Philip Turton Cosmetic Breast Surgeon

Breast Augmentation Frequently Asked Questions- Pre Operation:

Click here to jump to Post-op Qns following breast augmentation

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  • What happens at my first consultation?

Your consultation is always with Mr Turton. This is a detailed meeting to assess your current situation, medical history, suitability for breast enlargement, and to perform the biodimensional assessment. You will have a full breast examination, and comprehensive measurements made of your frame, existing breast size, glandular analysis, tissue characteristics, and anatomical variations in typical dimensions. The type of breast implants on the market, their safety, and the ones that have the best known life span and lowest complication rate will be discussed. Mr Turton will also detail your breast augmentation options and alternatives, the potential complications, any limitations, short and long term breast changes, costs, the need for future surgery, mammography and follow-up.

  • What size can my breasts be increased to?

Mr Turton advises strongly against large augmentation that takes your breast size excessively out of proportion to your frame. The biodimensional assessment will enable a choice of size to be made based on your proportions. This is the safest way of balancing the desire of breast enhancement with reduced detrimental effects. Most patients desire to be a "C" cup, and although cup size is not guaranteed, Mr Turton will be able to show you how your breast shape can be augmented, and take into account your desire. Using the Allergan round natural moderate, full, and tear-drop anatomical implants will provide Mr Turton the greatest flexibility for a near custom size implant, based on your frame and current breast measurements, if this is the style that you decide on. If you ask for a size that is much larger than your assessment suggests then you must be aware that there may be higher risks of complications and detrimental changes: eg nipple position looking wrong on the breast mound, breast tissue sag, palpability, less natural appearance or an unatural appearance, numbness, arms rubbing against side of breasts, ache, and future malposition and other problems. Not all patients have the tissue characteristics that enable larger implants- this tissue distensibility or compliance varies from patient to patient and can also change with time. Very tight tissues might not accommodate the size of the implant you truly desire. Sometimes tissue stretches in the months ad years after augmentation enabling larger implants later with exchanges.

If you have significantly sagging breasts (as opposed to just empty) or uneven sag (one breast more drooped compared to the other), this will look more obvious after augmentation and you may not like the look. Breast implants are not recommended as a treatment for significant breast sag, where usually a mastopexy is required. Additional surgery to reduce asymmetry or sag usually involves some type of mastopexy procedure which produces additional scars on the breast. If this is a procedure that you think you might need, you must be aware that there is a significant addtional cost of combining procedures.

  • Is it possible to choose which side is done first and will that reduce the pain felt on the first side i.e. can a right handed person choose to have the right side done first?

It makes no difference which side is operated on first. Local anaesthetic is carefully injected into the deeper tissues immediately prior to implant placement. This local anaesthetic has a good duration of effect of many hours. The sub-pectoral dual plane positioning of the implants feels more tender in general than when a sub-glandular position is used. Often one side feels slightly tighter, or more tender initially usually due to normal differences in nerve endings, sensitivities, and minor anatomical differences; implant settling often occurs earlier on one side than the other. However, this is irrespective of which side is operated on first. Mr Turton's routine is always to operate on the right breast first, and this is purely due to his very specific and methodical routine.

  • What happens on the day of the operation?

You should avoid any medication, herbal preparations, and vitamins except those that Mr Turton has said it is OK to take (please ask specifically). For example- No NSAIDS such as neurofen the week before surgery. You will also be fasting, and cannot take any liquids, any sips of water, or any food (no sweets, or chewing gum even), from the time specified (usually 6-hours prior to surgery). Avoid moisturiser on the breast area please. Arrive in good time, and you will be checked in first by nursing staff. You will be admitted several hours in advance of your operation so that it is completely unhurried. You should relax in your room (bring a book and magazines, ask for the wifi code if you wish to work or just browse the internet ). Mr Turton will take your pre-op photo and mark-you up. Mr Turton's anaesthetist will evaluate you and confirm that you can proceed (If you are unwell or have developed a chest infection your operation would obviously be cancelled and rescheduled). You will be walked from the ward to the operating theatre reception for your check in, and then your anaesthetist will commence your anaesthetic- you will drift off to sleep in about 5 seconds! Your will be under full anaesthesia for the full duration of the operation. Mr Turton will additionally use the longger lasting type of local anaesthesia to provides additional comfort on wakening. Every thing is geared around you, your 100% safety, and your well being. You will be woken up in the recovery room, and supervised 1 to 1 with an experienced recovery nurse after the anaesthetist has reviewed you. You will then be taken back to your room where you may start your recovery within the comfortable surroundings provided.

  • How long does the operation take?

Your operation will be conducted meticulously and unhurriedly. You are positioned on a padded operating table. There are additional gel supports that will be placed under your ankles and for your arms to rest on. Your head is on a pillow. Although you will be wearing special "TED" stockings already, once in theatre, we will also place anti-thrombotic boots around your lower legs which will gently squeeze your calf muscles on and off pneumatically throughout the operation (Mr Turton has never had a cosmetic braest surgery patient develop a DVT using this precaution), and there will be a special sterile operative warm air blanket covering your lower body (this is called the "huggy-bear" and it is set at a temperature designed for your comfort). An operation time of1 - 1.5 hours is typical for priary breast augmentation. Mr Turton uses various techniques to reduce operative risks such as haematoma and infection; consequently his reoperation rate is well below average. You are fully monitored throughout the operation and the consultant anaesthetist is solely with you (one-to-one consultant care).

  • Is it painful?

The chest area often feels "tight" and tender for a few days. You will be able to move about with a little more restriction than normal, taking extra care not to knock yoursef or do anything too physical. With sub-pectoral positioning of the implants you should avoid using your chest wall muscles forcibly, to avoid discomfort. This will be discussed. In particular though, when getting in and out of bed or out of a chair, it is quite hard not to use the pectoral muscles as you normally push your hands down to help support your weight! So, you have do this slowly and very gently if you need to. It usually feels sore for a few weeks with sub-pectoral positioning, but sometimes only a few days with sub-glandular positioning.

  • When can I drive?

Individual advice varies: From 3-days to 3-weeks. You should have come off the strong painkillers before driving (such as Tramadol, Codeine, Dihydrocodeine or Tylex). You should be comfortable that you could make an emergency stop or be able to swerve sharply if needed before driving. Please ask for advise if you are uncertain.

  • When can I return to work?

Usually after 1-week. Some patients return after less time, ie 3-days, and some longer. Jobs that involve strenuous lifting should be avoided for 2-weeks, and then discussed with Mr Turton to get a realistic time frame based on your particular circumstances.

  • How do I decide on the size of the implants?

The average breast size in the UK is a "B" cup. The starting point for breast augmentation for most patients is AA, A or B- cup. Some women are larger than this to start but as they have previously had children and a bigger bust request the volume of the breasts to be further increased to fill out the loose skin. This might not be possible though if you have been VERY big busted when you were pregnant or breast feeding, and so some looseness always remains- this is natural after all. The starting characteristics play a big part in what can be achieved- it is quite different in very flat chested, very tight tissue characteristic situaltions, to those breasts that have already breast-fed children for example. Mr Turton needs to take into account your desires and balance them with what is realistically achievable.

Most patients state a desire to be a "C" to 'D" cup. It is vitally important not to become fixated on "cup-size" as bra size is not standardised. It is the look that you want to achieve and can achieve that is most important to discuss, particularly in relation to your frame. If you want to stay in proportion to your frame, as most of Mr Turton's patients request, then you will be told the likely implant volume once the dimensions of your frame and the implant dimensions have been calculated. It is far superior to work around your dimensions to choose the implant volume, than to chose a particular volume of implant without doing this. This is one area that an experienced cosmetic breast specialist will excel at. If you desire a look that can't be achieved it is adviseable to step back and re-think if breast augmenation is right for you. For example, it is rarely possible to increase just one aspect of the breast in relative isolation without affecting another aspect.

Bring pictures with you or review your surgeon's album. Mr Turton likes you to review the breast augmentation pictures on his web site, and encourages you to print-off the post-operative pictures that seem closest to the size and shape that you want to achieve. This is a useful starting point to get you and your surgeon on the same wave-length and to faciliate discussions as to whether it is possible to achieve.

Asking for a natural shape augmentation is common. This produces a natural slope to the upper breast (see the side views in the post-operative photos for patients who have had anatomical implants or the more natural profile round implants). Not many of Mr Turton's patients request a very prominent rounded appearance in the upper bust, although this can be readily achieved if desired. Round implants can still be used to produce a natural look, but not in all patients, and not with some baseline tissue characteristics. Anatomical implants (shaped) produce the most natural shape of breast enhancement. Modertate and Full profiles increase the shape to the upper pole. The Extra-full profile produces the most rounded appearance.

There are specific cosmetic techniques that can be used to give you a proportionate result. So if you want a very subtle augmentation please make this clear as Mr Turton can work hard to deliver this for you.

  • How long will I be in hospital?

If you have surgery in the afternoon or evening you will normally stay overnight as this is Mr Turton's preference. Expedited recovery surgery is coming soon as part of Mr Turton's practice, and will enable you to go home just 2-hours after surgery. But for now, you will be reviewed by Mr Turton the morning after surgery and only released when ready. This is normally always by mid-day.

  • Can sex be resumed immediately after the operation?

For your comfort, Mr Turton advises waiting a few weeks as the breasts will be too tender to touch during this time. After this gentle sexual activity, without pressure on the breasts, can resume as long as no pain is experienced. Generally, it takes 6-weeks before you are able to lie on your front at night, which is a useful guide as to how pressure will affect your comfort. Breast massage must be avoided for a minimum of 6-weeks and should be very gentle after this too. In the long term, it is preferrable not to sleep on your front at all, and you should not routinely massage your breasts.

  • What forms of sports activity can I do after surgery after an augmentation with anatomical tear drop breast implants?

Anatomical implants (also called tear drops and shaped implants) need time to settle, and for tissue in-growth onto the textured implant surface to reduce future risk of a rotation. Different implant manufacturers have different types of texturing, which has an influence on Mr Turton's choice of breast implants. Not all texturing allows tissue in-growth, whereas the MPU_coated implants cause a very strong ingrowth. In addition, excess movement early on (first 6-weeks) will prevent in-growth and encourage a small seroma to form (like blister fluid) further preventing in-growth. Therefore, you will have more restrictions with your recovery programme, that must be followed to allow for this. Typical rates of progress that will not hinder your recovery from breast augmentation are as follows: No excessive stretching/movement should be undertaken for 6-weeks. With round breast implants the restriction is much less, especially if the implants have been placed in the sub-glandular ("overs") position.

Walking- no restriction, and it is important to mobilise straight away.

Static exercise bike in the gym- from 2-weeks

Gentle Cycling - from 3-weeks (not mountain biking!)

Paddling in a pool, Sauna/Steam room use- from 3-weeks

Jogging - from 6-weeks; Weight lifting - from 3-months

Cross trainers, Gym, Yoga, Pilates - from 6-weeks

Gentle swimming- from 6-weeks

Pole dancing, Belly dancing - from 6-weeks

Aerobics- gentle reintroduction from 6-8 weeks

Golf- from 3-months (except chip-and-putt which can resume much earlier); Scuba diving -from 3-months

Tennis/Squash/Badminton - from 3-months

Athletic swimming - from 3-months

  • Will I be able to fly after the operation?

Yes. UK domestic flights can be taken within 48-hours. International flights are best avoided for 2-3 weeks (please ask). This is more to do with Mr Turton being able to assess your recovery. Long-haul flights in general increase your risk of DVT, and you should wear anti-thrombotic stockings, stretch your legs, and perform leg and foot exercises during such flights. There is no altitude affect on your silicone implants (they are not at risk of bursting!).

  • If I lose/gain weight will my breast size reduce/enlarge?

In general, "Yes". Breast tissue is composed of thick glandular tissue and soft fatty tissue. Just as when you put on weight you find that it goes onto the bottom/hip area, you will also often find some of it goes onto the breast area. Big shifts in weight are therefore not desirable. Most people have minor weight fluctuation of 2-4 lbs, which has negligible consequences. Weight changes can make the breasts sag more, or for the implant to feels as if it has deflated (it won't have, but your breast tissue may be more stretched after weight changes, so that your breast feels softer. You have to imagine the breast as comprising skin and tissue that is like a container, with the implant not filling the container as well if the tissue has stretched from weight changes, age-related changes, or other physiological mechanisms!

If your starting breast size was very small (A to AA cup size), then losing weight tends not to make the augmented breast smaller, but reduces the thin normal fatty tissue layer under the skin, and in the breast tissue layer- this makes the implant edge more easily palpable (particularly in the outer edge near the arm-pit, and in the skin crease area under your breast). Implants that are partly under the muscle have the additional coverage of soft tissue that this provides which is particularly helpful in thin individuals, but remember- the pectoralis major muscle does not fully cover the implant, generally just the upper half.

  • How can I prevent sagging in future years?

You can't. However careful choices can modify your risk. Your breasts will always change as you get older, and this is irrespective of whether you have breast implants or not. This is because of biological changes that occur with ageing: loss of elastin, stretching of collagen, atrophy of breast tissue, loss of skin elasticity, sun damage to skin, smoking related damage, effects of weight change on skin and breast tissue, effects of pregnancies and breast feeding on skin and breast tissue, hormonal changes, weight of breast tissue and implant weight and size. Large breast implants also stretch the tissue, acting a little like tissue expanders.

The biodimensional assessment goes some way to reducing excessive implant sizes being chosen by patients. You should very much speak to Mr Turton about this. The larger the implant the greater the long term detrimental effects. This is because of the additional weight, and the compressive force of the implant on the surrounding tissues, which become thinner, and more stretched. In general you are better to avoid very large augmentations (eg over 350cc) and implant sizes that exceed your natural dimensions. Sub muscular breast implant augmentation may provide additional coverage to the implant but there are some negative aspects of sub-muscular positioning too and you sometimes have to trade-off one thing for another.

Wearing a well-fitting bra after your recovery is important (usually from 6-weeks). An underwire bra is safe and recommended. Wearing a comfortable sports bra at night is also very useful. A shock-absorber type bra should be worn during sport. Keeping the skin over the breasts moisturised helps to maintain the elasticity (bio oil is possibly advantageous here). Avoid the use of sunbeds and do not smoke at all (both have a very detrimental effect on skin elasticity and quality, as well as micro-vessel blood flow). Maintain your weight in the healthy range for your body mass index. Don't sleep on your front at night. If you have children/further children, after breast augmentation, you breasts will very likely develop some sag.

  • Are implants/surgery guaranteed for any length of time?

Acute problems after surgery are covered by your "fixed price package". Longer term problems are usualy defined as those that occur after a year, and the hospital would not usually provide ongoing free consultations or treatment beyond this date. But in that situation where an implant problem occured in this time frame (very unikley incidentally) you should contact Mr Turton so that he can advise. Problems unrelated to the implants (eg breast lumps) should be reviewed by your GP/Breast clinic.

Implant manufacturers have slightly different guarantees that relate to implant rupture. No manufacturer or surgeon can offer a cast-iron guarantee against long term changes which will always occur, may be subjective, and may be biological rather than anything to do with the implant or the initial surgery.

For example: Allergan anatomical implants carry a lifetime guarantee against rupture. If they rupture then Allergan will provide new breast implants free of charge (please check for updated confirmation from your surgeon). The cost of the operation (surgeon's fee, anaesthetist's fee and hospital fee) is NOT covered by this. However, as the Allergan anatomical implants are relatively expensive, this is a useful contribution.

Future surgery will be an additional cost that must be factored in before undergoing breast augmentation. Beware of anyone offering guarantees, or free follow-up for life, as it may not be worth the paper it is written on. As an example, I was recently consulted by a lady with faulty saline implants. She had experienced 3 deflations in 3-years and as her surgery was guaranteed against this, she had undergone each operation with the same surgeon and the same poor quality product being replaced. She had bad scars as a result and was very frustrated. I advised her against using the same product and performed revisional breast augmentation with a very satisfactory and more durable outcome using the Allergan implants.

  • If something goes wrong during/after operation is surgery guaranteed & will problems be resolved within cost?

Complications from breast augmentation surgery under Mr Turton are very rare. He will be unable to give you a categorical guarantee that they won't occur, but he is an experienced surgeon and mange problems if they do occur. There are some types of problem that are more minor and typically occur in the first few hours after surgery if they are to manifest at all, such as a collection of blood around the implant (from tissue bleeding or oozing) which is termed a haematoma. As this forms around the implant in the first 24-hours it needs evacuation so you go back under anaesthetic to have it washed out. In the first few weeks after surgery, the complication of implant infection can occur. This would likely result in needing implant removal. With the techniques Mr Turton uses, he has not ever had to remove an implant after breast augmentation for infection. However, if these complications do occur you will be covered by the fixed price package for further surgery. For example, if you need to have the implants removed because of an infection in the post-operative period, this is covered, as is the subsequent operation to replace new implants.

Fixed price packages tend to cover you for complications during the first 3-months after the operation, as this is the time that surgery related complications occur. They do not cover the more long term changes with implants like: rippling, palpability, breast sag, capsulation, rupture, and malposition. They also do not cover dissatisfaction with the size, or shape.

Mr Turton will always strive to meet your expectations but if there are limitations as to what can be achieved (often related to your starting point) then these will be discussed. It is important to be realistic. If you are concerend about "body dysmorphia" please mention this, and similalry if Mr Turton feels you may have body dysmorphia he would suggest you do not have surgery as it doesn't result in satisfaction for patients.

  • Are follow up consultations chargeable - even at the request of the consultant?

Your first post-operative follow-up is included in your surgical fees. Most patients are discharged at 3-months.Subsequent follow-ups will always incur a standard follow-up fee (cost approximately £100; please check with Mr Turton's secretary). You will generally require one further follow-up and then can take up the offer of annual or 2-3 yearly review depending on your circumstances, with a view to having an MRI (cost approximately £550) at 5-10-years to assess your implants. Mammography and USS (cost approximately £160 each) can be arranged depending on your age during the follow up period, if required. Costs reflect Mr Turton's time, and the charges for his rooms, administration and running costs. You are not charged if you attend for review by an out-patient breast nurse. At your follow-up with Mr Turton, you will always see Mr Turton- any follow-up is not delegated to someone else.

  • Will breast augmentation change my life?

Breast augmentation may make you feel more confident within yourself but will not change things if you are dissatisfied with your lifestyle. Surgery in itself will not change a life situation, but the confidence and self-assurance which result from it can indeed empower you to make the required changes, allowing you to live and enjoy your life, to the full. Some patients can rarely have a general problem with body image, and remain dissatisfied with their appearance even when the result has been within the expected and described range. This may be because of something called "dysmorphic body image syndrome". Patients who have a general body image problem are unlikely to gain benefit from cosmetic breast surgery or any cosmetic surgery and should avoid it. Mr Turton would also want to avoid operating on someone who he suspected of having such a problem.

  • Can I still wear the same style of underwear?

Due to possible changes in shape it may not be possible to wear the same styles.

  • Do I need to wear some form of support at all times or can I go without a bra?

Once you have recovered from surgery there is no reason why you shouldn't go without a bra on occasions. As long as you feel comfortable it will not have a detrimental effect. In the long term, however, breast tissue will be more susceptible to droop if you do not wear a bra most of the time.

 

Post Operation Questions (after breast augmentation)

  • How will I feel after Breast Augmentation Surgery?

The vast majority of Mr Turton's patients feel relaxed and comfortable immediately after surgery. Breast tenderness and a tight feeling, usually become apparent in a gradual manner. At this stage Mr Turton is happy for the nursing staff to dispense Paracetamol and an anti-inflammatory tablet for pain relief. If you have had sub-muscular implants you will usually need to have a stronger pain killer as well, such as Tramadol or Codeine. This combination is best taken regularly for the first 4-days. After this, the Tramadol can be just taken at night if required. It is usual to stop the Tramadol after 1-week. The anti-inflammatory and Paracetamol combination is very effective and can be continued for a few weeks according to how you feel, but should not be taken on an empty stomach. Sometimes it is easier to take the anti-inflammtory if you also take Lansoprazole to reduce stomach acid, as the anti-inflammatories make the stomach lining sensitive to acid) It is quite common for one breast to be more tender, and to swell slightly more (this is often the right side). Similarly one breast will often recover more quickly and this is quite normal.

Although this would be very rare, the gradual appearance of an obvious discrepancy in size would not be normal and should be assessed. Similarly if you feel unwell, feverish and devlelop a temperature you would need assessment. If the skin over the breast swells and becomes reddened and tender you would need assessment. Changes like this would be very unusual indeed, but it is important to know that should they occur, a prompt review is required to assess the cause and treat it.

Some patients don't like Tramadol (may feel too light headed, or the room feels as if it is moving, or it just causes nausea), but will tolerate Codeine (and vice versa). Adjustments will be made if needed. Occasionally patients feel nauseated as the anaesthetic leaves the system, or sometimes as a result of morphine that has been given by the anaesthetist during the operation. Both of these are soon out of the system and generally gone by the following morning.

  • What happens after the operation?

When the surgery is finished, the anaesthetic will stop and you will gradually wake up over about 5-minutes. At this point you are taken to the recovery area. You are supervised by the anaesthetist and the experienced recovery nurse and then by the recovery nurse alone. The tube that was in your mouth will have been removed and you will feel sleepy. You stay in recovery until you are more alert and then you are taken back to your room where you should feel quite comfortable. The nursing staff adjust your medication as needed. Your throat may feel slightly sore from the breathing tube but you will be able to sip water straight away. You may need to visti the bathroom, and you should have the nurse help you in case you feel light-headed.

At this stage there is still a drip on the back of your hand, and this is taken down when you are drinking properly. The venflon (the name for the small plastic needle in the back of the hand) is taken out the following morning, but can come out earlier if you are comfortable and not feeling nauseated.

There will be a thin wound drain tube and container by your side and this should be kept laid out straight alongside your body so that the tube is not curled up, otherwise it can kink, and stop the suction. This is simply removed the following day, and is not painful.

Your breast area feels tight and there will be a tubigrip (elasticated support) over your breasts. Often this is in a double layer overnight and then pulled down to a slightly looser single layer the next morning. There may also be a stabilising band (like a thick white elasticated belt) across the upper part of your breasts, which limits swelling in the upper pole of the breasts and limits implant movement. You will go home wearing both the tubigrip and stabilising band night and day, without removing either.

The dressings and the tubigrip must be kept dry. This helps reduce the risk of wound infection. You should therefore have shallow baths (run the water just up to cover your legs) and keep the tubigrip on (but dry) even when you are in the bath. It is good to get help with hair washing. Sponge wash the under arm area and pat dry afterwards.

You will be seen the following morning after surgery and the nursing staff informed as to when the drains can be removed. You will be given the "take home medication"- painkillers and antibiotics and should have clear instructions and understanding as to when to take them. Please ensure you discuss this with the nursing staff if not sure and If you have any queries after discharge you will be instructed to ring the ward for immediate attention. Mr Turton should be informed of any problems.

  • Are there any side effects to the operation?

The commonest one is feeling sleepy for a few hours. Sometimes the anaesthetic or morphine make you feel sickly, but usually for a short duration only.

You may feel slightly bloated for a few days. This is often due to slight constipation caused by morphine, codeine and tramadol medication. A gentle laxative (lactulose, movicol or senna) will help resolve this. Some patients feel a low mood, and this may be related to tiredness particualry if you didn't sleep well before or after surgery. Give yourself some time once home, get some sleep and you should feel better very quickly.

  • What clothes should I bring in to wear leaving hospital after the operation?

A loose button front shirt is ideal. Nothing that needs pulling on over your head.

  • Do I need to take time off work after surgery?

Yes. Please check with Mr Turton in relation to what you do. Generally 1-week off. 2-weeks or more may be needed if your job involves lifting or any heavier manual work. If very sedentary, you can occasionally return after 3-days, but remember that you will still be taking Paracetamol and anti-inflammatories, but must have stopped the Tramadol if returning to work.

  • When is it possible to resume household chores?

It is really important not to start household chores straight away. You may be glad to know that husbands/partners/friends will certainly need to help here. I advice against vacuuming and ironing for the first 3-weeks, and then only lightly for the following 3-weeks. The golden rule is "if it feels sore, then don't do it". Listen to your body. You want to avoid repetitive tasks that will stop implant settling and tissue in-growth on to the textured surface of an anatomical implant. If you don't have anatomical implants, you can resume chores more readily after 2-weeks.

  • When is it possible to resume shopping?

You can go shopping the following day. You should not carry heavy shopping bags for 3-weeks. I would advice against bra shopping until 6-weeks as this is when implant settling would tend to have occurred.

  • When is it possible to go out to a restaurant?

You can go out to a restaurant straight away. You should avoid a very heavy meal and avoid more than a glass of wine or champagne in the first week. Some of Mr Turton's patients go out to a restaurant the very next day.

  • When is it possible to resume decorating?

As this can be strenuous you should wait a minimum of 6-weeks.

  • I have small children; am I okay to lift them? or play rough and tumble?

Lifting small children can be very awkward until over 2 weeks have elapsed and it is adviseable to have someone else help you if you are in this situation (eg getting a baby/toddler out of a cot, or into/out-of a car seat). Please always discuss this with Mr Turton. Games with your children can be strenuous as well as painful, especially if you get knocked, so you should wait until after 6-weeks.

  • Is it okay to sunbathe after the operation?

Not initially! I would advise against it for the first 2-weeks. After this, yes, but you should use factor 50 + suntan lotion, or keep scars taped and completely covered by clothes. Remeber that you can get sun-burn through thin cotton. If the scar does get sun burn it causes a permanent redness.

  • How will my breasts look & feel after the operation?

During the first 3-weeks, the breasts tend to feel quite tight and swollen. After implant settling the breasts generally feel firm once all the swelling has resolved.

  • When can I lift my arms above my head?

After 2-weeks usually, unless Mr Turton advises you of specific exercises as part of the expedited recovery programme.

  • What pressure will it take to rupture silicone breast implants?

A car accident at 30/40mph could rupture the implants, or for example falling off a horse and hitting the breast area very hard. You would normally have obvious signs of a breast injury (swelling and bruising and tenderness), and a scan would be needed to evaluate this further. Minor trauma is very unlikely to cause a problem, and the modern implants that Mr Turton uses are extremely durable. The outer 3-layered membrane of the Allergan implant is very strong. Each batch of these high quality breast implants will have been through extensive quality assurance tests by the manufacturer before being released for use. Older implants become less durable, so by 10-years for example around 10% of implants are ruptured, even if there are no signs present, reflecting increased fragility with time. Take more care as your implants get older, and get them replaced by 10-15 years.

  • Is it possible to get larger implants after the 1st operation?

It is important to avoid unnecessary surgery. Redo breast augmentation carries additional risks and limitations. Further surgery years down the line is likely to be needed at some point, and it is better not to have this done simply for larger implants. When further surgery is required at a later date, implant size can be increased, but the same criteria and judgments need to be applied as for the first operation. It will still be the case that the bigger the size the more unwanted and permanent effects will appear both in the short and long term.

  • When can I wear an underwired bra?

Usually from 6-weeks. You should avoid trying on multiple bras at this stage. Get professionally fitted and buy from that shop initially. If the underwiring is uncomfortable go back into a sports bra and get refitted in a different shop.

  • When can I lay on my stomach?

Usually at 6-weeks; before this it is uncomfortable. Try not to sleep on your front though.

  • Is it possible to have the breast area tattooed?

There should not be a problem with this except for a small risk of implant infection. Tattooing temporarily injures the skin and it is conceivable that you could get cellulitis (redness caused by skin infection), which could allow the bacteria to travel through the breast lymphatics onto the implant. You may want to consider a short course of preventative antibiotics to reduce this risk.

  • It says no heavy lifting - what is classed as heavy?

Heavy is anything that is uncomfortable. In general terms lifting shopping bags that are full is what I would term "heavy". Lifting a kettle is OK. Lifting a baby is not OK. Lifting a vacuum cleaner is not OK.

It is also important to try to avoid using your arms to shuffle yourself up and down the bed, for the first 6-weeks. When you do so, you are pushing hard with your hands onto the mattress and this is forcibly contracting the pectoral muscles.

  • Will I be able to breast feed with implants?

Yes in a lot of cases this is still possible. As long as your implants are placed through a conventional inframammary incision it will not always alter your ability to breast feed. They do not alter the production of milk. The amount of silicone in the milk from a bottle is higher than that from breast milk; both are of course negligible. Some women cannot breast feed for other reasons of course. If your breast tissue is very small, or very compressed by the implant it is unlikely you will be able to satisfy the baby even if you lactate.

  • Will a general or local anaesthetic be used?

The operation is carried out under full general anaesthetic and this is regarded as the safest approach. Pure local anaesthesia is an uncomfortable way to perform a breast augmentation although Mr Turton has done this on a patient with an unresolved phobia. "Twilight anaesthesia" carries a level of risk of losing control of the airway if the patient's level of consciousness falls and should be avoided unless there is a very specific reason to use this route. If a request is made for Mr Turton to perform a breast augmentation under twilight anaesthesia, he would still insist on a consultant anaesthetist being present to maintain the patient's 100% safety. This should never be an area of compromise simply to reduce the cost of breast augmentation.

  • If I have excess breast hair is it possible to have treatment to remove them?

Mr Turton does not offer this service personally but a reputable clinic should be able to advise. Small amounts of breast hair are commonly seen in all age groups and are dealt with differently by different people. Laser therapy or electrolysis therapy to get rid of the hair root is still possible after breast augmentation surgery.

  • How long do implants last?

It depends predominantly on the type of implant used, and the manufacturer. The current 5th generation Allergan implants probably last far longer than previous types. In the biggest study performed to date, the rupture rate was extremely low (ie <5%) at 10-years obviating any definite need for automatic implant exchange. Mr Turton advises patients to consider initial clinical check-ups, USS or MRI to assess implant integrity. If all is well, there is no need for premature implant exchange, which otherwise costs over £4500! However, the cost of checking the implants can exceed the exchange costs too over time. So, if you want to avoid clinical checks and scans and you have no problems, Mr Turton currently advises his patients to consider exchange at around 10-15 years. The core FDA studies support a rupture rate of aroud 10% within the first 10-years, and often these are asymptoamtic.

There are many implants that are available to use for augmentation that do not have the same quality, safety, quality assurance, or longevity. These implants may cost a lot less and enable the price of the breast augmentation surgery to be much lower (this is sometimes done by competitors to encourage customers on the basis of price) but is almost certainly a short sighted approach. Low quality implants may have a higher rupture rate and capsulation rate.

  • Can I have them removed at a later stage if required & if so what are the consequences?

Yes. Implants are easy to remove, even under a local anaesthetic should it be required. The breasts will of course be empty, devoid of fullness, and the skin will be loose, usually with some wrinkles and sagging. The difference is profound as there will be age related changes that will have occurred and much less native breast tissue. Some patients choose to have a mastopexy at the time of removal to repostion the nipple better, and remove some of the sag.

  • How long is the scar tissue healing time?

Skin healing occurs in the first 7 days, but continues to mature over 6-12 months. The scars must be cared for and you should avoid touching or feeling along the scar line for the first 8-weeks. Mr Turton advises any patients with a history of poor scars to tape the scar for 3-months to keep the scar line like a fine pencil line. The scars gradually fade over the first 12-months to a pale colour. This can be speeded up by using bio oil on the scar after 3-months, or a silicone gel called Dermatix (only available over the counter).

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Breast Reduction

Frequently Asked Questions-

Pre Operation

  • What happens at my first consultation?

Your consultation is always with Mr Turton. This is a detailed meeting to assess your current situation, medical history, suitability for breast reduction, and to perform the bio-dimensional assessment. You will have a full breast examination, and comprehensive measurements made of your frame, existing breast size, glandular analysis, tissue characteristics, and anatomical variations in typical dimensions. Mr Turton will also detail the potential complications, any limitations, short and long term breast changes, costs, the need for future surgery, mammography and follow-up.

  • How much breast tissue can be removed/what size can my breasts be reduced by?

Usually 500gms to 800gms.

Massive reductions involve 1-2kgs/side.

Small reductions are also quite commonly performed (100-500gms), with emphasis on tightening the skin, reshaping the breasts and raising the nipple up to its normal position. This may be referred to as a mastopexy-reduction.

  • What happens on the day of the operation?

You should avoid any medication, herbal preparations, and vitamins except those that Mr Turton has said it is OK to take. For example- No NSAIDS such as Neurofen the week before surgery. You will also be fasting, and cannot take any liquids, any sips of water, or any food (no sweets, or chewing gum even), from the time specified (usually 6-hours prior to surgery). Avoid moisturiser on the breast area please. Arrive in good time, and you will be checked in first by nursing staff. You will be admitted several hours in advance of your operation so that it is completely unhurried.

You should relax in your room (bring a book and magazines, get the wifi code!). Mr Turton will take your pre-op photo and mark-you up. Mr Turton's anaesthetist will evaluate you and confirm that you can proceed (If you are unwell or have developed a chest infection your operation would obviously be cancelled and rescheduled). You will be walked from the ward to the operating theatre reception for your check in, and then your anaesthetist will commence your anaesthetic- you will drift off to sleep in about 5 seconds! Your will be under full anaesthesia for the full duration of the operation. Mr Turton will additionally use local anaesthesia which provides additional comfort on wakening.

Every thing is geared around you, your 100% safety, and your well being. You will be woken up in the recovery room, and supervised 1 to 1 with an experienced recovery nurse after the anaesthetist has reviewed you. You will then be taken back to your room where you may start your recovery within the comfortable surroundings provided.

  • How long does the operation take?

Your operation will be conducted meticulously and unhurriedly. You are positioned on a padded operating table. There are additional gel supports that will be placed under your ankles and for your arms to rest on. Your head is on a pillow. There will be pneumatic anti-thrombotic boots around your lower legs which will gently squeeze your calf muscles throughout the operation (Mr Turton has never had a cosmetic surgery patient develop a DVT), and there will be a special sterile operative warm air blanket covering your lower body (this is called the "huggy-bear". An operation time 2 - 4 hours is typical. Mr Turton places great emphasis on the suturing and will usually spend an hour on this specific aspect. Mr Turton uses various techniques to reduce operative risks such as haematoma and infection; consequently his re-operation rate is well below average. You are fully monitored throughout the operation and the consultant anaesthetist is solely with you (one-to-one consultant care).

  • Is it painful?

Most patients use Paracetamol for a few days only, but an anti-inflammatory is included in addition by Mr Turton. The careful surgery often means discomfort is truly minimal. A mild aching is reported by a very small number of patients weeks or even months after surgery.

  • When can I drive?

Individual advice varies: From 7-days to 3-weeks. You should have come off any strong painkillers before driving (such as Tramadol, Codeine, Dihydrocodeine or Tylex). You should be comfortable that you could make an emergency stop or be able to swerve sharply if needed before driving.

  • When can I return to work?

Usually after 1-week. Some patients return after a longer period, typically 2-weeks. Jobs that involve strenuous lifting should be avoided for 3-weeks, and then discussed with Mr Turton.

  • How do I decide on what size I want to be/ What size will my breasts be after surgery

Most patients want to be between a C and D cup. The starting size and the health of the remaining tissue during the operation dictates how much of the gland may be reduced. Mr Turton uses his extensive expertise in balancing the volume of the reduction, the goal of a desired breast size, and the blood supply to the remaining tissue. With massive macromastia, he will not compromise on the safety aspect at any point, and if he needs to curtail the resection just before a particular estimated cup size is reached he would always do so. For example, this may mean a patient is a DD rather than a D afterwards, or a D as opposed to a C. To reiterate, most patients want to be between a C and D cup, and this is achieved. Please note that there always will be imprecision trying to work to any particular cup size due the vagueries of this measurement and that it can't be precisely measured during surgery. It serves as guide only.

  • How long will I be in hospital?

If you have surgery in the afternoon or evening you will normally stay 1-2 nights. This is for your comfort andto allow your drains to stop any fluid building up pressure under the tissue and hence on the scar line. You will be reviewed the morning after surgery and only released when ready the next day. This is normally always by mid-day.

  • Can sex be resumed immediately after the operation?

For your comfort, Mr Turton advises waiting at least 3 weeks as the breasts will be too tender to touch during this time. After this gentle sexual activity, without pressure on the breasts, can resume as long as no pain is experienced. Generally, it takes 6-weeks before you are able to lie on your front at night, which is a useful guide as to how pressure will affect your comfort. Breast massage must be avoided for a minimum of 8-weeks.

  • What forms of sports activity can I do after surgery?

Walking - Mr Turton encourage all patients on walking- no restrictions, and it is important to mobilise straight away.

Arm exercises - You must avoid raising your arms above shoulder height for 2-weeks (either to the side or infront). eg No reaching for top cupboards! Get help with hair washing. Avoid using your arms to lift yourself up or push yourself along on a mattress.

Cycling - from 6-weeks

Paddling in a pool, Sauna/Steam room use- from 6-weeks

Jogging - from 6-weeks; Weight lifting - from 3-months

Cross trainers, Gym, Yoga, Pilates - from 6-weeks

Gentle swimming- from 6-weeks

Pole dancing, Belly dancing - from 6-weeks

Aerobics- gentle reintroduction from 6-8 weeks

Golf- from 3-months (except chip-and-putt); Scuba diving -from 3-months

Tennis/Squash/Badminton - from 3-months

Athletic swimming - from 3-months

  • If I lose/gain weight will my breast size reduce/enlarge?

In general, "Yes". Breast tissue is composed of thick glandular tissue and soft fatty tissue. Just as when you put on weight you find that it goes onto the bottom/hip area, you will also often find some of it goes onto the breast area. Big shifts in weight are therefore not desirable. Most people have minor weight fluctuation of 2-4 lbs, which has negligible consequences.

  • Is it better to lose weight before reduction surgery?

Yes. The breast shape will be better controlled if you have lost weight and assumed a normal body mass index prior to surgery. At the very least you should bring your body mass index (BMI) to less than 30 through a diet. Some patients struggle with weight loss when they have very large macromastia as is difficult to exercise. Mr Turton would be happy to offer his professional advice in this situation. He has access to a very helpful professional dietician, and physiotherapy services. Occasionaly patients with a BMI over 40 who are unable to achieve weight loss, will need to consider seeing a bariartic surgeon for a bypass or gastric restriction operation. Your General Practitioner can give you further advice, otherwise there are services available relating to this at both Roundhay Hall Leeds and the Leeds Nuffield.

  • How can I prevent sagging in future years?

You can't. However careful weight control can modify your risk. Your breasts will always change as you get older, and this is irrespective of whether you have breast reduction and mastopexy or not. This is because of biological changes that occur with ageing: loss of elastin, stretching of collagen, atrophy of breast tissue, loss of skin elasticity, sun damage to skin, smoking related damage, effects of weight change on skin and breast tissue, effects of pregnancies and breast feeding on skin and breast tissue, hormonal changes, weight of breast tissue and quality of supporting tissues.

Wearing a well-fitting bra after your recovery is important (usually from 6-weeks). An underwire bra is safe and recommended. Wearing a comfortable sports bra at night is also very useful. A shock-absorber type bra should be worn during sport. Keeping the skin over the breasts moisturised helps to maintain the elasticity (bio oil is possibly advantageous here). Avoid the use of sunbeds and do not smoke at all (both have a very detrimental effect on skin elasticity and quality, as well as micro-vessel blood flow). Maintain your weight in the healthy range for your body mass index.

  • Is the surgery guaranteed for any length of time?

You are covered by the fixed price package for the management of surgery related complications. As these would mannifest early, and usually in the first 2-weeks, the cover is typically for the first 3-months for peace of mind (check specific details at each hospital please). Breast problems that are unrelated to the surgery can occur subsequently in any patient (whether you have surgery or not) and are of course not covered.

  • In the unlikely event that something did go wrong during/after the operation is further surgery included in the fixed price guarantee and will problems be resolved where possible within cost?

Complications from breast reduction surgery under Mr Turton are very rare, and although he is unable to give each individual patient a categorical guarantee that they won't occur, he can attend to any surgery related complication under the terms of the fixed price guarantee.

The sort of problems that can occasionally occur are haematoma (collection of blood under the skin) in the first 24-hours needing evacuation; this will occur in under 5% of operations and there are techiques that are used to minimise the risk. Infection or slow wound healing can occur at the T-junction. Mr Turton has never had a major wound related infection after breast reduction, and has never had a patient develop MRSA. If such a complication was to occur then you will not only have the technical expertise at hand to deal with it, but also the peace of mind that it is covered by the fixed price package for further surgery, or for further outpatient treatment, should it be needed.

Fixed price packages tend to cover you for complications during the first 3-months after the operation, as this is the time that surgery related complications occur. They do not cover the more long term changes that can occur in breasts in most women. Such as developing a breast lump, or changes in sensation, and future breast sag, They also do not cover dissatisfaction with the size, or shape, unless it is related to a surgical problem. Mr Turton's post-operative pictures are the typical results achieved and not carefully selected photos simply to impress patients. These are the results he will expect to achieve with you, unless there are other limiations.

Mr Turton will always strive to meet your expectations but if there are limitations as to what can be achieved (this may be related to your starting point) then these will be discussed. It is important to be realistic.

  • Are follow up consultations chargeable - even at the request of the consultant?

Your first two post-operative follow-ups are included in your surgical fees. You will generally only require a follow up at around 2-weeks and again at around 2-3months. Most patients are discharged by 3-months. Subsequent follow-ups will always incur a standard follow-up fee (cost approximately £100; please check with Mr Turton's secretary).

Some patients desire annual or 2-3 yearly review depending on circumstances. Mammography and USS (cost approximately £160 each on top of consultation fees) can be arranged depending on your age during the follow up period, if required. Costs reflect Mr Turton's time, and the charges for his rooms, administration and running costs. You are not charged if you attend for review by an out-patient breast nurse. At your follow-up with Mr Turton, you will always see Mr Turton- any follow-up is not delegated to someone else.

  • Will breast reduction change my life?

Breast reduction may make you feel more confident within yourself but will not change things if you are dissatisfied with your lifestyle. Surgery in itself will not change a life situation, but the confidence and self-assurance which result from it can indeed empower you to make the required changes, allowing you to live and enjoy your life, to the full. Some patients can rarely have a general problem with body image, and remain dissatisfied with their appearance even when the result has been within the expected and described range. This may be because of something called "dysmorphic body image syndrome". Patients who have a general body image problem are unlikely to gain benefit from cosmetic breast surgery or any cosmetic surgery and should avoid it. Mr Turton would also want to avoid operating on someone who he suspected of having such a problem.

  • Will I still have to wear the same style of underwear?

Due to possible changes in shape it should be possible to wear more feminine underwear.

  • Do I need to wear some form of support at all times or can I go without a bra?

Once you have recovered from surgery there is no reason why you shouldn't go without a bra on occasions. As long as you feel comfortable it will not have a detrimental effect. In the long term, however, breast tissue will be more susceptible to droop if you do not wear a bra most of the time.

 

Post Operation Questions

  • How will I feel after Breast Reduction Surgery?

The vast majority of Mr Turton's patients feel relaxed and comfortable immediately after surgery. Breast tenderness and a tight feeling, usually become apparent in a gradual manner. At this stage Mr Turton is happy for the nursing staff to dispense Paracetamol and an anti-inflammatory tablet for pain relief. You will only occasionally need to have a stronger pain killer as well, such as Tramadol or Codeine. The anti-inflammatory and Paracetamol combination is very effective and can be continued for a few weeks according to how you feel, but should not be taken on an empty stomach. It is quite common for one breast to be more tender, and to swell slightly more (this is often the right side). Similarly one breast will often recover more quickly and this is quite normal.

Although this would be very rare, the gradual appearance of a great discrepancy in size would not be normal and should be assessed. Similarly if you feel unwell, feverish and develop a temperature you would need assessment. If the skin over the breast swells and becomes reddened and tender you would need assessment. Changes like this would be very unusual indeed, but it is important to know that should they occur, a prompt review is required to assess the cause and treat it.

Occasionally patients feel nauseated as the anaesthetic leaves the system, or sometimes as a result of morphine that may have been given by the anaesthetist during the operation. Both of these are soon out of the system and generally gone by the following morning.

  • What happens after the operation?

When the surgery is finished, the anaesthetic will stop and you will gradually wake up over about 5-minutes. At this point you are taken to the recovery area. You are supervised by the anaesthetist and the experienced recovery nurse and then by the recovery nurse alone. The tube that was in your mouth will have been removed and you will feel sleepy. You stay in recovery until fully alert and then you are taken back to your room where you will be made comfortable. The nursing staff will adjust your medication as needed. Your throat may feel slightly sore from the breathing tube but you will be able to sip water straight away.

At this stage there is still a drip in the back of your hand, and this is taken down when you are drinking properly. The Venflon (the name for the plastic needle in the back of the hand) is taken out the following morning, but can come out earlier if you are comfortable and not feeling nauseated.

There will be a drain by your side and this should be kept laid out straight alongside your body so that the tube is not curled up, otherwise it can kink, and stop the suction. This is removed the following day, and is not painful.

Your breast area feels tight and there will be a tubigrip (elasticated support) over your breasts. Often this is in a double layer overnight and then pulled down to a slightly looser single layer the next morning. You will go home wearing the tubigrip day and night, without removing either.

The dressings and the tubigrip must be kept dry. This helps reduce the risk of wound infection. You should therefore have shallow baths (run the water just up to cover your legs) and keep the tubigrip on (but dry) even when you are in the bath. It is good to get help with hair washing. Sponge wash the under arm area and pat dry afterwards.

You will be seen the following morning after surgery and the nursing staff informed as to when the drains can be removed. You will be given the "take home medication"- painkillers and antibiotics and should have clear instructions and understanding as to when to take them. Please ensure you discuss this with the nursing staff if not sure and if you have any queries after discharge you will be instructed to ring the ward for immediate attention. Mr Turton should be informed of any problems.

  • Are there any side effects to the operation?

The commonest one is feeling sleepy for a few hours. Sometimes the anaesthetic or morphine makes you feel sickly, but usually for a short duration only.

You may feel slightly bloated for a few days. This is often due to slight constipation caused by morphine, codeine and tramadol medication. A gentle laxative (lactulose, movicol or senna) will help resolve this.

  • What clothes should I bring in to wear leaving hospital after the operation?

A loose button front shirt is ideal. Nothing that needs pulling on over your head.

  • Do I need to take time off work after surgery?

Yes. Please check with Mr Turton in relation to what you do. Generally 2-weeks off. 3-weeks or more may be needed if your job involves lifting or heavy manual work. If very sedentary, you can occasionally return after 10-days, but remember that you may still be taking Paracetamol and Voltarol.

  • When is it possible to resume household chores?

It is really important not to start household chores straight away. You may be glad to know that husbands/partners/friends will certainly need to help here. I advise against vacuuming and ironing for the first 3-weeks, and then only lightly for the following 3-weeks. The golden rule is "if it feels sore, then don't do it". Listen to your body. You want to avoid repetitive tasks that will slow down tissue healing and resolution of swelling.

  • When is it possible to resume Shopping?

You can go shopping the following day. You should not carry heavy shopping bags for 6-weeks. I would also advise against bra shopping for 6-weeks as this is when breast tissue swelling would have generally resolved.

  • When is it possible to go out to a Restaurant?

You can go out to a restaurant straight away. You should avoid a very heavy meal and avoid more than a glass of wine or champagne in the first week. Many of Mr Turton's patients go out to a restaurant the very next day after being discharged.

  • When is it possible to resume Decorating?

As this can be strenuous you should wait a minimum of 6-weeks.

  • I have small children; am I okay to play rough and tumble?

As this can be strenuous as well as painful, especially if you get knocked, you should wait until after 6-weeks.

  • Is it okay to sunbathe after the operation?

Yes, after 6-weeks once you have healed. But you should use factor 50 + suntan lotion, or keep scars taped and completely covered by clothes. Remember that you can get sun-burn through thin cotton. If the scar does get sun burn it causes a permanent redness.

  • How will my breasts look & feel after the operation?

During the first 3-6 weeks, the breasts tend to feel quite tight and swollen. Near to full resolution for small reductions occurs in this time. After 3-months the breasts generally feel softer again but this can take 6-months for very large reductions.

  • When can I lift my arms above my head?

After 3-weeks usually, unless Mr Turton advises you of specific exercises to perform or avoid.

  • Is it possible to get further reductions in the future if necessary?

It is important to avoid unnecessary surgery. Further reductions are possible but the technique must be meticulous to avoid the risks of skin necrosis including loss of the nipple and areola. Liposuction is an option too that can be discussed.

  • When can I wear an underwired bra?

Usually from 6-weeks. You should avoid trying on multiple bras at this stage. Get professionally fitted and buy from that shop initially. If the underwiring is uncomfortable go back into a sports bra and get refitted in a different shop.

  • When can I lay on my stomach?

Usually at 6-weeks; before this it is uncomfortable. Some paitents will find it slightly uncomfortable even after 6-weeks.

  • It says no heavy lifting - what is classed as heavy?

Heavy is anything that is uncomfortable. In general terms lifting shopping bags that are full is what I would term "heavy". Lifting a kettle is OK. Lifting a baby is not.

It is also important to try to avoid using your arms to shuffle yourself up and down the bed, for the first 6-weeks. When you do so, you are pushing hard with your hands onto the mattress and this is forcibly contracting the pectoral muscles.

  • Will I be able to breast feed?

No. It is uncommon to be able to breast feed.

  • Will a general or local anaesthetic be used?

The operation is carried out under full general anaesthetic and this is regarded as the safest approach. Pure local anaesthesia would be too uncomfortable. "Twilight anaesthesia" carries a level of risk of losing control of the airway if the patient's level of consciousness falls and should be avoided unless there is a very specific reason to use this route. If a request is made for Mr Turton to perform a breast reduction under twilight anaesthesia, he would still insist on a consultant anaesthetist being present to maintain the patient's 100% safety. This should never be an area of compromise simply to reduce the cost of breast reduction.

  • How long is the scar tissue healing time?

Skin healing occurs in the first 14 days, but continues to mature over 6-12 months. The scars must be cared for and you should avoid touching or feeling along the scar line for the first 8-weeks. Mr Turton advises his paitents on scar care for the first 3-months to keep the scar line like a fine pencil line. Although they look dramatic at 3-weeks after surgery they soon soften and fade. The scars gradually fade over the first 12-months to a pale colour. There are special techniques that reduce scaring & this can be speeded up by using bio oil on the scar after 3-months, or a silicone gel called Dermatix (only available over the counter). The visibility dramatically reduces over 12-months. Around 5% of patients form thick red raised (sometimes itchy) scars, which are called hypertrophic scars. If this occurs it tends to be on the lower outer or lower inner aspect of the scar in the crease under the breast. This sort of scar tends to form more readily in some patients than others. If you have a history of bad scars please let Mr Turton know in advance of any surgery.

  • Where will the scars be & what will they look like?

Scarring will be around the areola, Vertically: areola to lower crease & Horizontally: in the crease under the breast. In larger reductions, to tighten the skin fold that runs up towards the armpit, it may be necessary or helpful to continue the excision in this area, resulting in a longer curving scar from the under-crease, on the outside of the breast.

  • Are there any foods that help heal scarring & skin recovery?

Vitamin C is needed for wound healing; in general most people who have a balanced healthy diet will have normal healing. Please eat sensibly.

  • What are the effects of smoking on scarring?

Wound healing is slower, and the risks of wound breakdown and necrosis very much higher. Scaring is worse. Mr Turton will insist that you stop smoking if he is to perform the surgery and this is a categorical gurantee that you must give. You must also avoid passive smoking. It impairs the microcirculation at a critical time when wound healing is most needed. Smoking when having this type of surgery is a recipee for a disaster. If you do not think you can give up smoking please do not ask for this surgery, or advice Mr Turton prior to surgery so that at the very least he can post-pone the operation.

  • What are realistic recovery times?

4-6weeks.

 

  • Is breast reduction surgery the correct surgery for me?

It may be that you suffer from many of the typical symptoms of heavy breasts such as upper back pain, neck pain, postural difficulties, bra strap pain, skin sores underneath the breasts. Or it may be that you simply feel that your breasts are out of proportion with your body and that you find it difficult to find clothing that fits. In any of these cases, breast reduction surgery could be right for you. It is essential that you discuss with your surgeon your symptoms, current size and expectations in terms of your post operative size and appearance.

 

  • How long will it take for the swelling to subside entirely

It can take six to nine months, but in most patients it has settled fully by 3-months.

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