BREAST AUGMENTATION

the facts…………………..

Your Consultation

Cosmetic surgery patients can safely be split into two groups.  Those born with, or who as they grow, develop features they do not like.  For example: a large nose, large breasts or even undeveloped breasts, protruding ears, or indeed, any feature that may make them unhappy.  Then there are those who are unwilling, or unable to come to terms with the effects of ageing, pregnancy or trauma.  Both groups may be unhappy to the detriment of their self-esteem.

Today in the United Kingdom, there can be few unaware of the benefits of cosmetic surgery and many consider it to be the “ultimate voyage of self improvement”.  However, good cosmetic surgery is not an accident, or a miracle, it has to be planned.

Planning starts with your consultation…..

Consultations should only be given by one person, a highly experienced surgeon who is the only one capable of determining whether you are a suitable candidate for the surgery that you are asking for.  Counsellors, lay or nursing, irrespective of their experience are not licensed to operate and although they may assist with simple explanations, you should not allow yourself to be placed in a situation where they advise surgery.  Most lay counsellor’s work on a commission basis and it is therefore unlikely that your best interests will figure prominently in their thinking.

At the consultation you will not find lay counsellors.  All consultations are carried out by highly trained Surgeons.

The patient prepared to accept advice from an unqualified source should not be too surprised if the standard of surgery reflects this fact.  Competent professionals will not be found associating with this type of organisation.  It may be wise to bear this in mind.

No substitute exists for a Pre-Operative Consultation.  It may be inconvenient; you may feel it unnecessary believing that you know what you want.  The truth is different.  Consultation is an integral part of any treatment you may have carried out.  It cannot be bypassed.

 We do not charge for Consultations.  A very high degree of knowledge and skill is required for a well-balanced opinion about the necessity for the operation in which you may be interested.  You must appreciate that even when the advice is not in favour of surgery, it comes from a highly qualified person who has given his time, attention and experience to your problem, consulting, both pre and post-operatively accounts for over 50 per cent of a surgeons time and good ones do not give this time away.  Neither will they tell you that you need surgery when you don’t.  Surgeons build reputation not only by the work they carry out, but the work they decline.

The Consultation is free of charge, but if you do not attend then a fee becomes payable.

Appointments for consultation may be arranged by telephoning the Patient Information Service.

Do’s & Don’ts

Considering cosmetic surgery?  The following simple rules should ensure that you end up looking better, not worse………..

• Avoid any organisation where “counsellors” are employed.  The only person qualified to advise you on your surgical requirements is the surgeon who is to carry out your surgery.  Nurse counsellors should also be avoided.  They have no training, which makes their advice of no use to you.  Counsellor usually means sales, which usually means problems.

• Do nothing until such time as you have consulted a highly experienced Surgeon.  Experience without training is not much use to you.  Always insist on a highly experienced Surgeon.

• Do not accept shared, or worse still, mixed accommodation.  You need your own room and bathroom.  Good surgeons will not be found working where conditions such, as this exists.

• Ask to speak to some of your surgeon’s previous patients.  Particularly those who have undergone the same treatment in which you are interested.  All competent surgeons have patients prepared to give testament to their competence.   If you were told that this would not be ethical, it would probably be better if you found another surgeon.

• Exercise caution when offered photographs depicting patient’s pre and post operatively.  There are several things to consider here.  The first is whether or not they are the property of the person showing them to you.  All too often the same photographs keep turning up with different surgeons claiming to have carried out the operation.

The second thing to bear in mind is the simple face that these photographs will represent the very best a surgeon or organisation can produce.  They are not going to show bad photographs.  If what you are shown does not impress, you should remember that what you are looking at is probably their very best.  You may not do anywhere near as well.

• All responsible surgeons and organisations publish detailed facts with regard to the procedure in which your interests may lie.  Avoid those whose information consists of nothing more or less than trumpet blowing.  Pictures of smiling patients do not tell you what you need to know.  Look for detailed information and explanations about the procedure, which should include the disadvantages and risks as well as the advantages.

• Ensure that your levels of expectation are realistic.  Plastic Surgery is not going to turn you into a film star, or much sought after employee, not is it going to mend marriages.  In fact, apart from improving some aspect of your appearance there is very little else you can justifiably expect from it.

If improvement of appearance is all you ask from your surgery, you will no doubt be delighted at the increase in self-confidence and rapid return of self-esteem.  However, as stated above, ensure that your expectations are realistic by discussing carefully with your surgeon just what can be achieved.

• Do not have surgery to please someone else.  This is a private solution to a personal problem and surgery carried out for this reason is rarely successful.  If you have surgery, have it because you want it, not for somebody else.

Considering Treatment?

Today it has become almost cultural to take vitamins and food supplements as an aid to maintaining health.  However, if you are considering aesthetic plastic surgery and regularly take food supplements please read the following very carefully.

Likewise, if you are taking any medication on a regular basis, the following information is of importance to you:

The following must not be taken two weeks prior to surgery being carried out and for the two weeks following:

Effamol G     Primrose Oil     Wheatgerm With Vitamin E      Evening Primrose Oil     Salmon Oil Capsules    Cod Liver Oil Capsules
Multi-Vitamins with E

No anti-inflammatory agents (mediations for the treatment of swelling, bruising, pains, etc) including:

 

No Naturopath preparations including:

 

Do not take medications containing salicylates including:

 

Or anything containing Aspirin.  You may take paracetamol.

Monoamine Oxidase Inhibitors (Moams), prescribed for depression must not be taken, nor any medication used to thin the blood.

Smoking may seriously affect the outcome of any surgery you may be contemplating but particularly in the case of:

 

You should stop smoking ideally from six weeks pre-operatively and for two weeks post-operatively.  If you can stop for this period of time why not stop permanently?

Please contact us if you require explanation or further information on the above.

Breast Augmentation

This booklet has been prepared to answer many of the frequently asked questions about Breast Augmentation. The information contained within is important to everyone thinking about Breast Augmentation treatment and we recommend that all sections be read carefully.

You must not use this information as something on which to base final decisions without the benefit of an individual examination. Descriptions of the surgical details regarding Breast Augmentation are in general terms and will not apply to everyone. This information may, however, serve as a starting point for your enquiry about Breast Augmentation.

The material contained within this booklet was designed to allow careful consideration at home of both the procedural and surgical details of the operation (Breast Augmentation) in which you are interested. It is free of photographs, makes no recommendations for surgery and in no way should it be considered promotional material for the hospital.

If you consult a surgeon you do so in the knowledge that he endorses the basic concept of this booklet.  Wherever his ideas or methods differ from those described within, he will draw this to your attention and describe his own preferences and the reason for them.

Differing methods should not be considered as deviating from normal, or accepted procedures.  There are hundreds of variations for each surgical procedure carried out and your surgeon has a duty of care to ensure that he selects that, which is appropriate for you.

Why have Aesthetic Plastic Surgery?

Examine your reasons – make sure that your expectations are realistic – have a positive attitude remember plastic surgery will not resolve your major life problems but should boost your confidence and self esteem.

Do not have surgery to please someone else, these are private solutions to personal problems and surgery for this reason is rarely successful.

When a reputable surgeon and anaesthetist carry out an aesthetic surgery operation, it is rare for severe complications to occur, but nothing can be guaranteed absolutely.

However, in very difficult cases it is conceivable that several procedures may be required before the ultimate end result will be achieved.  If this is the case, you will be advised of this fact before you are allowed to elect for surgery, and the price you are quoted will include the close of all surgery necessary.

Rarely is aesthetic plastic surgery covered by insurance policies.  Surgery required to correct poor attempts at cosmetic surgery may be covered by medical insurance if it can be shown that the correction of previous surgery is essential to the health or well being of the insured.

When surgery is carried out to correct the result of poor surgery carried out elsewhere, it is done so on the basis that more than one surgical procedure may be required and that such procedure(s) do not carry the guarantee applicable to surgery originating from this hospital.  This type of surgery is usually difficult and unpredictable and may require several procedures.  If you hold medical insurance, it may well be that the cost, either in full, or part, will be met by your insurers.  The Hospital will assist with the necessary forms.  An ever-increasing amount of surgery carried out at this Hospital is for corrective purposes.

Everyone is different and the same operation will have different results. Some take longer to heal than others, some skins produce raised scars and other, hardly any at all. This is due to differing natural healing responses, which cannot be evaluated prior to surgery. You must remember this. Minor revision surgery may be required because in major or complex procedures it is more likely that all the factors of shaping and healing, will fail to give a perfect result first time. Some revision surgery becomes necessary, because a patient fails to transmit his or her true requirements to the surgeon. If you have a passive personality (absolutely nothing wrong with that) and during your consultation say, you contribute little, you are most likely to end up with the surgical result which reflects your surgeons aesthetic tastes as opposed to your own. As previously mentioned, if your requirements are specific in any way, they must be made known to your surgeon during consultation. During your consultation regarding Breast Augmentation, your surgeon will listen carefully to what you say, noting down your requirements in your personal records. These notes will be of great value to him, both when planning your treatment for Breast Augmentation and carrying it out. If you are accepted for Breast Augmentation treatment, please do not make a definite appointment for your surgery to be carried out unless you are sure you can keep it. The Centre will require a fee equivalent to 10% of the total fee payable before booking a surgical appointment and this fee is non-refundable in most circumstances. Please discuss this point with administration.

Anaesthetics

Wherever possible, we avoid the use of general anaesthetics, preferring instead to use sedation therapy, Twilight, as it is sometimes known is a natural method of anaesthesia, which allows you to sleep naturally throughout your Breast Augmentation operation. Many patients say that in effect they were not really asleep but in a “twilight condition?which they enjoyed. The advantages of this type of anaesthesia are enormous both to patient and surgeon alike. You will benefit in that when you awake you will not feel sick, will not have a sore throat and will be able to drink almost immediately. Anaesthesia should not cause you concern.

 Hospital Administration

Patient Information Managers are appointed by to ensure that every patient is fully aware of the consequences of electing Breast Augmentation surgery. PIM’s as they are known, are the people who will book your Breast Augmentation operation should you elect surgery. However, before they do so they will need to know that you are confident of your decision and that you are aware of all aspects of your Breast Augmentation treatment and its effects upon you. You may feel that the information you are given is more than necessary or, unduly pedantic. We do not believe this to be the case, rather that well-informed patients make better patients. The future for cosmetic surgery is too bright to leave patients in the dark.

Breast Augmentation

Many women consider having Breast Augmentation in order to improve their breast size or shape or because they think their breasts are too small, uneven in size or unattractive. Some women have breasts that do not fully develop or have significant change in size or shape after pregnancy, weight change or ageing. You read earlier that the decision to undergo Breast Augmentation surgery should be a personal one. You should not consider this procedure to please someone else. Like all aesthetic plastic surgery procedures, Breast Augmentation will not resolve any of life’s major problems and you should understand that there may be reasons why this type of surgery may not be right for you. If you decide to take your enquiry further and consult one of our surgeons you should listen carefully to what he says and follow his advice.

The information contained within these notes includes description of problems which have not been experienced in this country, but because of lingering uncertainty associated with Breast Augmentation, mainly from America, we have endeavoured to cover every aspect of this surgical procedure in an attempt to inform as fully as possible. Your surgeon is the best source of information in regard to this procedure. Listen carefully to what he says and ensure that you ask all necessary questions regarding Breast Augmentation.

Each year, throughout the world, tens of thousands of women have Breast Augmentation surgery for cosmetic or re-constructive reasons with few or no complications. However, because of reasons mentioned, this figure is less than previous years. A survey, conducted by the American Society of Plastic and Re-Constructive Surgeons, found that 92% of American women who have Breast Augmentation report that they are satisfied with the results of their surgery. This impressive figure is made more impressive by the knowledge that of the amount surveyed, 35% sought the procedure for re-construction after cancer, or other diseases.

The benefits to Breast Augmentation patients are many and varied including:

• Symmetrical form and contour to the breast
• Enlargement and balance in breast size
• Correction of dropping breasts (Ptosis correction)
• Reconstruction following mastectomy
• Psychological benefits including improved self-image and self-esteem

There are three types of incisions used for inserting breast implants:

The inframammary incision for Breast Augmentation is made under the breast at the fold or crease line, or sometimes, about 1cm above. This is the most common incision, but with the disadvantage that the scar may be visible until such times as it has faded to a normal skin colour. Another method is the Peri-areolar incision. This is made around the edge of the areola (the darker skin around the nipple) with the disadvantage that the incision may be too small to allow insertion of some implants. Scarring with this new method is usually minimal. The third method is an auxiliary incision which is made in one of the crease lines of the armpit. This is used less often because it is more difficult to get proper placement of the implant in some patients, and if there is an implant problem, an incision on the breast may be required.

There are two locations for implant placement:

The sub glandular (or sub mammary) placement for Breast Augmentation is between the breast tissue and the chest wall muscles. This is the most common placement since it is easier to do and there is usually less pain after surgery. The disadvantage is that the implant may be more visibly in slim women, and mammography examination may be more difficult and less effective.

The second location for Breast Augmentation is the sub muscular placement between the muscles of the chest wall and the rib cage. The advantage is that mammography may be more effective and the breast may be more attractive in slim women. The disadvantages are that there may be more pain, or discomfort, after surgery and the breast will move with certain muscle actions. Whichever method is chosen for Breast Augmentation, after the implants are in place, the incision will be closed with sutures and tapes applied to the incisions for extra support. You will be advised about the type of bra to be worn. You will be required to avoid lifting, bouncing etc, for a period of time and advised when you will be able to return to normal activities. Massage may be advised post-operatively, but this is entirely at the discretion of your surgeon.

You are expected to follow the advice of your surgeon and the unlikely event of infection, bleeding, bruising or any symptoms of concern; these should be notified to your surgeon immediately.

As with any surgery, Breast Augmentation poses risks that you should know about, such as haematoma, infection, fluid accumulation and skin necrosis. A haematoma is a blood clot which forms as a result of a leak in a blood vessel. If this happens, you may have swelling, discomfort and discolouration. An increased risk of capsular contracture may be a possibility. Haematoma at the hospital is less than one half of one per cent in Breast Augmentation surgery and rarely does it have any effect on the aesthetic result of the operation.

Infection, pain, redness, swelling, or fever, following Breast Augmentation should be reported immediately to the hospital. Infection is rare but usually easily controlled by modern anti-biotic. Infection not reported could seriously compromise the success of any surgery. Nearly all infection occurs within a few days of surgery. If infection were to be serious and fail to respond to anti-biotic, removal of the implant would be required and replacement would not be effected until such time as the infection had cleared. Rarely is this the case. Body fluids, known as serus fluids may occur immediately following surgery or even later during the healing process. This gives the breast a full or swollen feeling and even though this happens rarely, it should nonetheless be reported to the hospital or surgeon.

Necrosis, which is skin decay, occurs when there is not enough blood to supply the skin. This may happen if the surgeon were to select an implant size too large for the available pocket he has created. We have not experienced this problem nor do we expect to.

Changes in nipple and breast sensation are in the main, quite minimal. Some patients described heightened sensation, a few have described a decrease in sensation and we have experienced a single case where nipple sensation has been absent for four years. Removal of the implants may well restore sensation but to the current time, the patient has emphatically rejected this alternative. The vast majority of cases were sensation change have been reported, are temporary and soon revert to normal. Permanent loss of sensation is not probable, but as we have seen, can occur. In fact, many hundreds of complications can occur with any surgery but if the surgeon is well trained and experienced in his techniques, he will never see the majority of these.

Capsular Contracture

A capsule is a layer of scar tissue that normally forms around any artificial material placed in the body. Capsular contracture occurs when the scar tissue shrinks around an implant, squeezing it, so that it feels firm, or in some cases, quite hard. This is the most frequently reported problem relating to breast implant surgery. It should not be considered a health risk. Most capsular contracture experienced today, stems from smooth shell silicone implants placed some years ago. No longer available, we expect the problem of encapsulation to continue to shrink until such time as it becomes an acceptable figure. Textured surface implants, described later, have largely resolved the problem of encapsulation in Breast Augmentation.

No one has discovered why some women develop capsular contracture and others don’t, or why in the same women one breast may contract and the other doesn’t. Contracture occurs in various degrees, from barely detectable firmness to a hard breast. It may be severe enough to be bothersome, even painful and may cause distortion of the breast. This condition may occur in one or both breasts and to a different degree on either side. It may develop any time, even years later, although it is most likely to occur in the first several months after surgery. Even if it’s treated successfully, capsular contracture can recur. To relieve or reduced the firmness of a contracture, doctors use a procedure called a capsulotomy. There are two types of capsulotomy “closed and open?

During closed capsulotomy your surgeon tries to break up the scar tissue by forcefully squeezing the hardened breast. This does not always work and may result in bruising, bleeding, or in rupture of the implant. If the implant ruptures, you will need surgery to remove and replace it. This type of capsulotomy is now quite rare. The other procedure called “open capsulotomy?involves surgery under anaesthesia. The surgeon removes the implant and either makes many cuts in the capsule to loosen it, or removes all, or part of it. If an implant is inserted again, the surgeon inserts the same implant, or a new one in the breast pocket.

Modern implants have a textured surface and encapsulation is no longer the problem that it was. With modern textured surface implants, encapsulation is relatively low, with figures of less than 6% being claimed. However, this figure may climb with the passage of time. Encapsulated implants are no longer the problem that they were but still occur in a minority of people undergoing Breast Augmentation.

Hardening of the breasts is not predictable. It cannot be avoided and is the course of nature taken by the body when dealing with a foreign object. However, as mentioned previously, encapsulation is no longer the problem that it was.

Many ladies considering Breast Augmentation surgery will have heard alarming stories about silicone bleed. Gel bleed as it is known, is the “sweating?of small amounts of silicone fluid through the outside covering (envelope) of the implant. This free silicone then may move slowly into the surrounding scar tissue, the nearby breast tissue and muscle, and even the lymph nodes in the armpit. In some cases this may cause a problem through sensitivity to the product, resulting in the prosthesis being removed and the area cleaned of silicone. It is unlikely that the implants would be removed in such circumstances. However such cases of sensitivity are quite rare in our experience.

A mammogram may be useful in some, but not all cases, to determine if an implant has been ruptured. Modern implants are quite strong and breakage is something which you should not be concerned about. If in the unlikely event, the envelope did tear or rupture as a result of a severe injury, such as receiving a strong blow to the chest, the gel may be squeezed, or may ooze into the surrounding body tissue. In rare cases it is conceivable that the gel could migrate to other parts of the body. Movement or migration of large amounts of silicone gel is believed uncommon.

If gel did migrate, it is possible for it to cause inflammation, tenderness and swelling around the ruptured implant. Gel migration is something of which we are aware but about which we have no first hand experience. This is a problem which only rarely will affect you. Silicone gel causes a shadow in an x-ray and free-floating silicone may mask the presence of breast cancer during routine mammography (x-ray of the breast). If you have breast implants, you should always tell the radiologist before having a mammogram so special techniques learned for this very reason can be used.

SILICONE BREAST IMPLANTS

A Safe Option

If you are considering Breast Augmentation with silicone implants it is important that before you finally decide to go ahead, you fully understand the implications of such a decision.

The benefits of Breast Augmentation are self-evident, creating in the patient an increase in self-esteem, confidence and well being. However, as with any operation there can be associated risks and these should be taken into account and discussed fully with your surgeon.

What is Silicone?

Silicone is a chemical compound created when silicone, which occurs naturally in sand, quartz and rocks is combined with oxygen, carbon and hydrogen. Depending on the arrangement of these molecules silicones can be produced in numerous different forms, for instance powers and oils and of course gels and elastomers as use din the manufacture of implants.

Is Silicone Safe?

Silicones are amongst the most widely used materials in the world today, you are undoubtedly already using them in a variety of products such as lipsticks, hand lotions, deodorants and hair sprays.

Silicones are also used widely in food and drink preparation and packaging, it is in fact almost impossible on a day to day basis for us not to have contact with some form of silicone particles. The inert properties of silicone have also led to it being an invaluable material in medical technology. Since the mid 1940’s silicones have been commonly and safely used in many areas of medicine. Silicone is currently used in such areas as chemotherapy, kidney dialysis, heart pacemakers, heart valves, hydrocephalic shunts, syringes, as well as in dentistry and pharmaceutical coatings.

Silicone and Breast Cancer

Scientists and doctors alike agree that there is no proven link between silicone and an increase in breast cancer. The results of major studies have clearly shown that the incident of breast cancer is no higher in women with implants than those without, some recent papers clearly show reduced incidence.

Auto-Immune Disease

Auto immune disease is a general term to describe a rare condition in which the body’s natural defences effectively turn against themselves. Connective tissue disorders are the tissue injuries symptomatic of auto immune disease. No evidence from studies carried out on the relationship between auto immune disease, connective tissue disease and silicone implants has proven any increased risk of illness.

In 1998 the British Department of Health instituted an independent review group (IRG) of the safety of silicone implants, giving special interest to the subject of auto immune disease. This comprehensive and unconstrained report again came to the conclusion that no link between silicone implants and auto immune disease can be established. We would suggest that the IRG report and informed consent brochures available from the Medical Devices Agency (MDA) are important research material for patients considering reconstructive or augmentative breast surgery.

Known Complications

As with any surgical procedure certain complications are inherent and must be clearly understood by the patient before surgery can be agreed to. The recognised difficulties of Breast Augmentation surgery are as follows:

Capsular Contractures

The body’s natural response to any foreign body is to form a fibrous capsule around it. In the majority of breast implants the capsule remains soft and unnoticeable. Unfortunately in some cases the capsule contracts and becomes hard and in few instances can cause discomfort or pain. You should be aware that in these rare circumstances such a problem could require further surgery. The innovation of textured shell implants over the last ten years has significantly reduced this problem in Breast Augmentation surgery.

Infection

As with any surgery there is a possible risk of infection, this presently stands at around 2% with Breast Augmentation. Should the infection fail to respond to anti-biotics your surgeon may decide to remove the implant. Once the infection has cleared the implant may be introduced.

Extrusion

In certain severe cases of infection the implants can extrude out of the body, however, this is extremely unusual, poor surgical procedure such as improper sizing and positioning of implants can also lead to extrusion again this is very rare.

Rupture

Due to the remarkable strength of modern implant shells it is highly unlikely that an implant will rupture under normal conditions. Ruptures can occur when damage has been caused to an implant during the implantation ?this will often take a little time to detect as cohesive gel will remain within the natural capsule.

Mammography

It is important for implant patients to inform the Doctor/Radiographer of the existence of their breast implants. Although the implants are radio-opaque it is now possible with modern techniques employed in mammography to see around the implant.

Haematomas

Haematoma is a risk within any area of invasive surgery, this is a build up of blood concentrated around the area of surgery that may cause discomfort and swelling, small haematomas normally disperse naturally ?large ones however will often need to be surgically removed.

SURGICAL PROCEDURES

Your Consultation

Cosmetic surgery patients can safely be split into two groups. Those born with, or who as they grow, develop features that they do not like. For example: a large nose, large breast, or even underdeveloped breast, protruding ears, or indeed, any feature that may make them unhappy.

Then there are those who are unwilling, or unable to come to terms with effects of ageing, pregnancy or trauma. Both groups may be unhappy to the detriment of their self-esteem.

Today in the United Kingdom, can there be few unaware of the benefits of cosmetic surgery and may consider it to be the “ultimate voyage of self improvement? However, good cosmetic surgery is not an accident or a miracle, it has to be planned.

Planning starts with your consultation……..for FREE, no obligation consultation

FREEPHONE 0800 0281 329

Following detailed study in the United States, women with augmented breasts were reassured to know that detection time for breast cancer in women with augments was identical, time wise to those without. To sum up this very important paragraph; implants do make the job of the radiologist more difficult ?they do not however, prevent him from carrying it out.

Media-hype from the United Stated, did for quote some time cause a question mark as to whether or not silicone implants increase the risk of breast cancer. Studies of women with breast implants show no increased risk of cancer. In fact, in the largest study ever carried out, the University College of Southern California found that over the past decade, women with augmented breasts had done slightly better in the cancer stakes than their non-augmented peers. If there was the slightest evidence to suggest that Breast Augmentation increased, even slightly, the risk of cancer, the United Kingdom Department of Health would not allow the procedure to be carried out.

In January of 1992 the Department of Health cleared the use of silicone implants in the United Kingdom and state that if any reason to withdraw them was found it would notify users with the appropriate advice. In April of 1994, following the findings of the specialist advisory committee set up by the UK Department of Health, it was advised that no evidence, scientific or medical, existed to justify the withdrawal of silicone implant devices and practitioners were formally cleared to carry out the procedure.

At the same time, a Breast Implant Registry was set up to record the names of all women who undergo Breast Augmentation, as a final safeguard. Effectively, this means from June 1994 onwards all patients undergoing Breast Augmentation may be traced should it ever be necessary.

In the United Stated the use of silicone as a filler medium for implants is currently not allowed, pending yet further investigations into its safety. Saline is used instead, which provides in our opinion, an inadequate result in that it can leak away. Further, the feel of the breast is unnatural.

Silicone implant safety is well known in the United Kingdom and the use of these devices by us is based upon the overwhelming evidence throughout the world in regard to their safety but in particular in January 1992 and April 1994 advice from the Department of Health.

General Anaesthetic

After you have discussed your operation with the surgeon, it will be necessary for you to consider your anaesthetic requirements. In order for the operation to be performed painlessly, it will be necessary for you to have an anaesthetic of one type or another. Although we try and avoid the use of full-blown general anaesthetics wherever possible, in many cases, for reasons of your absolute comfort and safety they are required. Modern general anaesthetics are safe. You need not fear them. They are even safe for the type of patient seeking elective surgery because of their fitness levels.

If a GA has been selected as being appropriate in your case you will meet your anaesthetist before the operation but, because your operation is not urgent in a medical sense, it is sensible for you to be as fit and healthy as possible, prior to the anaesthetic.

In order to avoid unnecessary disappointment, this leaflet has been prepared describing some common problems, which can result in the operation being postponed. If you are in any doubt, please contact the hospital prior to leaving home. If it is essential to postpone your operation you will then be spared the journey, when a new date can be arranged.

Most people have never had an anaesthetic. The latter part of these notes describes what will happen before, during and after your anaesthetic. The description is quite detailed, in the hope that it will take away some of your anxieties. Your anaesthetist will be taking care of your all through the operation, although you will only be aware of his presence before and after the operation.

Coughs, sore throats, colds and influenza, or any infection in the breathing passages, can be made much worse by a GA.  For this reason you should be symptom free for at least two weeks before an anaesthetic.  Important symptoms include a fever, sore throats, runny nose or cough.

It is very important that your stomach is empty before you have a GA. For this reason you should not eat, or drink anything, for at least 6 hours prior to your operation. This will be advised to you on the day of booking your operation with the Patient Information Officer.

Most medical conditions do not cause difficulties for your anaesthetic, providing that they have been adequately treated beforehand.  If you have a problem such as diabetes, chronic bronchitis, or asthma, which deteriorates from time to time, it is best to have your anaesthetic during a good period.

If you are worried that you may not be fit enough for an anaesthetic, ask yourself this question: “while I have suffered from this problem, have I ever been fitter?”  If the answer is yes, please phone the hospital before leaving home, so that we can advise you on the desirability of having an anaesthetic at that particular time.  It may be necessary to delay your operation for a few weeks so that your medical condition can be improved.  This may be a disappointment at the time, but is done for your comfort and safety.

If you suffer from high blood pressure, you may like to ask your GP to check it for a few weeks before your operation. If your blood pressure is unacceptably high, your GP will be able to read it before your have your operation. You will appreciate that your GP will already have cared for you during your medical illness. He is, therefore, in the best position to advise on treatment, which will return you rapidly to full fitness.

Many people do not want their GPs to know that they are having a cosmetic operation.  This is because they believe that he will be unsympathetic.  This is very rarely the case.  We prefer to involve your GP in any treatment, prior to your operation, as his advice can be immensely helpful.  We will always ask your permission before contacting him and will only do so if you agree.  We hope that you will agree for the reasons just given.

It is important that you bring with you all pills and medications that you are currently taking. It is important that your anaesthetist knows what you are taking, so that he can give you an appropriate anaesthetic, which will not interact with your tablets.

Excessive consumption of alcohol can cause bleeding during and after your Breast Augmentation operation. It is better not to drink at all before the operation but if you feel the need, please do not have more than one pint of beer, or one short, on the evening before your operation is carried out. If you smoke, you are more likely to develop a chest infection after your operation. Any reduction in cigarette consumption is helpful. Ideally, you should stop smoking completely from the time of your first consultation or for that period of time advised by your surgeon. Smoking has an adverse effect on the outcome of many surgical procedures.

Your anaesthetist will ask you for details of your teeth.  What he wants to know is whether or not you have any crowns, bridges or cosmetic dentistry, which will require him to use a different technique.  Teeth can be and often are, damaged by failure of the patient in informing the anaesthetist that crowns or bridges are present.

The possibility of damage to teeth during anaesthesia is remote, if you have given full dental information prior to your anaesthetic.
Your surgeon will tell you when you can expect to go home after your Breast Augmentation operation. If you are discharged on the day of your operation, it is dangerous for you to drive, operate appliances, or machinery. Long journeys by public transport can be exhausting, even after a minor operation. It is therefore advisable for you to arrange to be collected by a friend or relative. You may also find it helpful to stay with someone overnight. You should not drink alcohol for 48 hours after your anaesthetic or for that period of time advised by your surgeon post operatively.

Each anaesthetist uses a slightly different method.  It is not therefore possible to describe precisely, what will happen.  The following description, will however, give you some idea of what to expect:

Before your operation your anaesthetist will wish to see you. He will discuss your medical history and will examine your heart and lungs. A nurse will already have taken your temperature and blood pressure. Some patients may also have a heart tracing taken (ECG).

The anaesthetist will decide whether this is necessary on the basis of your age, medical history and the examination.

Conversely so, you should not worry if your anaesthetist does not take an ECG reading.  This simply means that your obvious good health obviates its necessity.  An ECG is taken as an added precaution, and you should not assume that the anaesthetist thinks you are ill.  Before an ECG is taken, he will explain why he thinks it is necessary, and afterwards will tell you what it shows.  You will then have a chance to discuss you anaesthetic.  Many people worry unnecessarily because they have head “dreadful stories”.

Modern anaesthetics are extremely safe, and we hope that you will feel free to ask as many questions as you like so that we can set your mind at rest.  You may also be written up for some sleeping tablets, which are optional, but are often helpful the night before an operation.

Before your operation you may be given a pre-med. This is usually a tablet, but in certain circumstances may be an injection. The pre-med will make you pleasantly drowsy and reduce your anxiety. Although you will have been starving in preparation for your Breast Augmentation operation, it is perfectly in order for you to drink a small amount of water to help you swallow the tablets. At about this time you will be asked to put on a theatre gown, and to remove all jewellery, except your wedding ring, which will be covered with tape. You should only wear the gown and your lower undergarment.

About ten minutes before your Breast Augmentation operation, you will be asked to get onto a trolley and taken to the anaesthetic room, which is next door to the theatre. The anaesthetic nurse will confirm with you the operation you are having, and will then put on you a blood pressure cuff, and small stickers, which will allow your anaesthetist to monitor your heart beat whilst you are sleeping.

You will then be anaesthetised.  This will involve a small injection in your hand, wrist or below.  You probably will not feel the injection at all, but if you do, it will be no worse than scratching yourself.  You will be asleep within twenty seconds after the injection.

Some people feel a little dizzy just before they fall asleep, others fall asleep instantaneously.  Each person reacts differently, but the majority of our patients do not find our anaesthetic procedure either disturbing or unpleasant.

Whilst you are asleep your anaesthetist will be looking after you all the time.  His sole duty is your safety and welfare.  Several sophisticated electronic monitoring devices are used to assist your anaesthetist.  These constantly monitor your heartbeat, blood pressure, and the quality of anaesthetic being given.

All the machines are fitted with alarms to give your anaesthetist early indication of the very rare occurrence when an abnormality may arise.  This allows the abnormality to be corrected.

When your Breast Augmentation operation is over, your anaesthetist will wake you up. By the time you become aware of your surroundings you will be in a special recovery room.

A nurse will be with you until you are completely awake.  You will still be having your heart rate and blood pressure measured at regular intervals by automatic machines.  When you are fully awake (usually about 15 minutes) you will be lifted back into your own bed where you may drift back into natural sleep.  Even though you will not be allowed out of the recovery room until we are confident that your anaesthetic has worn off, it is quite common not to remember anything until you wake from this natural sleep.

Most of these operations are not nearly as painful as your might imagine.  Often the pain can be relieved by simple tablets such as Paracetamol.  Stronger painkillers are always available should you need them.  The nurses will ask you at regular intervals if you are feeling discomfort, or pain, but you may ask for painkillers at any time.

Questions

Are there any risks associated with a general anaesthetic?

Every anaesthetic carries a small risk.  The risk is minimal provided that you are in the fittest possible condition at the time of your anaesthetic, you have ensured that your anaesthetist is fully aware f your medical history and current medication and that you are starved at the time of your operation.  You can help by being honest about your medical history and any previous anaesthetic difficulties.

If your anaesthetist is fully informed he can choose the best anaesthetic for your personal needs.  If there is a risk associated with your anaesthetic, you anaesthetist will discuss it fully with you.  Almost all problems can be overcome, although your operation may have to be postponed for a few weeks.  Postponement of an operation is always a disappointment for the patient.  We understand this, and would only suggest it if we felt that it would add to your safety.

Will I wake up at the end of the operation?

Yes, you will.  There are only a few reasons why patients do not wake up at the end of an anaesthetic.  Most are for medical reasons, which can be anticipated and treated, provided we know your medical history beforehand.  Very rarely does an accident occur.

Almost all accidents occur because the anaesthetist is inexperienced and fails to monitor the patient properly.  Your anaesthetic will be administered by a senior anaesthetist who has passed all the examinations and is employed as a consultant in the NHS.  The monitoring apparatus used at this hospital is all up to the minute technology.

Will I wake up in the middle of the operation?

No.  This problem nearly always occurs in ladies who are having a light anaesthetic for a Caesarean section.  Because the baby’s safety must also be considered, it is vital that the least possible anaesthetic is given.  Sometimes an anaesthetic that is suitable for the baby is too little for the mother.

When you have your operation, the anaesthetist has only you to consider and you will be given as much anaesthetic as you need.  Waking during anaesthesia does not occur often.  It is a fear you need not have at this hospital.

Some operations can, in suitable cases, be performed under local anaesthesia.  The patient is awake and only the part of the body being operated on is anaesthetised.  If this method of anaesthesia is used, you will not need to starve and your medical problems are less important.

Another type of anaesthetic we like to use is sedation therapy.  Instead of a full general anaesthetic, a local anaesthetic is used but with the addition of safe drugs which thoroughly relax you.  If you are awake during your operation, you won’t remember, or feel anything.  However most patients doze, remembering nothing until they wake up in their own bed.

Many people do not like to be awake during an operation, or even the thought of being awake, even though they will not be able to see the operation itself.  If you feel that you are one of these people, but have been advised to have a local anaesthetic, sedation therapy is for you.  If you are given a sedative, you must be starved prior to your operation, and

                       
YOU SHOULD NOT DRIVE OR DRINK ALCOHOL FOR AT LEAST 12 HOURS AFTER THE OPERATION.

           
This information has been prepared to help you understand your anaesthetic. If you are worried in any way about what you have read, please contact the hospital so that a further explanation can be given.

We hope that you will be pleased by your new appearance.  Our aim is to make your stay at the hospital as pleasant and trouble-free as possible.

We hope this information has answered most of your questions regarding Breast Augmentation. If it hasn’t please jot down any concerns you may have which can be dealt with either by telephoning us on 0800 0281 329 so you can elect to take your enquiry further, during your consultation. If you do attend for a consultation please feel free to bring along a relative or friend whose judgement you trust, if you feel their presence would support you.

Photographs

Many patients express disappointment at the fact that these notes do not contain photographs taken prior to and following surgery.  The use of photographs projecting “only favourable results” is misleading and such photographs bear no relationship to the surgical result, which can be obtained apart from the patient so depicted.

Photographs of patients show only what was possible in that particular case.  There is no guarantee that you will fare as well, or won’t do better.  If you are interested in seeing photographic examples of your surgeons work, ask for them during your consultation when he can positively ensure that no confusion is allowed to exist.

About our In-House Therapist

Suzie has studied and qualified in many therapies, among them: Psychotherapy, Hypnotherapy, Neuro-Linguistic Programming, Emotional Freedom Technique, Anatomy, Physiology and Physical Therapies.

Suzie has worked extensively on studying the effects of thoughts, life experiences and stress on individuals.  Now an Eclectic Therapist, she works with a wide range of clients at varying levels; from deep seated emotional issues to Image Consultancy.  Suzie’s extensive range of skills have been nurtured through her varied background and experience.  Having worked as a model for several years, she then moved into Theatre and TV, later training as a make-up artist.  It is hardly surprising; therefore, that Suzie is passionate about looking your best, feeling your best and being your best.  She is engaging, warm, grounded and potent individual with a wicked sense of humour.

More recently, Suzie has been working as a trainer and facilitator for key corporate organisations.

Don’t miss the opportunity to work with this unique therapist and coach who is keenly aware of the thoughts and feelings of those who wish to make a change.

A quote from Suzie:-

“Many years ago I had a cosmetic procedure.  Whilst I was very pleased with the result, I realise now that I would have benefited in having a caring professional to help support me in addressing other psychological issues that were present, I did eventually seek out a therapist and coach who worked with me, enabling me to take control of my life and make the most of myself and my opportunities.  Seeing the results from people who take time to work with a therapist and coach encouraged me in the belief that what I am doing is worthwhile and valid”.

Our Methodology

Has four main influences in which our therapist and coach is fully qualified and able to support you:

Life Coaching 

• Identifying goals and working towards them
• Overcoming any obstacles on the way
• Often used in conjunction with other therapies
• Promoting personal responsibility
• Understanding the techniques
• Putting into operation new ways of being

Hypnosis 

• One of the most powerful tools to aid relaxation and de-stress
• Allowing positive suggestions deep into your sub-conscious
• Giving lasting results

NLP (Neuro-Linguistic Programming) 

• Understanding self and others
• Using a range of techniques towards significant improvement
• Helping you communicate more effectively
• Building relationships and rapport with others
• A very powerful technique when used with hypnosis

Psychotheraphy 

• Using the essence of this therapy for coaching purposes
• Supporting more deep-rooted issues which sometimes occur

What you will gain from coaching 

• Clarity
• Focus to fulfil your true potential
• A new found confidence and sense of self
• You will be empowered to go out and be the best you can be!

Making the most of your for the rest of your life 

If you are considering a surgical procedure, it is quite normal to wish for an enhanced look.  Our therapist can also help you focus on the bigger picture, by discussing the psychological and emotional aspects, dealing with what is important to you: focusing on the thoughts, beliefs and feelings that run parallel to your decision.  In this way, you will gain the maximum advantage before, during and after cosmetic surgery, enabling you to make the right decision for the right reasons and with a realistic outcome.  In short, we will be concentrating not only on the “you” outside but also the “you” inside.

We have an extensive range of techniques that can guide, mentor and coach you through to:

• Personal well-being
• Making the most of yourself
• Professional success
• Understanding your strengths
• Achieving your goals
• Being the best you can
• Freeing you from guilt and limitations
• Increasing your self-confidence
• Losing weight (and keeping it off!)
• Eliminating fears and phobias
• Relieving stress

From a one-off session, discussing whether this is correct for you, to your decision to go ahead with surgery, our in-house therapist can help you from step one, supporting you through any fears and anxieties and any emotional issues.

---

"I am so glad I came to see you when I did… I can move on with my life with confidence once again." - Jenny