Angelica Kavouni answers your questions on breast surgery
2007, Brand New YouView PDF
We get the views of our leading surgeons on the risks, tips and alternatives for breast surgery.
Dr Sing is a senior cosmetic surgeon with the Transform Cosmetic Surgery group, and the practitioner responsible for Jordan's boob jobs. He is a member of the British Association of Cosmetic Surgeons and a fellow of American Association of Aesthetic and Restorative Surgeons.
Angelica Kavouni is one of London's leading female plastic surgeons. She specialises in female body sculpting, especially post pregnancy Yummy Mummy makeovers and breast enhancement.
Simon Withey is cofounder of Mybreast, an organisation developed and supported by a UK community of respected and fully accredited plastic surgeons working together to raise the standards of breast enhancement.
Dr Erik Scholten is a specialist surgeon at the Hurlingham Clinic. He is a full member of the British Association of Plastic Surgeons and is on the Specialist register for Plastic Surgery of the General Medical Council.
Which type of implants are safest and best?
"At present in the UK the main implants used are of silicone gel or saline." says Dr Singh. "Saline implants carry a small risk of deflation and infection. I prefer to use silicone gel implants as they maintain their shape for a longer period."
Dr Scholten agrees: "The safest implants are cohesive gel silicone. The quality of breast implants has massively improved in the last 45 years. It is up to the individual surgeon which is the most suitable implant for a given patient."
"There is no hard and fast rule with implants these days." agrees Angelica Kavouni. "The majority have a textured surface (which helps to anchor the implant and reduce the incidence of capsular contracture).
Some come with a lifetime guarantee: with these you can assume they have been through rigorous testing and are unlikely to rupture."
Where will the implants be inserted?
"The implants may be inserted through incisions under the breast, through the nipple or through the armpit; each has different advantages and your surgeon should discuss each option with you. The choices for implant pocket are either above or below the chest muscle." explains Simon Withey.
"I prefer to place implants in the front of the chest muscle, because I feel the breast is made to be in front of the muscle. As long as there is enough breast tissue to hide the implant, it gives an excellent result," says Dr Singh.
Conversely, Angelica Kavouni prefers to place implants underneath the chest muscle: "I believe this gives a more natural shape and movement when compared with implants placed above the muscle. If the patient has virtually no breast tissue or is extremely skinny, the additional layer of muscle coverage hides the implant," she says.
Will I be left with noticeable scars?
"The scars for breast enlargement a replaced either below the breast, through the areola or through the armpit. The least visible scars will be the armpit scars, but this method is very technical." explains Dr Singh.
"The most popular insertion of the implant is through the crease under the breast, via an incision approximately 4cm long. The fine scar becomes invisible to the naked eye within 6 months." says Angelica Kavouni. "However, the scarring for a breast lift or breast reduction operation will be slightly more noticeable."
Will I lose sensation in my breasts?
While your breast will be numb after surgery, all our experts agree sensation should be regained within a round 6 weeks, or possibly sooner. "7-10% of patients experience some change in sensation of the breasts following surgery, in the majority of cases this will fully recover." reassures Simon Withey.
However, the sensitivity of the nipples can change after the surgery warns Dr Scholten: "Sometimes the nipples get more sensitive, or some people may experience less sensitivity in the nipples than before the operation."
What are the risks involved with breast enhancement?
"All surgical procedures carry risks associated with general anaesthetic, bleeding, infection and fluid build-up," says Dr Singh.
The most common complication following breast augmentation is capsular contraction." explains Angelica Kavouni. "As implants are a foreign body, they will get covered in a layer of scar tissue. Capsular contraction is when the scar tissue shrinks around the implant squeezing it so that it feels hard. Most capsular contracture stems from using smooth shell implants but with modern textured surface implants the incidence of encapsulation is low, probably around 5%."
Is it easy to tell when someone has had implants?
"With textured silicone implants, it is perfectly possible to have an extremely natural look and feel to the breast following augmentation." says Simon Withey. "The key is to plan carefully and ensure the right size of implant is placed in the anatomical pocket that will best suit the patient."
"When implants are very big the augmented look is very evident." warns Dr Scholten. "Some people like this 'porn star' look but in general, the more breast tissue a woman has before the surgery and the smaller the implant, the more natural result she will get."
"Placing implants underneath the chest muscle and opting for tear drop shaped implants can also add to a natural shape," adds Angelica Kavouni.
Could a breast enhancement procedure affect breastfeeding at a later stage?
"Having breast implants does not affect the ability to breastfeed the baby in any way," says Dr Scholten. "The silicone breast implant is covered by a thin layer of tissue (the capsule) so the implant is in no contact with the breast tissue that produces the milk."
"However, a breast reduction or lift may affect the milk ducts, so be sure to ask your surgeon if you are considering these procedures." advises Angelica.
How long should implants last?
There is no agreed time limit on longevity of the implants, but all our experts advise they should last between 10-15 years.
"It is unnecessary to change implants unless complications occur," says Angelica Kavouni. "If you do experience problems then an ultrasound will be requested to see if leakage or contracture has occurred."
How much time will I need off to recover from a breast surgery?
Angelica Kavouni advises more rest and recovery time: "I advise a two week break from work and also tell patients to limit arm movements: do not lift anything heavy for three weeks and refrain from exercise for six weeks."
"With implants, patients who have them placed beneath the breast tissue often feel well enough to work within three to four days, recovery may take a little longer if the implant is submuscular," says Simon Withey. "I suggest most patients to take 10 days away from work."
What qualifications should I look for in a surgeon?
"Consider seeing at least two surgeons before you make up your mind. You need to feel comfortable with the surgeon and take care to prepare for your consultation with a list of questions," says Angelica Kavouni.
"Ask to speak with ex-patients to find out their experiences and ask to look at before and after photos of the surgeons' work. Membership of professional bodies such as BAAPS, BAPRAS or EBOPRAS is not essential, but these organisations do have lists of approved surgeons.
Angelica Kavouni answers your questions on breast surgery.
What cup size is right for what frame?
"We measure the distance form the nipple to the crease under the breast, from nipple to nipple and from nipple to suprasternal notch ( the bony part at the front of the neck)"
What are the emotional and psychological effects of breast augmentation?
"The practical effects are that larger implants can be heavy and cause back problems down the line. It's also an unfortunate fact that women with new, bigger breasts might experience an increase in male attention."