• How will I feel after Breast Augmentation Surgery?

The vast majority of Mr Turton’s patients feel relaxed and comfortable immediately after surgery. It is common to wake up with a dry feeling in your mouth. You will feel usually have a very nice sleepy feeling initially. Some women will feel feel nausea but that will usually pass within a few hours. Sometimes you may also feel quite emotional during the first day after surgery, although it is not common it is a fairly normal side-effect of the anaesthetic drugs. You normally still feel sleepy when you are back on the ward for the first 4-hours, but if you do fall asleep you are easily woken up a this stage and will commonly be aware as the nursing team are in and out doing their routine observations or the hospitality team are offering snacks and meals.

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 anti-inflammatory tablets for pain relief if you have no sensitivities or allergies to these products. If you have had sub-muscular implants you will sometimes need to have a stronger pain killer as well, such as Tramadol. If you need the stronger pain relief then it 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 before then end of 1-week. The anti-inflammatory and Paracetamol combination is very effective and the majority of patients just manage with this and nothing stronger at all. They can be continued for a few weeks if required and can be use according to how you feel. They should not be taken on an empty stomach. Sometimes it is easier to take the anti-inflammatory if you also take Lansoprazole to reduce stomach acidity, as the anti-inflammatories make the stomach lining sensitive to acid and it could in rare situations even cause an ulcer or even bleeding if you are sensitive and keep using them.

• One breast feels more sore than the other, should I be worried?

It is quite common for one breast to be a bit more tender, or to swell slightly more than the other side. Similarly, one breast will often recover more quickly in the weeks that follow and this is quite normal too. There are always differences between the two breasts, which is a reflection of the pre-operrtaive differences that were there too. Sometimes swelling is also subtly different between the two sides during the first few weeks. It is very common that the tissue in the breast is also sometimes tighter on one side than the other (there can be different proportions of the more dense gland or tighter fibrous tissue between sides) so that when implants are placed it causes more discomfort on that tighter side. These changes in the feel usually resolve over a number of weeks although if you have had a lot of differences it can take longer.

 Some patients do not like Tramadol (may feel too lightheaded, 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 or actually vomit in the early post-operative period, 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. Anti sickness drugs will be used if you have a tendency to sickness.

• What happens after the operation?

When the surgery is completely finished, and the dressings have been applied, the anaesthetic will be discontinued and the anaesthetist will allow you to gradually wake up over about 5-10 minutes. You will normally gradually become aware again once you are around in the post-operative 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 visit 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 feel 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 underarm 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 particularly 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.

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

During the first 3-weeks, the breasts tend to feel quite tight and swollen. This is more typical when the breast enlargement has been done in women who have never had children and whose breasts are quite small and flat. In these women the breasts generally feel firm even once all the swelling has resolved, as the implants are relatively firm and also under tight tissue. When implants are placed for breast augmentation to fill an empty breast the tight feeling is less common and settling is quicker. Depending on how loose the breast tissue was before surgery, will also affect how the breasts feel. Similarly, when lying on your back without a bra, the degree of looseness before surgery will affect how the breasts fall to the side (often more on one side than another) after surgery. It is also important to remember that every patient is different, and the way your breasts have developed anatomically is often a little different- some patients have wide gaps between their breasts and others have a very narrow gap, and these starting points are not changed by the implants. It is very important to not have expectations for changes that simply cannot be changed even with the best breast implants and the best cosmetic breast surgeon!

• Are there any worrying signs that I need to look out for?

Although this would be very rare, the gradual appearance of an obvious discrepancy in size from how it was when you left hospital would not be normal and should be assessed back at the hospital. If this is caused by bleeding around the implant, the breast would become enlarged and firm and feel very painful, and this is termed a delayed haematoma. It is uncommon for this to occur after you have left hospital, but if you suddenly strain the pectoral muscle with a forceful or brisk arm movement it can occur even the first week after surgery, so please follow the instructions given carefully otherwise a haematoma would need to be removed back in the theatre!

An acute deep infection around the implant is also very rare. Although it has never happened to any of Mr Turton’s patients having breast augmentation, we know cases are reported in the UK each year with the ‘at risk’ period typically being the first few weeks after surgery. It is important to avoid this as it can cause serious sepsis requiring implant removal and emergency treatment. Signs that this has occurred include: feeling very unwell (like bad flu), fever, rigors, a high temperature, skin over the breast swells and is reddened and tender you must have an assessment in hospital. Changes like these would be very unusual indeed, but it is important to know that should they occur, a prompt review is always mandatory to assess the cause and treat it.

• 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 you will. Please check with Mr Turton in relation to what exactly you do. Generally, 1-week off is the minimum. 2-weeks or more may be needed if your job involves lifting or any heavier manual work. If very sedentary, you may occasionally work from home (if this is possible in your line of work) after 4-days, but remember that you may still be taking Paracetamol and anti-inflammatories. You must have stopped the Tramadol if returning to work or driving.

• When can I lift my arms above my head?

After 2-weeks usually, unless Mr Turton advises otherwise. After sub-muscular implants there are specific stretches that you can do as part of the expedited recovery programme but not usually earlier than 2-weeks.

• 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. These repetitive tasks can cause issues if they are started again too quickly. I advise against vacuuming and ironing for the first 3-4 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 especially if you have an anatomical implant. If you don’t have anatomical implants, you can resume chores more readily.

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

You can go out to a restaurant a few days after surgery if you feel well. You should avoid heavy meals and not have more than a glass of wine or champagne in the first week. You will tend to feel bloated for a few days and you prefer to stick to light meals until the bowels are working again. Morphine is a drug that is given during the anaesthetic and a normal side effect is to cause the bloating feeling in the tummy, and to cause constipation (just from one single dose). So I recommend that you take a laxative for a few days when you got home to tackle this before it becomes a bigger problem. Despite this, some of Mr Turton’s patients go out to a restaurant the very next day!

• When is it possible to resume shopping?

You could go shopping a few days after surgery if you feel well and are being driven around, doors are being opened for you etc. But you should not carry shopping bags for 3-weeks. I would advise against bra shopping until 6-weeks as this is when implant settling would tend to have occurred.

• When is it possible to resume sporting activities or do home decorating?

Strenuous activities generally take 6-weeks before we allow you to start doing them. Patients who are very regular gym users and have regular routines are usually very keen to start back with some exercise and Mr Turton will give specific advise as to what you can and can’t do. For example, if your wounds are healing well and you have made good progress, we can advise on exercises and toning that can start earlier than 6-weeks.

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

If you have had implants placed under the muscle it takes longer to be able to lift again. In general we find lifting small children can be very awkward until over 2 weeks have elapsed and it is advisable 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.

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

Heavy is anything that is uncomfortable. In general, 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.

• How long does the scar under the breast take to heal?

The site of the incision on the breast skin, usually in the crease under the breast heals rapidly and should look clean and intact as soon as 7 days after surgery. But the scar needs to develop strength, and there are also sutures under the skin in the fat and fascial layer. It will feel slightly thickened and slightly raised from the stitches under the skin. These only slowly dissolve and so only after this has occurred will the scar mature, which takes place 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 consider using surgical tape or Dermatix gel to the scar for 3-months, which often helps to keep the scar line like a fine pencil line. The scars gradually fade over the first 12-months to a pale colour. Some patients use bio oil on the scar anyway, but if you can afford the slightly more expensive silicone gel called Dermatix (only available over the counter), I feel this works better.

• When can I wear an underwired bra?

Usually from 6-weeks. You should avoid trying on multiple bras too early though! 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. It is also important not to get het up over bra cup-size! This is a variable measure between bra manufacturers and there is no exact correlation with bra cup size and the volume of your breast implant!

• When can I lay on my stomach?

It is better not to lay on your stomach as it puts pressure on the implants and over time stretches the implant pocket. It is possible to lie on the stomach area usually by 6-weeks; before this it is uncomfortable and must not be done. It is therefore important not to sleep on your front though and if you used to do this, try to train yourself to sleep on your back- the large V-shape allows can be very helpful here. Implant malposition is more common in front sleepers too.

• 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.

• Is it okay to sunbathe after the operation?

Not initially! I would advise against it for the first 6-weeks. After this, yes, but you should use factor 50 + suntan lotion on the breasts and scar line. Keep scars completely covered by clothes. Remember that you can get a sunburn through the thin cotton. If the scar does get exposed to UV light and sun, it can cause a permanent redness.

• Will I be able to breastfeed 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 breastfeed. 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 breastfeed 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. Be aware that mastitis during pregnancy or breast feeding can trigger capsular contraction around the implant, and it is more commonly seen in the year that follows breast feeding. Also pregnancy changes the breasts and may make them feel more empty again. It is better not to have breast implants if you know you are likely to have a baby in the next few years.

• 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.

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

It is very uncommon for patients to be unhappy about their size, but it does occur occasionally, usually someone expecting to be bigger, fuller, or to have a narrower cleavage. Often there is a reason why you haven’t had bigger implants placed- i.e. your tissue characteristics are too tight, the nipple would look too low, it would increase the risk of complications such as malposition or pain, there may be no ability to narrow the cleavage as this are is a bony structure and you had a wider gap, or that you were wanting to avoid  implants that were too noticeable and you under-stated your desires. The best thing is to accept your result and grow to like it. Rushing for a further operation is never the answer, and redo surgery for a different size implant always has to be paid for in full by the patient, which equates to the same costs all over again. And if you were to do this, who is to know that you would be happy? The actual size and shape that you desire is called a ‘subjective’ issue, and it is impossible for the surgeon to know precisely what it is you want AND to be able to guarantee you the precise outcome. The size that is put in is therefore not negotiable after surgery and sometimes what you desire is simply not achievable any way! Patients commonly have uniquely different starting points. It is imperative to remember that implants behave and look differently in one patient’s breasts compared to another patient, due to different tissue characteristics, physiological and anatomical differences and a multitude of different measurements. It is the skill of your surgeon to evaluate you and work with you to try to educate you as to what is possible before surgery. Mr Turton has an excellent track record with implant selection and implant planning, and he can also use 3D simulation which may help. But if you have any body dysmorphia issues you must be honest and discuss this before surgery. You always have to prepared that the results of implants do not meet your expectations, and accept this as one of the unfortunate potential outcomes, albeit one that is rare in our hands.

If you do subsequently desire larger implants, you should wait over a year since they were placed before considering up-sizing. It is important to avoid unnecessary surgery, but if you remain very unhappy with size and continue to wish you had gone bigger, it might be possible to do so once your tissue has had time to stretch a little. However, redo breast augmentation carries additional risks and limitations and if you have already been happy about size, it is possible you will still be unhappy after an exchange.

For all patients who have had implants in for a number of years, we always say that further surgery is required for revisions or exchanges as these are not lifetime devices and your breasts will change with time whether you like it or not. However, remember it is better not to have this done simply for larger implants, but when further surgery is required at a later date, implant size can be increased at the time of the exchange if that is desired. But the same criteria and judgments need to be applied as for the first operation, and taking into account your current tissue characteristics, whether the nipple level has drooped, and whether the breast has become redundant below the level of the implant. 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, so please be cautious.

• How long do implants last?

It depends predominantly on the type of implant used, and the manufacturer. The current generation of Allergan and Mentor implants may well last longer than previous types but there are no recent large MRI based studies that given more accurate information beyond the original post-approval FDA studies. In the biggest study performed to date, the rupture rate was extremely low (ie <5%) at 10-years but this was not MRI based. Mr Turton advises patients to be cautious- We charge just £100 for a clinical follow up appointment. Follow up ultrasounds scans cost around £300, and MRI scans cost around £800. Other procedures are more expensive. These can be done yearly if required. If you develop breast symptoms several years after breast enlargement you should always see a specialist and if you cannot afford to pay privately, you should still be referred to an NHS breast clinic by your GP for assessment.

Not many patients consider clinical check-ups, USS or MRI to assess implant integrity, almost certainly because it is expensive. If all is well, there is no need for premature implant exchange, but I generally advise patients to consider renewal at the 10-year mark as problems and risks of rupture are recognised to increase more and more after this time period. Implant renewal if there are no complications to deal with costs around £4900 in 2019. Please remember that the core FDA studies support a rupture rate of silicone breast implants to be around 10% within the first 10-years, and often these are asymptomatic (silent rupture).

There are many implants available to use for augmentation, and they do not have the same quality, safety, quality assurance, or longevity. Some of 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.

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

The outer multi-layered shell of the Allergan and Mentor implants 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. 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 n the early years after breast enlargement, but when implants are old it is possible, For example, the modern implants that Mr Turton uses are extremely durable when they are first placed, but they loose strength over many years so by 10-years for example around 10% of implants will have ruptured, even if there are no signs present, reflecting increased fragility with time. Take more care as your implants get older, and my advise is to get them replaced by 10-years.

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

Yes. Implants are usually easy to remove, even under a local anaesthetic in some situations 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 if they have been in for many years 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 reposition the nipple better and remove some of the sag.