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 desires. We have a choice of most manufacture’s implants. We commonly use implants from the manufacturer’s Allergan, Mentor and Blite. We may recommend implants in round or tear drop style according to what we are trying to achieve, and taking into account your desires, limitations, tissue characteristics, and other factors. With many choices of natural moderate, moderate plus, full, extra full, round and tear-drop style anatomical implants Mr. Turton has reasonable flexibility for a near custom size implant, based on your frame and current breast measurements if you want Mr Turton to decide.
If you ask for a size that is 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 unnatural 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. It is sometimes not predictable pre-operatively. Very tight tissues might not accommodate the size of the implant you truly desire, or for the shape to form in the way expected. Sometimes tissue stretches in the months and 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 additional cost of combining procedures or having the mastopexy (uplift) at a later date.
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 breast 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 of 1 – 1.5 hours is typical for primary 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. It is more likely that you need to wait until 2-weeks post-op before driving if the implants are placed behind the muscle. 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. If you have a baby, please be aware that you will not be able to lift him/her out of the car seat during the first 2-weeks after surgery (the same applies to a cot).
When can I return to work?
Usually after 1-week, if not doing any lifting. Some patients return after less time, ie 4-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 situations, 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 to heal around the implant surface. Too much early movement with an anatomical implant will result in a rotation or malposition. Different implant manufacturers have different types of texturing, which has an influence on Mr Turton’s advise and choice of breast implants. The Biocell macrotextured Allergan implants and the MPU_coated Silimed or Polytech implants cause adherence to the tissue, reducing movement, but have a higher risk of rare complications such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL), a very serious condition. As of 2018, we know enough about the frequency of BIA-ALCL with different textures to suggest avoiding these heavily tectured varieties. Instead, you can consider the less textured implants which do not adhere and the risk of BIA-ALCL is around 1 in 30,000, or the smooth round implants where no definite cases have occurred in primary augmentation!.
In addition, excess movement early on (first 6-weeks) will prevent settling and encourage a seroma to form (this is like blister fluid/plasma). 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 or spin classes!)
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 £750) any time from 3-years onwards, and in the USA practice they recommend this is done every 2-years, although few patients do this in the UK unless there is a specific problem. Mammography and USS (cost approximately £180-280 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.
Download The Information Sheet for Breast Augmentation: