WHY so popular?
Breast augmentation (or augmentation mammoplasty) is the medical term for breast enlargement. It is the most popular cosmetic surgery procedure that Mr Turton performs, and this is mirrored across the UK and across the world. In fact there are in excess of 10-million women who have had the procedure. The first breast enlargement was carried out in 1962!
Statistics show that 94% of women who have had implants recommend the surgery to others.
It is socially accepted, and women naturally want to maintain an optimum appearance. Breast implants have evolved significantly and are quality assured.
Over 56 years have elapsed since the first breast enlargement procedure in America. Techniques, implants and safety have all evolved and we have passed through from the 1st Generation devices of the 60s, to the 4th and 5th Generation devices of the 90’s. It is also now socially accepted to have breast enlargement and population statistics show that between 1 and 3% of women have breast enlargement now. Women naturally want to have an optimum breast shape and improve their appearance. Lacking breast shape commonly affects confidence. Getting breast shape and a good breast size might might mean creating it where that shape has never existed or restoring it if it has been lost, typically from age related changes or after having children. Some women want very natural looking breasts and others want their breasts to be a little bigger and occasionally noticeably bigger. Above all it is important that women having breast enlargement decide to do so for themselves and never because someone else wants them to. You must also have your surgery by a specialist in their field and in the safest hospital environment rather than a small clinic
Main reasons to request breast enlargement:
- Never had satisfactory breast development
- To have breasts that are in proportion with your body
- After childbirth, weight loss; loss of volume or shape with age
- In order to satisfy the desire for a fuller bustline.
In addition to positive cosmetic results, data has shown patients often receive a substantial psychological boost. It can improve body image and restore confidence.
How do I chose my implant size?
Most women ask for a natural and proportionate result, and Mr Turton will use his extensive experience to give them exactly that.
Patients may ask to be as full as they can be and achieve a natural appearing breast that is safest for their tissues in the long-term. They leave the choice of implant size under these circumstances entirely to Turton, and will accept the size of breast that he feels is safest for their tissues long-term.
This is done by using a detailed combination of your chest wall and breast measurements, assessment of your tissue characteristics, and taking into account your height, weight and body shape. It enables Mr Turton to determine what will work and what won’t.
There are hundreds of implant sizes that Mr Turton can choose from to provide you with the optimal result. Mr Turton will first determine the best base width to the implant, then the implant height (for a round implant, these dimensions are the same), followed by the thickness of the implant at it’s maximum point (this is called projection), and then the lower pole ventral curvature (LVC), and take off shape in the upper pole. This will give an optimum volume measurement in cc for your starting point. He will help you choose between textured, microtextured (nano textured) and a smooth shell, taking into account potential advantages and disadvantages. And he will recommend any changes to the cohesiveness and fill properties of the implant.
What if want to go bigger than recommended?
A small increase above optimal size can give a poor result. For example, the nipple position on the breast may look too low just by increasing the implant size by 50cc. A lot depends on your starting characteristics, your nipple position on your current breast in relation to the level of the crease under the breast and how tight your tissues are.
Can I request a specific bra size and certain cc of implant?
We cannot guarantee a specific bra size. Their is no universal way of assessing bra size, and their is no easy way of measuring it during surgery. Implants do not come in bra sizes and there is no exact formula that a specific implant translates into a specific cup size. Where you are wanting to achieve a certain outcome is best communicated by a detailed consultation and further review. We can use the Crisalix 3D simulation to guide you and you can communicate if this outcome is close to what you are looking for. However, you need to be realistic and understand that simulations are approximations and not a guarantee. Your tissue charactertistics will determine if your tissue can accommodate an implant of a certain size. Although tissue can stretch it has limits. Choosing larger implants than is optimal causes more tissue stretch and a greater likelihood of sag and needing future procedures such as mastopexy (uplift).
Going bigger than the optimum size produces more negative results on the breast tissue. If you choose to have an implant that is larger than Mr Turton feels is optimal for your tissues, you must understand that you may not have a natural appearing breast. You will need to accept the increased risk of re-operations, complications, deformities, and additional costs, time off from work and normal activities in the future that may result from selecting an implant that is larger than is ideal for your tissues. You need to remember that no implant regardless of size or shape can guarantee upper breast fullness long-term, and the larger the implant you select, the more likely stretch of the lower breast envelope which will allow loss of upper fullness.
What does it cost?
- The average total cost is £4620
- If you require breast enlargement and a breast uplift the cost is higher, usually £6900 to £7500
- Breast implant exchange costs around £5200 with conventional implants and £7100 with Blite implants
- The predominant variability in cost relates to the type of implants and additional surgery
- As of September 2017 at the Leeds Nuffield the fixed price cost for Breast Enlargement with BLite implants was between £5340 and £5828. The cost is higher than for breast enlargement with conventional silicone implants as these light weight implants (30% lighter on average) are a premium product and they cost us more. For example the largest anatomical BLite implants cost our hospital £1200 for just one implant.
- Beware of low cost set ups in the UK. In a competitive market, achieving cheaper surgery usually means a compromise in quality of surgeon, quality of facility or quality of your implant- it is not worth it! Beware the false or misleading advertising promising lifetime implants- these do not exist- no implant is guaranteed to last for life.
Which is the best implant manufacturer?
There are many things to take into account when choosing a specific implant manufacturer and Mr Turton would suggest you allow him to help you choose.
All of the implants that Mr Turton uses are CE approved (the European regulation) or FDA approved (the American regulation).
BLite: CE approved BLite implants are up to 30% lighter than traditional implants. They provide natural fullness with less weight, reducing gravitational stress on the breast. This implant costs more but if you are a very active person or are more concerned about gravitational sag then this might be a better option. Choice between microtextured and smooth, anatomical and round.
Allergan: FDA approved and extensively studied. Choice between macro textured, microtextured and smooth, anatomical and round. Established implant type, good quality assurance. Smooth round implants combined with the sub-muscular approach very popular in America and a common choice in my patients in the UK. Consideration needed if choosing the macro textured type these days as rare risk of BIA-ALCL thought to be higher.
Mentor: FDA approved and extensively studied. Established implant type, good quality assurance. Choice between micro textured (Siltex) and smooth, anatomical and round.
Sebbin: CE approved. Choice between microtextured and smooth. A smaller company but established for many years in France and recently made available in the UK.
Polytech micro polyurethane coated: CE approved. The MPU coating sticks firmly where it is placed. Some evidence of a lower capsular contraction rate, but needs careful consideration when using as pros and cons. Rare risk of BIA-ALCL thought to be higher.
What is the Implant Guarantee?
Whichever manufacture you choose, you will find there is a broadly similar manufacturer’s guarantee. This may state ‘a lifetime guarantee against implant rupture’ – this does not mean the implant will not rupture! It also does not mean the manufacturer will pay for your surgery if they rupture, as they will not! The guarantee should be caefully read as it relates to each manufacturer to understand it. The manufacturer’s implant warranty for the main implants used in the UK, usually means that in the event that your implant ruptures the manufacturer will provide you with a replacement ‘implant’- the cost of purchasing that implant might then be deducted from the cost the hospital charges you for the operation. It is a small saving. Some manufacturers also reimburse around €1000 towards the cost of the surgery if the rupture has occurred within the first 10-years. Hospitals such as the Nuffield Health Leeds also offer a more robust ‘patient promise’ on aftercare, but even then surgical costs are met by the patient. Fixed price packages for surgery at the Nuffiled Health Leeds provide a very comprehensive package so that if you have any significant complications within a year of surgery you do not have to pay for outpatient reviews or further surgery.
Is implant surgery safe?
Breast augmentation is a relatively safe operation in the hands of an experienced specialist but is never risk free, and so it must be carried out to exceptional standards and with patient safety as paramount. Your surgeon needs to spend plenty of time with you at a consultation. Be particularly weary of places that are run by nurses suggesting your choice of implants, that are often underpinned by dubious marketing practices. There are lots of potential risks from having breast implants and these should be minimised by staying under the care of the best specialists for Breast Enlargement Surgery.
The hospital environment may present a glossy waiting room, but what is it really like behind the scenes? The Care Quality Commission (CQC) is the national body that checks hospitals. The Leeds Nuffield Hospital where Mr Turton holds his specialist clinics and surgery is rated as OUTSTANDING by the regulator. It is one of only six private hospitals to achieve such a high rating. He also works at Spire Hospital Leeds, and this was also highly rated achieving GOOD overall. Check your hospital’s rating
Is silicone safe?
- Breast Augmentation with silicone implants has been performed for over 55-years
- Silicone implants’ manufacturing and quality checks have evolved during this time frame
- The safety of silicone breast implants is established and is published as an independent review. There have actually been 4 such independent reviews and they essentially reached the same conclusions.
- No obvious increase in breast cancer or autoimmune disorders
- Rare association of some textured devices to a very rare type of localised lymphoma (ALCL)
How long do implants last?
Mr Turton advises that you should consider and plan for replacement by 10-yrs. Many places and even manufacturers give rupture rates that are not scientifically based and lack validity. The most reliable data came from compulsory 10-year studies and only a few manufacturers undertook these. There is therefore no reliable data to say one manufacturer is better than another, and it it is wise to refer to the robust data from the FDA submission for McGhan and Mentor implants.
Symptomatic rupture is now rare (<5% at 10-yrs) but increases with time. If a cohesive implant ruptures the gel doesn’t “run” initially. The gel in a good quality implant has a consistency like a jelly that has just come out of the fridge. You can push your finger into it and withdraw it slowly with the silicone staying together in the implant. The outer layer of the implant is the strong elasticated shell that holds the silicone gel. This outer shell is made from several layers of a stronger denser silicone that resists stretch and pressure. If it breaks or splits, silicone doesn’t usually immediately escape. In fact it rarely does so and you may have no idea as you would not normally have any symptoms early on. You also have another line of defence – your body forms a strong but thin tissue layer around your implant within a few weeks of surgery – this is called the capsule. It is like a membrane and is an important structure as even with a silent rupture it serves as a further protective layer between your implant and the breast tissue.
Even with no symptoms, and a normal clinical examination, silent ruptures may be detected in about 10% of patients on MRI at 10-years. This was shown in the original FDA data submitted by the manufactures McGhan and Mentor when they applied for the rigorous process of regulatory approval in America. It is robust data and serves as the best guide to current implant behaviour. Having an exchange at the 10-year mark is therefore a good safe practice to follow because of this, even thought the implant manufactures state the lifespan of their implants is 10-20 years, and even though the implant manufactures offer a lifetime guarantee in case of rupture. The guarantee provides a new implant and not the full cost of your revision surgery. Some manufactures now claim rupture rates of <1% at 9 years but the data on which this is based is different to the FDA data that used MRI studies! The patients could have silent ruptures.
If a silent rupture goes on to get worse, the gel in the implant may partially fragment and become more liquid with time; this might cause symptoms of inflammation (might cause discomfort), capsule contraction (the breast implant feels harder, the breast shape may become distorted, the breast may ache), or silicone leakage into the breast tissue, lymph nodes or into the organs in the body. Any changes should always be investigated urgently by a breast specialist. It is harder and more expensive to revise implants once complications occur and cosmetic results may not be as good.
How long does the operation take?
Breast augmentation is a low risk surgical procedure if done with the right specialist surgeon and in the right hospital. It will usually take around 50-60 minutes and is done under a general anaesthetic. Mr Turton will always schedule you for an overnight stay when you are under his care, for your safety and comfort, and this has remained the preference of his patients for over 14-years.
Is it painful?
Mr Turton injects a long-acting local anaesthetic into the deep tissue before the implant is placed and the incision closed, so when you wake up the breast area often just feels tight straight after surgery. Usually a paracetamol and ibuprofen combination is then all that is required.
We conduct a full preassessment in advance of surgery to that on the day everything is relaxed and un-rushed. You are told when to arrive at the hospital and will have been instructed when to fast from (no food or drink after this time please). We allow a good amount of time to settle you into your own private room. Most patients will relax and watch a film or use the complimentary wifi. You can of course bring a friend or your partner. You will have a further check from our nursing team to ensure you are well on the day. You are always seen in person by Mr Turton and the breast care nurse. A series of photographs are taken and your will have markings drawn on your breasts which serve as guidance during the operation. The option for incision will usually have been made in clinic. Although it is possible to use the areola or under-arm area the optimum place to reduce complications is in the crease just under your breast .
When can I drive?
- Individual advice varies
- From 4-days to 2-weeks
When can I return to work?
- Usually after 1-week, but avoid lifting please
How do I decide on the size of the implants?
- The average breast size in the UK is a “B” cup
- Most patients desire to be a “C” or “C-D” cup
- Bring pictures with you, & review your surgeon’s album
- Listen to your Mr Turton’s advice about your optimum size implants based on his expertise, very thorough assessment of your tissue characteristics and starting point
- Take advantage of Mr Turton’s 3D Crisalix simulation of your before and after results
- Asking for a natural shape and proportionate augmentation is common and advised
- There are specific cosmetic techniques that can be used to give you a proportionate result
- If you have a lot of breast sag (nipples close to the lower breast fold or below), implants on their own do not give a nice result. If one breast has more sag than another you will still notice differences after implant surgery, unless you have a mastopexy (uplift) to correct it. The degree of difference you have prior to surgery is therefore important to understand. Patients with a lot of breast sag (ptosis) may require a mastopexy (uplift) at the same time (mastopexy-augmentation) or if it is severe, doing the mastopexy first, waiting four months then having the augmentation. Some patients may have an augmentation and then decide on a mastopexy to improve the nipple position at a later date. Read my section on mastopexy-augmentation in the Uplift Information Sheet.
To see anonymous pre and post operative photos of patients who have had Breast Augmentation Surgery performed by Mr Turton in his Cosmetic Breast Surgery Leeds practice, please review the images section.
Risks and complications
As with any surgery there are associated risks. In general the sort of complications we see are minor swelling, and dull aches during the first week. Bruising is usually very minor or not at all. You can get loss of nipple sensation, although this usually recovers in a few months. Redness around the scar usually settles naturally with scar maturation.
There are some uncommon risks for example haematoma, seroma, and infection which on occasion may require further surgical intervention. You are monitored closely after surgery and have our contact number after discharge if you require assistance after discharge form the hospital. Our hospital remains open 24-hrs per day and 365 days per year.
Extremely rare complications include ALCL a rare type of lymphoma in the tissue capsule around the implant. Mr Turton has not seen any of his patients have this problem in over 13-years or practice and he takes specific precautions. Please read Mr Turton’s Augmentation Information Sheet thoroughly. Further detailed information provided by Allergan is very useful to read and can be found here.