. This is done through the same scar under the breast crease. When a tear drop implant is used the projection then pushes the nipple and breast tissue up a little, which because it has been separated from the muscle, can slide up vertically. As there have been pockets surgically dissected below the muscle for the implant and also above the muscle to allow the breast tissue to slide the technique is called “dual plane”

This technique provides a small degree of lift for the breast and overlying nipple without the need for a full surgical uplift procedure which would leave visible scars on the front of the breast. Of course the degree of lift is limited but if your nipple has dropped but not below the level of the crease under your breast then this will be a suitable technique for you. When you attend for your consultation Mr Grover will assess whether this is the best technique for you and explain carefully what is involved.

How does Mr Grover achieve a natural look?
The key to achieving a natural look is that in addition to size being an important goal, equally important are breast shape, achievement of lift and harmony with the rest of the body. Mr Grover will pay equal attention to all these four goals and having extensive experience with all the surgical techniques from subglandular, submuscular and dual plane methods will choose the one which best enhances your current anatomy. Implant technology and shapes also allow greater opportunity to achieve the most natural look possible and choosing which implant style will best achieve this is essential. Part of your consultation will include the opportunity to wear trial implants in a special bra to simulate the result of your surgery so you have some idea of the outcome and what creates harmony with the rest of the body. There is no doubt that part of achieving a pleasing outcome requires artistic judgement during surgery and Mr Grover appreciates the importance of an artistic element in surgical technique in order to improve surgical outcome. He is recognised for this ability and has been invited to lecture on this interaction to improve the outcome of cosmetic surgery at the Royal College of Art in London and at the Louvre in Paris.

Before and after photos of patient operated on by Rajiv Grover

Can breast enlargement help to lift breasts which have dropped?
Although a degree of lifting can be achieved with implants alone, in the event that the skin of the breast has stretched to the point where the nipples have dropped significantly it may be necessary to reposition them upwards by means of an uplift or mastopexy. It is not often that this is required and most women achieve an excellent shape with just implants alone, however if Mr Grover feels that a natural shape can only be achieved with an uplift as well as an implant he will discuss this with you in detail.

Before and after photos of patient operated on by Rajiv Grover

Do breast implants cause breast cancer?
There is no evidence that silicone in breast implants causes cancer in women. On the contrary, recent studies have shown that women with implants seem to have up to 30% less breast cancer than the general population although this is really just a reflection of their smaller breast size rather than any influence of the implants themselves.

Will breast implants interfere with breast screening?
Accurate mammograms can still be performed after breast enlargement even though implants are opaque to x rays. A special manoeuvre (Eklund) has been developed to allow the breast tissue to be x-rayed around the implant by assessing it in two directions instead of only one. This allows accurate mammography without loss of accuracy compared to women without implants so please inform the radiographer at the time of your x ray about your implants.

What happens if I get pregnant after I have breast enlargement?
Breast implants do not interfere with breast feeding but care should be taken to maintain the shape achieved by the surgery. If pregnancy should occur particular care should be taken in supporting the breasts in order to maintain the best possible shape subsequently. This is achieved by wearing a supportive bra day and night during pregnancy and also whilst breast feeding to provide constant support. If you can limit breast feeding to six weeks or less this will also reduce the stretching of your breasts and therefore preserve your shape.

What happens at the consultation?
At your initial consultation, Mr Grover will evaluate your general health and chest, and explain which surgical techniques are most appropriate for you. For instance, if your breasts are sagging, he may also recommend a breast lift although a degree of lifting is achieved by the insertion of a breast implant alone. After discussing the proposed surgery Mr Grover will give you an idea of your new look by using trial implants in a special bra to simulate the result of your surgery so you have some idea of the outcome.

How do I prepare for surgery?
It is important to avoid taking any Aspirin or products containing Aspirin for 2 weeks either side of the operation since Aspirin has an adverse effect on bruising. The same is true for non-steroidal anti-inflammatory drugs (such as Brufen, Nurofen and voltarol). While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days at home, if needed.

One item you must bring to hospital with you in preparation for surgery is a soft bra (without under wire) of your new size. This is to provide support over your bandages and will be worn for 4-6 weeks after surgery (but can be removed whilst you are washing etc). This can be a soft sports bra but a stiff sports bra may be too painful so any soft bra is fine so long as it provides a degree of support and does not dig in too much below the breast. Mr Grover will suggest what size will be suitable at your consultation.

Where will my surgery be performed?
The surgery is performed at the King Edward VII Hospital in central London where Mr Grover works as a Consultant Plastic Surgeon. You will usually be admitted on the day of surgery, and stay overnight. It is advisable that a friend or relative accompanies you home when you leave hospital on the day after surgery.

What type of anaesthetic will be used?
Breast enlargement is usually performed under a general anaesthetic, so you'll sleep through the entire operation.

What does the operation involve?
The method of inserting your implant will depend on your anatomy and Mr Grover’s recommendation. The incision is usually made in the crease below the breast where it meets the chest as it is well hidden here and allows accurate placement of the implant to create a feminine and natural looking cleavage. Occasionally the incision may be placed in the armpit. Every effort will be made to insure that the incision is placed in such a way that the resulting scars will be as inconspicuous as possible.

Working through the incision, Mr Grover will lift your breast tissue and skin to create a pocket either in front of the chest muscle (the subglandular pocket), or underneath your muscle (the submuscular pocket). The implants are then placed within the pocket and centred beneath your nipples. Following this the incisions are stitched in several layers to protect the implant and external strapping is applied which you will need to keep in place for two weeks as it provides extra support for the breasts during this period. The whole operation takes a little over an hour.

Before and after photos of patient operated on by Rajiv Grover

What happens after the operation?
After surgery the breasts will be tender and slightly swollen for a few days and it is advisable to limit arm movements and take the painkillers which you are prescribed. Most women can drive by a week after surgery and return to work after 10-12 days.

You will need to keep the strapping applied by Mr Grover during the surgery in place for 10 to 14 days and wear a supportive bra over this. After this period the strapping will be removed and your sutures taken out at Mr Grover’s clinic. Although by that stage everything will be healed you will need to keep wearing the supportive bra day and night for a further four weeks although it can be removed for showering. As the implants settle in their new pocket it is best to avoid sports for the first 3 to 4 weeks and then build up gently.

There may be changes in the sensation of the nipple and breast which are temporary. It is fairly common for the skin above the incision to feel somewhat numb for 2-3 months but this improves spontaneously. Some patients describe increased sensation or sensitivity which again is a result of the stretching of the breast tissue and its nerves. If this occurs it may last for 2-3 months before returning to normal.

What are the scars like?
The incision for breast enlargement can be placed either in the fold under the breast, or in the arm pit. Mr Grover favours making the incision under the breast so the scar is hidden in the fold as this route allows the most accurate placement of the implant and the creation of a natural looking cleavage. However with all these methods the scar can be kept short (4-5 cm) and is positioned to be as inconspicuous as possible.

What is capsule formation?
When a breast implant is inserted, because it is a foreign material, the body makes a thin film around it which acts like a biological bag. This is a very thin membrane and cannot be detected visibly from the outside or by palpation (feeling) of the breast. In a small number of women who are unlucky this thin membrane (“biological bag”) forms scar tissue because the body reacts more vigorously to the implant and this makes the covering much thicker. This is called capsule formation and because it tends to squeeze the implant and makes it appear firmer and rounder, this process has also been called hardening. To date there is no way of predicting from the outset who will get this problem.

The current incidence of this problem is between 4-5 % of women undergoing surgery and rarely occurs before 2 years. It initially starts as a firmness which is palpable but does not distort the appearance of the breast. Over the next year or two it continues to tighten so that eventually the breast does look rounder. This whole process is slow so this is unlikely to happen before 3-4 years. Should you be unfortunate and one of the 4-5% which get this problem you will need to have more surgery to remove the capsule and replace the implants with new ones. It is important to realise that the rate of getting this problem does relate to the type of implants used and the figure of 4-5% is seen with cohesive gel implants which have a textured surface (these are the ones used by Mr Grover). Other implants which are not cohesive or have a smooth rather than textured surface can give rise to capsule rates as high as 13-15%. Mr Grover will explain this to you when you come for consultation and show the difference between all the different implants so you appreciate the importance of the textured surface which will reduce your risk of capsule formation as low as possible.

Before and after photos of patient operated on by Rajiv Grover

What are the risks?
It is important to stress the possibility of risks but in practice these are rare and breast enlargement is one of the most reliable of all cosmetic surgery operations.

  • Excessive internal bruising (haematoma) occasionally occurs and may require removing some stitches to wash out the bruising from beneath the skin. This has no effect on the long term outcome of surgery.
  • Infection is rare because routine antibiotics are given following surgery. If infection occurs despite this, then the implant may have to be removed although after the infection is treated a new breast implant can usually be put in.
  • Changes in the sensation of the nipple and the breast (either an increase or a decrease) can occur following breast augmentation, but these are usually temporary.
  • Occasionally hardening of the implant may develop due to scar formation. This problem occurs in about 5% of women undergoing breast. The exact cause of this problem is not fully understood but may be due to the body's sensitivity to the otherwise inert breast implant. This hardening can occur months or even years after surgery. If this condition is severe more surgery may be needed in the future to remove the capsule and replace the implants but this is rare before 5 or 10 years.
Summary
Procedure time 60-90 minutes
General / Local anaesthetic General
No. nights in hospital 1 night
Time off work 7 days
Sensitivity period 10-14 days
Back to normality / sports 3-4 weeks

 

Breast augmentation is the commonest cosmetic surgery operation in the UK and is extremely successful at improving breast size and producing a natural shape with enhanced cleavage. By balancing the hips it improves a women's figure and emphasizes their waist.

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