The decision to have breast implants is not a minor one. The first consultation about breast augmentation can take up to an hour. A second consultation may be necessary.
Implant position: The pocket created to contain the implant is always completely behind the breast but its upper part can additionally be behind the pectoral muscle. While the latter option is anatomically incorrect, it is often the best option if you are slim as it camouflages the upper edge of the implant.
Site of incision: My practice is confined to making the incision in the groove beneath the breast (about 6cm long). Other possibilities are around the areola and in the armpit, neither of which I have ever used.
Implant surface: Textured or smooth. Since the discovery of the rare condition Anaplastic Large Cell Lymphoma (ALCL) has been associated almost exclusively with textured implants I use only smooth surfaced implants for breast augmentation.
Breast position: If your breasts have drooped so that the nipples are below the level of the groove beneath the breast then breast augmentation without a breast lift (mastopexy) is unlikely to be satisfactory.
Post operative care
I don’t usually use drains after a breast augmentation operation but I like you to stay overnight in hospital.
The whole of your breasts will be taped with paper tape. You can shower immediately with the tape on.
If the implant pockets are not under the pectoral muscle you will have considerably less pain than if they are.
If they are submuscular it will hurt to move your arms for a few days and you are likely to need 7-14 days off work depending on the nature of your work.
I like to check you at 3 to 4 days and remove the tapes, leaving just a small tape on the incisions. You can wear a stretch bra at that stage.
Check again at 2 weeks. Stitches are buried and absorbable – nothing to remove.
Since the nipple always has to be re-sited higher up, all breast reductions methods result in a scar right around the areola and a scar vertically down from there to the inframammary fold (groove beneath the breast). Usually there is also a curved transverse scar running the length of the inframammary fold. There are “vertical scar” techniques which seek to avoid this transverse scar and this is sometimes appropriate.
Loss of nipple sensation is not uncommon. Numbness of some skin beneath the nipple is usual.
You may not be able to breastfeed should you have a pregnancy after breast reduction.
The nipple has to move up and retain its blood supply. it is possible for this blood supply to be inadequate and to lose part or all of a nipple but this is an exceedingly rare complication.
Symmetry should be very good but may not be perfect.
out of town?
Ideally a consultation should be face to face but is certainly possible to arrange a telephone consultation. If you can email the photos first so much the better. If it is clear what procedure is required then the in-person consultation can be the day before or the morning of the surgery.