• 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-inflammatory 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 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 these 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 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 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 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.

  • 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 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 stop implant settling and tissue in-growth onto 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 advise 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 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.

  • 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. Remember that you can get a sunburn through the thin cotton. If the scar does get the sun, 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, 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 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.

  • 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 around 10% within the first 10-years, and often these are asymptomatic.

There are many implants available to use for augmentation, and they 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 reposition the nipple better and remove some of the sags.

  • 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).