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 mastopexy, 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 uplift and whether you might consider breast augmentation too (same time, or later) can be discussed. Mr Turton will want to let you know about your best options and if there are any alternatives and the potential complications. He will let you know about the limitations of surgery, short and long term breast changes, the need for future surgery, mammography and follow-up and cost estimates. Please look at his Breast Uplift Information sheet and read it completely prior to the consultation.
Will my breasts be smaller after breast uplift?
A breast uplift can be done without removing any breast tissue. A full breast uplift therefore makes use of all of your own tissue to reshape and bring the dropped breast back into its correct position. The skin envelope of a drooped breast is made smaller by cutting away the excess skin, and the contents (your breast tissue) is then more tightly packed into this reduced envelope giving you the nice shape. This more compact breast will probably be smaller size in your bra. The overall size after surgery depends on how much breast tissue you have to start with. Some women have too much breast tissue and actually need (and request) a degree of breast reduction with the uplift. For others, the breasts would be too small and subsequent (two stage) or simultaneous (one-stage) breast augmentation to supplement your volume with silicone implants is requested
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 on the day (If you are unwell or have developed a chest infection since your pre-assessment check, your operation would obviously be cancelled and rescheduled). When Mr Turton is ready for you in the theatre, your nurse will accompany you from the ward to the operating theatre reception for your first check-in, and then on to the anaesthetic room where your anaesthetist will commence your anaesthetic- you will drift off to sleep in about 5 seconds when they are ready to do so and you will be told before hand! Your will be under full anaesthesia for the full duration of the operation. Mr Turton will additionally use the longer lasting type of local anaesthesia into your breast tissues to provides additional comfort on wakening for around 8-hrs. 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 soft 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- the flowtrons (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 1.5-2.5 hours is typical for primary breast mastopexy. 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 yourself or do anything too physical. It is better to keep elbows in to the sides of your body at all times- if you reach up bringing your elbow away form your sides it stretches the breast tissue under the skin. If you also have implants placed , 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 very slowly and very gently if you need to. It usually feels more sore for a few more weeks with sub-pectoral positioning of implants and mastopexy, but sometimes only a few weeks with mastopexy alone.
When can I drive?
Individual advice varies: From 1-2-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 advice if you are uncertain.
When can I return to work?
Usually after 2-weeks. Some patients return after less time, ie 7-days, but any 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 whether I need implants?
If you have empty breasts but without significant droop (usually a hollowed flat appearance in the upper breast, but the nipple is still well above the level of the crease under the breast) you probably just need breast implants to fill out the shape again and don’t need a mastopexy. Ask for Mr Turton’s professional opinion.
If you have very marked droop and you want to get more fullness than a mastopexy can provide, it is better not to have implants at the time of the mastopexy, but wait for around 4-months and then have a second operation to have implants placed.
If you have minor droop you could have implants at the time of the mastopexy, although the risks are a little higher for all complications. If you have a lot of breast tissue, you may not feel the need to have implants at all (many don’t) and this is the better option for you in the long run.
Discuss this with Mr Turton at your consultation.
The costs of each operation need to be taken into account.
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 part of Mr Turton’s practice, and will enable you to go home more quickly surgery. You will be reviewed by Mr Turton the morning after surgery and only released when ready. This is normally always by late afternoon.
Can intimacy be resumed immediately after the operation?
For your comfort, Mr Turton advises waiting a minimum of three 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 8-weeks and should be very gentle after this too. In the long term, it is preferable 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 mastopexy?
You can return to all of your normal sporty activities. The only impact is when you are having implants placed as well- if this is the case please restrict your physical activities for a minimum of 6-weeks and taper back over a 3-month period.
Will I be able to fly after the operation?
Yes. UK domestic flights can be taken within 7-days. International flights are best avoided for 6 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 surgery or implants if placed!).
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 if you have implants, if makes them feel deflated and you may notice rippling. Losing excess weight makes your breasts more empty at the top of the breast, and if you haven’t had implants it might be something you desire to fill out the breast again.
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 any implant’s weight and size (if placed). 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. If you do have implants after mastopexy, 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.
Is surgery guaranteed for any length of time?
Acute problems after surgery are covered by your “fixed price package”. This includes typically having to go back to theatre to evacuate a haematoma, or having to come back to clinic to check wounds and wound healing.
Longer term problems after mastopexy are usually defined as those that occur after a 6-month period form your surgery and the hospital would not usually provide ongoing free consultations or treatment beyond this date. If you form a breast lump for example, it is very unlikely it would be related to your surgery. If you have private medical insurance you may be covered to attend Mr Turton’s private breast clinic. If you don’t have insurance you can self fund consultations and investigations, other wise you should go through your GP to get referred to the NHS breast clinic for review.
If something goes wrong during/after an operation is surgery guaranteed & will problems be resolved within cost?
Complications from breast mastopexy surgery under Mr Turton are very rare (<2% occurrence). He will be unable to give you a categorical guarantee that they won’t occur, but he is an experienced surgeon and manages 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, which is termed a haematoma. As this forms 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 infection can occur. This would likely result in needing antibiotics. If you have an implant when you have mastopexy the risk of complications is higher and 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 like: rippling, palpability, breast sag, capsulation, rupture of implants, 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 concerned about “body dysmorphia” please mention this, and similarly 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 and Mr Turton doe not charge for your consultations during this time. Subsequent follow-ups will always incur a standard follow-up fee (cost approximately £100; please check with Mr Turton’s secretary), which will be collected at the consultation on your card (please always bring this with you to avoid additional charges). You will not generally require further follow-up. Some patients desire check ups in the future and this is not covered by medical insurance if you are free of symptoms and have not been referred. It therefore costs £100 per consultation. Any investigations such as mammograms and ultrasound scans are considerably more and are levied by the hospital per test, eg mammogram and ultrasounds cost around £550, and biopsies cost over £1200).
Will breast mastopexy change my life?
Breast mastopexy may make you feel more confident within yourself but will not change things if you are dissatisfied with your lifestyle or your body in general. 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 if it is not frequent. In the long term, however, breast tissue will be more susceptible to droop if you do not wear a bra most of the time.
Will my scars fade?
The scars mature over a 1-2 year period. They tend to feel slightly thick and firm, slightly lumpy in places and look more obvious being quite red in the early period. But the scar will mature, and the suture material will be reabsorbed. Some sutures are designed not to being to break down for the first 3-months and so scar maturation takes longer, usually 18-months. We use the optimum techniques in designing and managing your scars but scars are permanently visible even after full maturation. A small proportion of people, around 5% get thicker raised scars (hypertrophic).