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Popular Breast Procedures Explained

By Consultant Plastic & Reconstructive Surgeon, Simon Mackey


Breasts change throughout a woman’s lifetime. They enlarge at puberty, during pregnancy and with weight-gain, but can become empty and more ptotic (droopy) after breast-feeding, with significant weight-loss, and due to the effects of ageing and gravity. In the following article, Consultant Plastic and Reconstructive Surgeon Mr Simon Mackey provides an overview of the most commonly requested cosmetic breast surgery operations.

Breast implant surgery – also called breast augmentation or enlargement – is the most common type of cosmetic surgery carried out in the UK. It's estimated more than 30,000 such procedures are carried out here every year.

Breast implants have a long and proven safety record and are manufactured in a vast array of different shapes, sizes and volumes. The most commonly used implants world-wide are silicone breast implants. The outer-layer, or shell of a modern implant is textured to try and prevent the formation of “capsule”, and the silicone gel within the implants is cohesive, so will not run even if the implant is cut in half. The implants with the most safety data are a little more expensive than the cheapest possible implants, but safety is recommended over cost.

Selecting the correct implants for you is key to getting the best outcome from breast enlargement. The shape, feel, style and size of the implants have to be right for your body. Implants are most commonly inserted through a scar in the fold beneath each breast, but other techniques are available. Implants can be positioned beneath the breast tissue alone, or beneath the pectoralis muscles, and there are advantages and disadvantages to each implant position. It is important that you are able to work closely with your surgeon to tailor the best possible plan for your needs. It is also important that you realise there is a significant chance that you will require revision surgery throughout your life-time to maintain the best possible results following breast augmentation. Some women choose to change their initial size, or may need additional surgery due to breast changes resulting from ageing, pregnancy, and weight fluctuations. Additionally, a breast implant may rupture or become hardened (capsule), necessitating removal or replacement.

Breast reduction can improve posture or comfort, and improve symptoms of musculoskeletal pain such as neck, shoulder or back-ache. For some ladies, reducing breast size can also improve mobility and make it easier to buy clothing. A number of different scar patterns can be used to perform a breast reduction such as “vertical-scar” or “Wise-pattern” techniques – there are advantages and disadvantages to each of these, and some techniques are more appropriate for you than others depending on factors such as breast-size or skin elasticity. It is sometimes possible to reduce breasts using liposuction alone. Normally, however, it is necessary to remove some excess skin, and it is also desirable to lift the nipple position, so a formal breast reduction is required. It is impossible to guarantee a particular breast size following this surgery. Most women find that their breasts are asymmetrical by up to a cup-size. Where both breasts would ideally be reduced, these asymmetries can be corrected using breast reduction.

Breast-lift or mastopexy, raises the position of the nipple on the chest wall without reducing breast size. This is achieved by tightening the skin of the breast through a variety of scar patterns. This alone can make the breasts appear “fuller” and more youthful. Mastopexy can be combined with breast enlargement in a procedure known as augmentation-mastopexy. This is one of the most challenging cosmetic breast surgery operations, and needs to be planned and performed carefully to obtain the best possible result. Peri-areolar, vertical-scar and wise-pattern techniques are available.

Inverted nipples can sometimes be corrected using non-surgical techniques. Frequently, however, a minor operation is required to reverse inversion. This can be performed under a local anaesthetic.

Breast asymmetry can be improved using a combination of the procedures outlined above. Asymmetry may result from abnormal development of the breasts, or result from the treatment of breast disease.

Even after an operation, the breasts will continue to change, and further surgery may be required through your lifetime in order to maintain the best results. Before committing to this type of surgery, you should ensure that you have fully understood its limitations and acted to minimise potential complications. Mr Mackey strongly advises you to stop smoking before any cosmetic surgery as this can increase complication rates and adversely affect the results of surgery. Certain nutritional supplements, and anticoagulant medication and blood thinners (such as aspirin) all increase the risk of bleeding and should be stopped prior to surgery unless otherwise instructed.

Please check that your surgeon is on the GMC’s specialist register for Plastic surgery and a full member of BAAPS, and BAPRAS. This ensures your surgeon is adequately trained, safe, and provides high-quality and modern treatment.

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