Do I Need A Mastopexy To Make My Breasts More Perky?

Do I Need A Mastopexy?

A mastopexy is a great way to reshape the breasts but when it comes to achieving a good outcome, it is important for us to communicate what might be possible so that we can align our goals.
Over time the shape of the breasts can change and these changes can be accelerated by having children or losing weight, resulting in a droopy or saggy appearance to the breasts.
Many patients want to achieve a more perky appearance to rejuvenate the breast contour.
The reasons that breasts lose their perkiness is because the skin gradually stretches.
This happens over time in all of us because of the effect of gravity.

The Alternative To Mastopexy

It is not possible to give elasticity back into the skin, and so there are two options to combat the problem.

  1.  To remove the extra skin and tighten the breast.
  2. To add volume to the breast to fill the skin envelope and tighten the skin.

So for this reason, patients often wonder whether it is a mastopexy they need or breast implants; with a mastopexy doing the former, and implants the latter.

Mastopexy

Option 1: Mastopexy to remove the skin and tighten the breast

 

Breast Implants instead of mastopexy

Option 2: Breast Implants to fill the skin (without a mastopexy)

The main difference is the size of the resulting breasts and that will be about the same size after a mastopexy, but bigger after implants.

So it depends on how big you want your breasts to be.

If you want the breasts to be the same size as they are or smaller, then it is a mastopexy or a breast reduction that would restore the perkiness, but if you wanted them to be bigger, then implants might be all that is required.
However, if the breasts have sagged significantly, implants might not be able to fill the skin envelope enough and you may need to combine it with a mastopexy.  You can read more about a mastopexy combined with implants here.
Often if restoring the breasts to a more perky shape is the primary goal, then a mastopexy on its own is the best option. 

The Limitation Of Mastopexy

You will need to be prepared for the sort of shape that you can achieve with a mastopexy.
We always stress that gravity will continue to operate on the breast and so it tends to settle to a more natural shape without the round and full look that is associated with breast implants.
The problem comes when people want the rounded look and do not want to be bigger, because sometimes you may consider having implants just to achieve this look.
This is an option, but does carry with it the potential complications and limitations associated with implants.
This is why an in-depth consultation is always advisory, so that you can discuss your aims and objectives with your surgeon to see if a mastopexy would be suitable for you.
We can discuss whether the shape you could achieve, which can often be quite transformational to the breast, will be in line with what your goals are.
When you have a mastopexy, there will be a full and rounded look in the upper part of your breast to start off with, but over time they will settle to a more natural shape.

Mastopexy settling

After mastopexy, the fullness in the upper part of the breast settles into the lower part of the breast

Our primary goal is to have a happy patient and a happy patient is one who knows what to expect and can make an informed decision as to what might be the right operation for them.
We will not dictate to you what surgery you should have, and we will always inform you of what likely outcome you can reasonably achieve.
There is never any obligation to proceed.
If you have any concerns or doubts, then it is always best to go away and think about things and consider what surgery might be the best for you.
If you would like to come to the clinic for a chat, you can email or call us on 0121 454 3680.

For more information you can download one of our guides below:

Request Our Mastopexy Guide

Request Our Breast Augmentation Guide

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Life After Breast Implant Removal

Are you thinking about breast implant removal?

If you are considering breast implant removal but are worried what your breasts might look like afterwards, you are not alone.
As your body and your circumstances change, you might find that the breast implants that you once loved, become uncomfortable and out of keeping with your frame.
There are many reasons that people want to have their implants removed or you may just be worried and think that your implants need to be changed.

When should you change your breast implants?

If you are concerned, then you can read my blog post about when you should change your breast implants here.
If you are considering breast implant removal, then you may have many questions about what would be involved and what you will do once your implants are removed.
The Staiano Clinic is the only clinic in the UK that specialises in cosmetic breast surgery and is owned and run by a Plastic Surgeon.

Should you have your implants replaced?

If you would like a consultation with one of our surgeons, then we can go over your options for breast implant removal and talk about whether you would need to have implants replaced, or whether you would be happy to be without implants.  If you are having your implants replaced, then you can think about whether you have implants of the same size, or if you have bigger or smaller implants.  It may be that all the options are feasible, but you will need to consider the consequences of changing the size of your implants.
You can read more about what to do if you are considering replacing your implants here.

Will I need a breast lift after implant removal?

If you are thinking of changing or removing your breast implants, then you might be concerned about how your breasts will look afterwards, or more specifically, will you need a breast lift after your implants are removed?
Jonathan speaks about whether you will need a breast lift after implant removal in this video and shows some examples of cases of breast implant removal with and without breast lift:

If you would like a copy of our Frequently Asked Questions Guides, please click the links below:

Breast Lift Frequently Asked Questions Guide

Breast Implants Frequently Asked Questions Guide

If you have any questions you can give us a call on 0121 454 3680 or email us at info@staianoplasticsurgery.co.uk.

The Pros and Cons of Fat Grafting

The Pros and Cons of Fat Grafting

 I have recently seen a patient of mine in the clinic on whom I performed fat grafting to the calf.  She is a young lady who was born with a congenital defect of her ankle which meant that her left leg did not grow in the same way as her right leg and her calf and ankle were much thinner on the left side. We spoke about her options which were either to perform fat grafting or use an implant.  There can be particular problems with implants in the calf, particularly in terms of infection or being able to feel the edges of them and sometimes they can erode through the skin.
Of course, there are potential complications with any operation and there are complications with fat grafting too, but the main thing was that she was so young that the long-term durability of fat grafting is superior to implants and so we chose to go down this route.  She needed two operations spread over several months, but she has really got a fantastic result.  Her calf feels soft and supple just like the other side which is not surprising because once the fat is grafted it is normal fat.  The beauty of it is that it will change with you, so that if you put on or lose weight fat cells will get bigger or smaller just as they would have done if they had stayed in their donor site, (in this case her thighs).
I love the technique of fat grafting and you can produce really exceptional results, particularly when there is a 3-dimensional defect, because the fat can be laid down in a very careful and precise pattern.

Fat Grafting for cosmetic breast surgery

Clearly most of the work we do here at the clinic is in the breast and fat grafting for the breast is not as popular as you might think.Moving fat from one area and injecting it into the breast to enhance the volume without the need for silicone implants and all the potential long-term effects they can have is surely appealing.
But the main problem for cosmetic breast augmentation is that fat grafting only produces subtle results, and by definition most people who require breast augmentation are slim and so there is usually a limitation on the amount of fat that can be removed and this then has to be split between the two breasts.
I was privileged to be invited on the Faculty for the BAAPS 2017 Plastic Surgery Conference last week and was delighted to meet Foued Hamza who practices in Paris and London and presented his results of fat grafting in the breast.  He showed some really impressive results and also talked about the limitations that he has found during his extensive experience.  Like any surgical procedure the pros and cons need to be discussed with the patient so that we can make an informed decision together.
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The secret to getting a happy patient…

Is to have one whose expectations are aligned with what is feasible with the surgical technique being considered.  Certainly, there is no way that fat grafting can compete with implants when it comes to adding a predictable and significant volume to the breast.
The volume achievable is usually a cup size or less, and so the procedure often needs to be repeated and whilst it can sound appealing, the fact that it is harvested from the abdomen, buttocks or thighs, there is usually not a significant body contouring effect because fat harvesting is much gentler than traditional liposuction and so smaller volumes of fat are removed.
It can also be a bit uncomfortable where the fat is taken from, and there are risks of infection and fat necrosis or oil cysts, so this all needs to be put into the mix as to whether you think fat grafting to your breast might be right for you.
Because we are all specialists here at The Staiano Clinic we can talk to you about the pros and cons of each procedure and will not expect to have a ‘one size fits all’ approach.
If you would like to know more or have any questions please contact us at the Clinic, you can call us on 0121 454 3680 or email info@staianoplasticsurgery.co.uk.

What Happens To My Nipples During A Breast Lift Or Breast Reduction?

What Happens To My Nipples During A Breast Lift Or Breast Reduction?

People often ask ‘What happens to my nipples during a breast lift or breast reduction?’.  It is commonly believed that the nipples are removed during a breast lift or breast reduction and then put back on at a higher place on the breast mound once the extra skin and volume from the lower part of the breast is reduced.
However, whilst this is certainly one of the recognised techniques for breast reduction, it is usually reserved for massive breast reductions and is not something that is commonly performed during one of the more standard breast reductions or breast lift procedures.
When the nipple is removed it is known as a free nipple graft and when doing this, there can be problems:

  • with healing of the nipple
  • often the nipple itself lacks projection
  • the pigmentation of the nipple skin may not be normal
  • and there is always altered sensation in the nipple.

For these reasons it is usually better to keep the nipple attached to the breast on what we call a pedicle which is a stalk of tissue which maintains a nerve and blood supply to the nipple and so gives a greater chance of it healing and having improved sensation compared to a free nipple graft.
However, there is still a risk of altered sensation and the possibility of healing problems even when a pedicle is used.
When performing the surgery, we cannot see the blood vessels and the nerves travelling in the pedicle and so we have to leave enough volume attached going to the nipple and hope that the blood supply and nerve supply is sufficient.
Similarly, there will be milk ducts in the pedicle and so you may be able to breastfeed following a breast lift or breast reduction; however, this is not guaranteed because of all the tissue around the pedicle is released and removed in order to allow the nipple to be moved into a higher position on the chest.
It can be a balance especially when doing a very big breast reduction between removing enough tissue from around the pedicle in order to give a significant reduction in the volume of the breast, but not too much so that the blood or the nerve supply is compromised.
This is something that comes with experience and is why it is important to have a full discussion with your surgeon pre-operatively around the sort of results you can expect to achieve.
We will not be able to tell you the exact cup size you are likely to be, because this is not something that is possible to predict, but we will be able to give you a realistic expectation of what might be possible and what your chances of needing a free nipple graft are.
Breast reduction and breast lift can be revolutionary operations and transformational, not only in terms of the cosmetic outcomes they deliver, but also the functional aspect by removing the weight and lifting the breasts on the chest to make them so much more comfortable.
However, moving the nipple is an integral part of the operation, and so you need to be fully aware of the potential for scarring and complications so that you can make an informed decision as to whether surgery might be right for you.

Want to find information on pricing?

Find out prices here for Breast Lift or Breast Reduction.

For more information, please contact the clinic on: 0121 454 3680, or email us.
You can also join our Director Mr Jonathan Staiano on Facebook Live at 7pm every Tuesday evening, where he does a live Q&A.
Please feel free to comment on the blog.

Download our guide with frequently asked questions about Breast Lift and Breast Reduction

Do I need a scan to check my breast implants?

Do I need a scan to check my breast implants?

Patients often come to me to ask ‘do I need a scan to check my breast implants?’.
There are different types of scans that can be done to check on the breast:

Mammogram

This is an x-ray that looks at the density of the tissues and is mainly used for looking at lumps in the breast.
It is not very good at looking for problems with breast implants.
*note: a lot of patients worry about having a mammogram if they have got breast implants in, but there is no need for concern because it is routine to use implants in patients with breast cancer who need regular mammograms. You just need to let the xray doctors know that you have implants in so that they can adjust the way that they do the mammogram.

Ultrasound Scan (USS)

This involves using a handheld probe with gel on the skin to look at the integrity of the implant.
It is the same scan that is used when you are pregnant to get a picture of your baby.
It is often the first test for looking for rupture of breast implants.

Magnetic Resonance Imaging (MRI)

This is a bit more involved than an ultrasound scan.
You lie on a table and a large doughnut passes around you.  The doughnut contains magnets so you must tell the operator if you have any metalwork inside your body.
An MRI scan is more sensitive and specific than an ultrasound scan.  This means that it is more likely to be able to tell if the implant is intact.

Intracapsular Rupture Of Breast Implants

All implants are surrounded by scar tissue, known as a capsule and if the implant ruptures but the capsule stays intact, all of the gel will be held within the capsule.  This is known as an intracapsular rupture and this can happen without you being aware of it, in which case it is known as a ‘silent rupture’.
The cause of this is a constant friction of the implant shell, perhaps because of a fold or knuckle in the implant that might be made worse by some degree of capsular contracture.  Over time there can be a thinning of the silicone shell in areas of wear and this can lead to a gradual break or tear.
It is for this reason that I personally do not advocate routine scanning of patients who have breast implants in.
Scans have a cost, both financially and in terms of your health by exposure to radiation (for X-rays and CT scans) and so should only be performed if they are going to change how you are treated.
While they are very accurate in predicting whether your implant is ruptured or not, no scan is 100% reliable. This means that there is a small chance that the scan could say that your implant was ruptured, yet it might be intact and the scan might say that it is intact and it may be ruptured.
I have seen cases where the scan has been wrong both ways.
My practice is to offer all of my patients a yearly review where they can come back to the clinic for a check-up to see if there are any concerns or questions about your implants.
I would only offer a scan if there was a change in the size or shape of your breast that could indicate a problem with the implants.
If there was a problem with capsular contracture, then this is diagnosed clinically, not with a scan.
We make a decision to perform a capsulectomy and replacement of implants based on how bad the capsular contracture looks and feels, not on the basis of any scan.

Extracapsular Rupture Of Breast Implants

So far I have talked about a ‘silent rupture’ of breast implants, which is usually confined to the within the fibrous capsule around the implants (intracapsular rupture) and you normally do not notice when it happens.
This is different to an extracapsular rupture which is where the silicone shell of the implant ruptures as well as the fibrous capsule around the implant.
This is a different situation to an intracapsular rupture and this is the sort of thing that most people will imagine when thinking about rupture of breast implants.
It takes a significant amount of trauma to forcefully rupture the implant shell and in these circumstances, the capsule may also rupture resulting in a change in the shape of the breast and the presence of free silicone within the breast tissue.
Silicone within the breast tissue can cause lumps and may travel to the lymph nodes in the armpit causing lumps here.
This is something that we saw quite a lot of during the PIP scandal where a French manufacturer was producing poor quality implants with a weak shell and a high rupture rate. These implants were filled with non-medical grade silicone which was irritant to the breast tissue and removal of these breast implants was recommended by the Plastic Surgery Associations.
The situation today is not as desperate as this because modern day implants have a thick shell (we only use premium breast implants which have a double shell).  Also, the gel in implants these days is firmer than it was in the past, this is known as ‘cohesive gel’ and we call the implants ‘form stable’ which means the silicone does not tend to leak like a liquid if the shell ruptures.
It does mean that modern day implants feel firmer than older implants, but they are safer in situations of rupture.
The silicone gel is medical grade and not so irritating to the breast tissue, but nevertheless, if there is an extracapsular rupture with free silicone in the breast, your implants should be changed.
An extracapsular rupture is normally quite obvious.  There will have been some significant trauma, like a road traffic accident with a seat-belt over the implant, and there will have been a change in the shape of the breast.
In these circumstances, a scan would be indicated.
In fact, in any situation where there has been a change in the size or shape of your breast, or if you have noticed a lump, then a scan may we’ll be required to make sure that all is well.

As well as a routine annual appointment, all of our patients have open access to the clinic and can make an appointment to come and see us at any time.

If you have noticed changes in your breast, then you need to get checked out.
This means that you need to see your surgeon, or your GP.  If you have breast implants in, then your surgeon will be able to get an idea by examining you whether you have a problem related to your implants or your breast.
If the problem is related to your breast and your breast tissue, then your surgeon may refer you to your GP to see whether you needed any specialist investigation or referral.
If it is felt that your problem is related to your implant, then a scan can help to delineate this, not only looking to see if the implants are intact but also looking for any suspicious lumps or swelling that could signify something more sinister.
For more information give us a call on 0121 454 3680 or email info@staianoplasticsurgery.co.uk.

Download Our FREE Guide With Frequently Asked Questions About Breast Implants Here

Gyno Correction Without Scars

Gyno correction is a common treatment here at The STAIANO Clinic and because all of our surgeons are fully trained plastic surgeons, we have developed techniques that can produce results with minimal or no visible scarring.
Gynaecomastia is a common problem amongst young males and it can affect self-confidence and may also be uncomfortable.
If you want to be able to take your children swimming or go on a beach holiday with your friends, it can be daunting to take your top off in public when you have excess breast tissue (it goes by many names – man boobs, gynaecomastia, gyno – but it is all the same thing, excessive breast tissue in a man).
If you are considering gyno correction, the last thing you want is visible scarring on your chest that is going to make you as self-conscious as the original problem.
We take care to place our incisions in places where they will fade and blend in to your normal chest contour and so, once things have settled, it can be impossible to see the scars!
If you want to know more about gyno correction, look no further.

Download a FREE copy of our Guide with Frequently Asked Questions about Gyno Correction

Listen to the our Director, Jonathan Staiano talk about this with some examples of our cases in the video below:

All of the surgeons at The STAIANO Clinic are fully trained plastic surgeons with a wealth of experience and expertise.  We pride ourselves in our aftercare and will do everything that we can to ensure that you get the best result possible.
You can read more about correction of gynaecomastia on our main page here and you can also read our blog post about why there is a price range for gynaecomastia correction here.

REQUEST A PRICE FOR GYNO CORRECTION

If you would like more information, please call us on 0121 454 3680 or email us.

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Mommy Makeover, 1 Op or 2?

Mommy Makeover In Birmingham

DOWNLOAD OUR TUMMY TUCK GUIDE

DOWNLOAD OUR BREAST LIFT GUIDE

DOWNLOAD OUR BREAST IMPLANT GUIDE

The Mommy Makeover is a term popularised by our American colleagues (hence the ‘o’ in Mummy) and is used to describe plastic surgery operations of the breast and abdomen combined.
The abdominal operation would usually be a tummy tuck or a mini tummy tuck and the breast operation could be a breast lift, breast reduction, breast implants or breast lift with implants. It is so called because it is surgery that might be needed following pregnancy due to stretching and descent of tummy and the breast.

However, the Mommy Makeover is not limited to post-pregnancy women and may be required by anyone who has had significant weight loss, because this too will cause the tissues to stretch and descend causing a redundant apron of skin in the abdomen and droopy breasts that have lost volume.

A Mommy Makeover is a significant operation, that is something that we quite commonly perform here at The STAIANO Clinic. You would need a full and frank discussion with your Surgeon, in fact you would normally need more than one consultation to go over all the pros and cons of having a Mommy Makeover, rather than having a tummy tuck and breast surgery at different times. As is the case with most things in plastic surgery, there are no right or wrongs. It is a question of weighing up the benefits against the risks to see what would be right for you.

OPERATION TIME

Tummy tuck and breast reshaping operations done separately are relatively major undertakings, and so to combine them does make it into quite a big operation. Either operating time would be longer than either one separately, but it would be slightly less than the time taken for each combined. Much of the time during surgery is involved in setting up, prepping and draping and anaesthetic time, and so there will be economies in performing it all in one go. However, the length of time of anaesthetic for a Mommy Makeover is usually between 5 and 8 hours and so this can knock you back and you will need to factor in adequate time for recovery.

RECOVERY

Again, the recovery following Mommy Makeover is much less than the tummy tuck and breast shaping if performed separately because your abdomen would be healing at the same time as your breasts, so essentially there is only one recovery period which is not much longer than it would be if you were having a tummy tuck on its own. This means that the time off work following a Mommy Makeover would be much less than if you were to have two operations and it might be easier for your employer if you were to take just one period of sick leave.

COMPLICATONS

Tummy tuck and breast reshaping surgery are not without their complications and you must be aware of this before contemplating surgery. There will be several wounds to heal and so the risk of some wound healing problems is greater than each separately, but no more than them combined. In fact, if there is a minor wound healing problem in the tummy or the breast then they can both be healing at the same time and so while the rate of complications might not be less, if you do get a complication in both areas, it can be easier to deal with as complications usually involve things like minor wound breakdown requiring dressing. Clearly, if you had a major complication in both areas it would be difficult to cope with, but fortunately the scenario is rare. As I mentioned the anaesthetic is quite long for a Mommy Makeover, but from an anaesthetic point of view it is safer to have one slightly longer anaesthetic than two shorter ones. It is a bit like air travel where the danger times are take-off and landing, it does not matter that much how long you are flying for. Similarly, for a general anaesthetic, dangerous times are on induction and when waking up from an anaesthetic.

PSYCHOLOGICAL ASPECTS

The psychological aspects of cosmetic surgery should not be under-estimated and any time you are changing the shape of your body there will be an emotional element to deal with. It can be a rollercoaster because in the initial post-operative stages the tissues are swollen, the scars are fresh and it is not uncommon for one side to behave differently to the other giving asymmetry. Most of these things settle but can take many months to do so and so you need to work closely with your Surgeon for the support to get you through this period.

Breast reshaping or a tummy tuck can induce immense psychological and emotional changes usually very positive, but can be difficult to acclimatise to particularly in the early stages. You may struggle to cope physically or emotionally and it is always best to address these issues before surgery and here at The STAIANO Clinic we have dedicated Counsellors who can help to support you, as well as the office and nursing team who will be with you throughout your experience.

If you feel that a Mommy Makeover is too much to take on then do not worry, it is very common to have the procedures in two stages, and to simply deal with the area of most concern in the first instance and recover and then consider having the other area done. This can be months or even years later depending on how you feel.

COST

There is a cost saving to having a Mommy Makeover compared to having the operations separately. It may not be as dramatic as you might think. The time spent in the operating theatre is very expensive and so the fact that the operating time is slightly reduced does have a bearing on the final cost. However, there is often not a dramatic difference in hospital stay as the tummy tuck usually has a 2 night hospital stay and breast reshaping a 1 night hospital stay, whereas a Mommy Makeover would be a 3 night hospital stay on average. And so, whilst there is a reduction in the overall cost this will probably not be the sole reason for choosing a Mommy Makeover. The other thing to consider is that payment is all required up front, whereas if you were to stage the procedures you would have time in between to prepare for the cost, although the hospital’s do provide 12 month interest free credit to help you spread the payments for any cosmetic procedure.

In summary…

I think it comes down to the individual as to whether you think a Mommy Makeover might be right for you. If you want one period of recovery and feel mentally and physically prepared for the changes that will take place, then there are definite benefits in having one period off work and one period of recovery and healing. However, if you are unsure or have one overwhelming area that you would like addressed then it might be worth having this addressed first and seeing how that heals and how you recover from it before considering having the other area dealt with.
If you want more information then please visit our pages on:

Breast Reduction, Breast Lift, Breast Augmentation and Tummy Tucks

Or, if you have any questions, then Jonathan is on Facebook Live every Tuesday night at 7 pm. Or you can email the Clinic or give us a call on 0121-454 3680 with any questions, we would love to hear from you.

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Breast Uplift With Implants

Have you been looking for more information on having a breast uplift with implants?

In this video Jonathan talks about the combined procedure of having a breast uplift with implants.

Not all plastic surgeons will perform the operation of a breast uplift with implants because it is a difficult operation with a relatively high complication rate.

Here at The Staiano Clinic, we do offer breast uplift with implants as a single operation, but we discuss the potential risks as well as the benefits of performing it in a single operation.
Like many things in plastic surgery, there are no rights or wrongs and it is up to you as an individual to get as much information as you can to allow you to make a balanced decision about what is right for you.
There is no doubt that a breast uplift with implants can produce dramatic changes to the breast and in selected cases is the best way to improve the shape of the breasts.  However, you might want to consider either staging the procedure or maybe even just having a breast uplift or breast implants as you may be happy once the shape or the volume have been improved.
Listen to Jonathan discuss the benefits and risks of a breast uplift with implants with examples of his work.

If you have any questions, you can find Jonathan on Facebook Live every Tuesday at 7pm for a live Q&A, so please like our page and join in.
If you would like any further information, please visit our page at https://www.staianoplasticsurgery.co.uk/breast-lift.
You can also call us on 0121 454 3680 or email: info@staianoplasticsurgery.co.uk

Capsular Contracture After Breast Augmentation.

What is capsular contracture?

Capsular contracture can happen to breast implants over time.

All implants have a capsule that forms around them.

A capsule is made up of scar tissue and it is the body’s reaction to the implant.

It is a normal reaction and it happens to all implants, no matter where they are in the body – in your hip, or your heart, in your chin or your eye.

The capsule is normal scar tissue and is nothing to worry about.

Over time the capsule (like all scar tissue) tends to contract and it is the capsular contracture that is the problem.

The problem is not with the implant, the problem is with the scar tissue that forms around the implant.

If an implant is solid like a hip implant or a chin implant, the contracture of the scar tissue does not have much of an effect on the implant.
However if the implant is soft, like a breast implant, then the contracture does have a constricting effect on the implant and this is what causes the problem.

 

Breast implant having been removed from its surrounding capsule, seen side by side.

Capsular contracture is a progressive condition and over time, the implant can start to feel hard, then it can start to look ’rounded’ and then it becomes uncomfortable.
That is the natural history of capsular contracture.
Capsular contracture is graded according to the following scale (Baker classification):

  1. Grade I capsular contracture: you cannot see or feel your breast implants (i.e. everybody has at least a Grade I capsule)
  2. Grade II capsular contracture: you can feel but you cannot see your breast implants
  3. Grade III capsular contracture: you can feel and see your breast implants
  4. Grade IV capsular contracture: your breast implants feel painful

No matter what the shape or profile of your implant, when the scar tissue contracts around it, it becomes spherical, like a ball.

This can make your breast look unsightly and feel uncomfortable.

For whatever reason, capsular contracture often only happens on one side which can lead to your breasts looking asymmetrical.

 

Capsular contracture is a progressive condition but it is usually very slow to progress.
Capsular contracture does not need to be treated and it is your choice whether you have your implants replaced.

Prevention of capsular contracture

There are a number of potential causes for capsular contracture that we work hard to avoid in order to minimise the risk of capsular contracture.

Small amounts of infection around the breast implant or a collection of blood around the implant (haematoma) can predispose to capsular contracture.

We do everything we can to minimise the risk of infection with breast implants and are very careful to control any bleeding at the time of surgery.

Fortunately the risk of infection and haematoma are very low after breast implant surgery.

Using textured rather than smooth breast implants and placing the implants under the muscle has also been shown to reduce the risk of capsular contracture, but probably the most significant thing that you can do to reduce the risk of developing capsular contracture is to use polyurethane foam coated breast implants.

These implants have not been widely adopted in the U.K. but have a been used in hundreds of thousands of women worldwide.

They are controversial and like most things, they have pros and cons and you can read my blog post about them here.

I think they are good implants and I use them a lot because I do not want my patients to have problems with capsular contracture in the future, but I discuss the risks and the benefits with everyone because ultimately it is your decision as to what type of implant that you have in your body and you need to be comfortable with the choice.

Treatment of capsular contracture

The good news is that capsular contracture is not a harmful condition and it is perfectly acceptable to leave it alone.

It does tend to be a progressive condition and so will probably get worse, but progression is usually slow and it can take many years for it to develop.

The bad news is that the only effective treatment of capsular contracture is surgery.

There are no tablets or creams or any other cures that have been shown to be effective in the treatment of capsular contracture.

Surgery involves removing the capsule (capsulectomy) and replacement of the breast implants.

This surgery is more extensive than the original surgery to insert the breast implants and so it is more expensive and because it is more extensive, it is more traumatic and creates more scar tissue.

Because capsular contracture happens in the first place because of scar tissue forming around the implant, another capsular contracture happens quicker after a capsulectomy and implant replacement than it does after the initial breast implant operation.

For this reason, my advice to patients is always to wait as long as possible before undergoing a capsulectomy in order to minimise the number of operations to your breast in your lifetime.

The type of surgery that can be performed on the capsule could be:

 

Capsulectomy

this is removal of the capsular tissue and can be partial or complete.  This can be quite an extensive operation and there is a risk of bleeding that can form a haematoma and cause the breast to swell up. This would require another visit to the operating theatre to evacuate and wash out the haematoma.

Capsulotomy

this is scoring of the capsule to release it and allow it to expand if a new implant is being placed (note, if you are changing from a silicone to a polyurethane implant, then a total capsulectomy should be performed to allow virgin tissue around the polyurethane implant to grow in to it).  This is usually performed in cases where there is only a mild form of capsular contracture otherwise capsulectomy would be needed.

Capsulorrhaphy

this involves using the thick tissue of the capsule to suture together areas of the breast pocket to manipulate the shape and appearance of the breast.

This is usually required in situations where the implants are being replaced because they are not sitting well in the breast pocket.
They could be:

  • Too high
  • Too low
  • Too far out to the side
  • Too close together in the middle (synmastia)

It may also be required if the implants are being replaced for smaller implants because the breast pocket may be too big.

The other situation where capsulorrhapy is useful is where there is a poor definition of the inframammary fold.  The inframammary fold is a very important feature of the breast as any surgeon who performs breast reconstruction after mastectomy will tell you.

A very important part of breast reconstruction is to recreate the inframammary fold and these techniques used in breast reconstruction can be transferred to cosmetic breast surgery if needed.

The inframammary fold is the part of the breast where a wire of a wired bra would sit.  If you look at the shape of a breast, it is not simply a dome on the chest wall.  In the upper part, there is a smooth transition from the upper chest to the upper pole of the breast, but it is important to avoid this shape in the lower pole.

The lower part of the breast has a defined and crisp fold which gives a natural shape to the breast as it sits on the chest wall.

This is important, not only so that the wire of a wired bra sits comfortably, but also to give a normal and natural look to the breast. If there is blunting of the sharp angle at the inframammary fold, then the breast lacks aesthetic appeal.

It can be difficult to recreate the inframammary fold in situations where it is not well defined, either following breast enlargement surgery or as a result of your natural breast shape.  This can involve a combination of internal sutures and capsulorrhaphy.

Want to know more about Capsular Contracture?

If you have any questions about capsular contracture or if you are worried about your breast implants, then you can get in touch with us here.

If you would like a free copy of our Breast Implants Guide, then you can request one here.

You can also see Mr Staiano, our director, on Facebook Live every Tuesday evening at 7pm, so you can ask questions there or post your questions to laura@staianoplasticsurgery.estaging.co.uk beforehand using the hashtag #AskJJ.

B-Lite Implants – Should we be protecting our patients from them?

I was very pleased to see the arrival of B-Lite implants recently on visiting one of our plastic surgery conferences.
The concept of manufacturing an implant that is lighter than the standard silicone implant is something that I heard about some time ago.
I talk about them in one of my Facebook Live Q&A’s here:

When I discussed this amongst a panel of experts I was in a few years ago, we were uniformly agreed that it would be beneficial if there could be a lightweight implant.
My patients often comment on the weight of implants and although I am always quick to point out that they feel heavier when you hold them in your hand compared to when they are in your body (because of the moment effect, see below). Nonetheless, they do still have a weight and obviously the bigger the implant the heavier they are.

B-Lite Implants – The Moment Effect

The moment effect is something that you might have heard about from your maths lessons and it is the concept that when a weight is held further away from a pivot point it creates a greater downward force than when it is closer to the pivot point.

This is why when you hold a box out with your arms stretched it feels heavier than if you hold it close to your body and so when breast implants are held in your hand or placed in your bra they feel heavier than when they are implanted in your chest and therefore closer to your body.

There is no doubt that breast implants alleviate a huge amount of suffering and unhappiness by restoring volume and shape to the breasts.

However, it is also true that carrying excess weight in your breasts can be uncomfortable which is why breast reduction surgery has such a high patient satisfaction rate.

The B-Lite implants are now available in the UK and you might think:

Great, we no longer use standard implants anymore.

However, you will find that we are very cautious about introducing new things, particularly in medicine.

This is particularly true in the field of breast implants with the recent PIP scandal although the PIP scandal was not created because a new implant was introduced to the market.

The PIP scandal was created because of criminal activity of an implant manufacturer in France.

Nevertheless, it has tainted the whole industry and made everyone even more cautious than they already were.

I am a believer in offering my patients all the available options which is why for some time now I have offered polyurethane foam implants where many of my colleagues do not even inform patients of their existence because they do not use them.

This is how I feel about the B-Lite implants.

They are new and I tell everyone that they are new and they are also more expensive than standard implants and so they may not be for everyone.

I also have to say that in my practice I do not tend to use very large implants as most of my patients are looking for a natural result in keeping with their frame.

I do not really see patients who have problems with the weight of their implants.

Having said that I am happy to talk about them although I do not necessarily recommend them because we do not have a large experience of their use and so we do not know what the results will be like in 5 or 10 years.

On talking to some of my colleagues, I know that they do not offer or mention these implants for this very reason because they want to see the long-term results.

This is perfectly understandable.

However, it does leave me to think whether we can be too paternalistic towards our patients sometimes.

As doctors go, I see myself as being on the conservative side.

I am not one to embrace new technologies or devices as any rep who has come to see me will tell you.

I certainly do not believe in trying to look for solutions to problems that do not exist.

In my breast reconstruction practice there are always new types of mesh or glue that are being introduced and claims that they will transform the operative time or the postoperative stay.

I have never been one to adopt them and would rather see the outcome through long term patient studies.

This is why I found it odd to be at the other end of the argument with the B-Lite implants and my colleagues were saying that they prefer to wait and see long term results.

I think the difference is that there is a significant element of patient choice when it comes to implant selection which is not true in breast reconstruction.

When it comes to selection of type of suture or mesh or whether glue is used or not with a reconstruction, I do not feel that the patient will have a significant opinion on this, so I feel I can make that decision on my own without involving the patient.

There are many patients who are happy to leave it up to the surgeon as to the type of implant too, but then there are also those who get very involved with the implant selection.

This is understandable because it is something that is going to go into their body for a very long time.

I do my best to facilitate the decision and present the pros and cons of each type of implant and I certainly have my own preferred makes and manufacturers but I am not tied to any particular make and so happy to discuss and offer any of the implants available as I have used most of them.

This is how I feel about B-Lite implants and I simply inform patients that they exist and give them as much evidence as I can so they can make an informed decision as to whether it is something that might be right for them or not.

It is not like they are a prototype or unlicensed, as they have all the relevant approval to be used in the UK. They are actually made in the Polytech factory which makes the polyurethane implants that we use.

I know that patients can be swayed by what we say and there is a lot of hyperbole used in breast augmentation surgery talking about the best method for this or the most advanced technique for that, but when it comes down to it, there is often no strong scientific evidence to support one method or technique over another and it is just an opinion, not facts.

Our job as doctors is to work through the opinion and look at the facts.

I also think our job is to pass those facts on to you to help you make a balanced and informed decision.

I will continue to mention B-Lite implants to my patients and give my opinion, but I will try not to sway you one way or another.

Download our FREE Guide: BREAST IMPLANTS – YOUR QUESTIONS ANSWERED