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How to treat Breast Asymmetry

We specialise in breast reshaping here at the STAIANO Clinic and can perform breast lifts, breast reductions, breast implants and breast lift with implants.

There are many cosmetic clinics which offer breast implants but not all will treat patients with more complicated problems.
Patients with breast asymmetry will often present for surgery.

The first question we would ask is:

Are you happy with either of your breasts or do you want them both changed?

If we can just operate on one side then this will lower the risk of complications and be beneficial for all.

It may not always be possible to just operate on one side, particularly if one breast is sitting lower than the other one with uneven heights of the nipples.

It is possible to lift the nipple, but it is not possible to lower a nipple (at least not without leaving a scar where the nipple was). So we can raise the low one, but is extremely difficult to lower the high one.

The next question to ask is:

Is there a problem with the shape, the volume or both?

In general terms, problems with the shape involve a breast lift and problems with the volume involve breast implants or breast reduction, (depending whether you want them bigger or smaller).

Surgery for breast asymmetry usually involves a combination of breast implants, breast lift and sometimes breast reduction.

Different things need to be done to each breast and so there is always a risk that they will settle differently and you may have to accept some degree of asymmetry.

Everybody is born with a degree of asymmetry and this is quite natural.

What we aim to do with surgery for breast asymmetry is to bring your breasts and your frame back into balance and make it easier for you to wear clothes and bras without needing to use a chicken fillet or external prosthesis in one side.

If you have different size breasts with one sitting lower than the other (usually the bigger one), you could have them made the same size by using different size implants.

The implants come in set volumes and so we would be unlikely to make them identical and would usually need to use a sizer in theatre to work out the best match.

The implants would not do anything about the shape of your breasts and so one would still be sitting lower than the other.

This would probably not be in issue when wearing clothes but may be an issue out of clothes.

In order to correct this you would need a lift of the breast that was sitting lower, which is usually the bigger one and so it would also be possible to perform a reduction at the same time as the lift to balance out the volume.

Then we could use the same size implant in each side.

This is something that we could discuss in the clinic and there is no right or wrong answer.

Some patients would prefer not to have breast tissue removed and then replaced with an implant and would prefer different sized implants.

Others would rather have a reduction to match the size and the same size implants so as you age or undergo weight fluctuations, it is more likely to have a symmetrical change in your breasts.

Treatment of breast asymmetry is complicated and requires a bespoke approach and a partnership between the surgeon and the patient so that a plan can be made that can produce a realistic expectation with acceptable risks and an acknowledgement of the limitations of what we can do.

If you have a breast asymmetry and have any specific questions then I do a live Q&A every Tuesday at 7pm on Facebook and I would be happy to give my opinion.
If you want to come to the clinic for a consultation then you can contact us here or phone (0121) 454 3680. We would love to see you.

You can download my breast implant guide here.

You can download my breast reduction and breast lift guides.

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The risks of cosmetic surgery

Every day I hear patients talk about the risks of having cosmetic surgery.

They are worried that they won’t wake up from the anaesthetic and will leave their children motherless.

They tell me stories they have heard about someone who once died having a cosmetic procedure.

I sense that there is often a feeling of guilt particularly when parents are having cosmetic surgery because they feel that they should be spending the money on their children and it is selfish.

I can totally understand these feelings.

I think they are based on the notion that somehow cosmetic surgery is less worthy than other types of surgery.

I am the first to point out to patients the risks of having cosmetic surgery and I think it is essential that you are fully informed to allow you to make a balanced decision.

However the decision has to be balanced.

Unfortunately we are fighting against the media who can portray an unbalanced view.

The fact that there is a television series called ‘Botched’ tells us that we love stories of when things go wrong and we love to see images of people who have come to harm having cosmetic surgery.

However in the day-to-day practice of cosmetic surgery and certainly in terms of the complication rates of this sort of surgery, the actual risk of coming to harm is extremely small.

We have to appreciate that there are risks with any surgery and indeed with any undertaking in life.
Crossing the road, driving a car, having a shower or even putting your socks on is associated with the potential to come to harm and yet whilst we all know the risks we accept that they are small and so we can balance them against the decision of wearing socks or smelling nice or reaching our destination.

The other reason that I feel patients often make unbalanced judgements about having cosmetic surgery is that our society does not value mental health on equal terms with physical health.

You just have to see how someone is treated in the workplace if they return from having a period off for stress compared with if they return from having a period off following a broken leg.

Your colleagues will be forthcoming to make sure you can rest with your leg up and to see if they can get you any lunch if you’ve broken your leg and yet we struggle to engage or to know what to say when someone is suffering with a mental health problem.

By the same token if you’re having surgery to improve your feeling of self-esteem, it is deemed somehow less worthy than if you are having surgery to improve a physical element such as a hernia repair or surgery for indigestion or headaches.

There are risks with any surgery yet we wouldn’t feel the same way about leaving our children behind or feeling selfish if we were having a hernia repaired which was uncomfortable and affecting our quality of life.

Yet if we are having a breast reduction which may be equally uncomfortable and perhaps even more so, we somehow feel that this is less necessary and are likely to experience more guilt over it.

Cosmetic surgery has a bad name, but it is never just cosmetic.

There are always emotional and psychological elements and there is no doubt you can have a tremendous benefit in terms of improvement in quality-of-life and feeling of well-being.

The media portrayal of what cosmetic surgery involves is nothing like the day-to-day practice of most plastic surgeons in the UK.

I am passionate about raising awareness of the real side of cosmetic surgery and the real people that I can help.

On Wednesday, the 29th of January I am holding an event in my clinic in Birmingham where I will be talking about breast implants which have come under a lot of scrutiny recently.

I will be presenting a balanced view about all of the controversies and complications associated with breast implants to allow you to balance this with the benefits that you might hope to achieve by having breast implants.

The event is free and you be welcome to bring a friend. If you want to come along then please let me know.

You can leave a comment on this post or email me at info@staianoplasticsurgery.co.uk or call (0121) 454 3680.

Please comment below and I hope to see you there.

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Smooth Breast Implants

There has been a resurgence recently in the use of smooth breast implants for breast enlargement.

Breast implants were invented in 1961 and the first manifestation of them had a smooth shell.

This was not adherent when placed inside the breast and had a tendency to move and for visible rippling.

In 1968 polyurethane foam implants were introduced which consisted of a silicone implant surrounded by a three-dimensional foam.

The scar tissue would grow into the foam rather than forming a smooth shell around the implant and so when it contracted, it was broken up by the foam and it did not compress the implant and make it feel hard.

In the 1990s there was controversy about polyurethane implants and they were withdrawn from the market for a period of time.

It was recognised that the roughness of the foam was beneficial in the development of capsular contracture and so the shell of smooth implants was roughened in a process known as ‘texturing‘ to roughen the surface and mimic polyurethane foam.

In the UK, textured silicone implants have been the mainstay for breast enlargement with only a minority of cases performed with smooth silicone implants.

Until now…

ALCL is a cancer of the capsule around breast implants and has been associated with the texturing of the implant.

For a long time there were no cases of ALCL in patients with smooth breast implants.

There are some now, but it is a lot less likely to occur in patients with smooth breast implants compared to those with textured or polyurethane foam implants.

For this reason, many surgeons are moving towards smooth breast implants rather than textured breast implants.

Time will tell whether we start to see more problems with rippling or capsular contracture.

Here at the STAIANO Clinic, we are not tied to any make or manufacturer of breast implants.

We will talk to you about the pros and cons of smooth implants, textured implants and polyurethane foam implants so that you can make the best decision for you.

There are risks of using smooth implants which is why they were modified in the early days of implant development.

However there is now the benefit of the low risk of ALCL which needs to be balanced against these risks.

If you have any questions about breast implants you can download my guide with Frequently Asked Questions here or join me on Facebook LIVE at 7pm every Tuesday evening when I hold a Q&A every week.

I am holding a breast implant event from 5-7pm on Wednesday January 29th 2020 if you have any questions about breast implants and want to learn about the pros and cons of the different types of implants as well as alternatives to having breast implants at all.

Feel free to come along and please bring a friend. There is no need to book but if you book in advance, you can have a free sizing session with our clinic nurse Vicki.

BOOK HERE

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

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Why Would Anyone Have Breast Implants?

Why Would Anyone Ever Want To Have Breast Implants?

I keep seeing adverse publicity about breast implants in the media.

Whether it be breast implant illness, ALCL or a celebrity with out of proportion breast implants or with visible rippling or strange looking breasts.

The media seems to love to focus on the negative aspects of cosmetic surgery and breast implants in particular.

Someone who would not consider having breast implants might be forgiven for wondering why anyone would go through with such a procedure.

What the media failed to focus on is the positive effects that breast implants can be bring.

Any responsible surgeon will tell every patient the risks as well as the benefits of having surgery.

Breast Implants, Like Any Surgery, Carry A Risk

 In the same way that there are potential downsides of having a hip replacement or open-heart surgery, there are also benefits and it is ultimately up to the patient to weigh the risks against the benefits and decide whether surgery is right for them.

If the media focused on a patient with an infected hip replacement or a failed coronary artery bypass graft you might be extremely nervous if you are thinking of having these procedures.
However the reality is that the vast majority of operations produce far greater benefit than harm.
I’m not trying to justify breast implant surgery or make out as if there aren’t negatives.

There is no doubt that there are people who have been unhappy with having implants but what I would like to see is balance in the media proportionate to the outcomes that can be achieved.

The mother who has had children or a young woman who has always felt out of proportion can gain immense emotional as well as physical benefits from restoring volume and shape to their breasts.

…but this would not make a very compelling magazine article.

Base Your Decisions On Facts

The things that I hear about in the media such as breast implant illness, ALCL or implant rupture are not things that I see on any sort of regular basis in the clinic.

You need to make an informed decision if you’re considering having breast implants but make sure you base that decision on evidence and facts rather than articles or personal opinions.

There is no doubt that there are potential downsides of having breast implants but the patients who really benefit are the ones that accept and acknowledge these downsides but also realise the tremendous upside that can be achieved with what is at the end of the day, a relatively simple operation.
Don’t take my word for it, do you research but try to make sure that you base your decisions on the best evidence that you can find rather than opinion in a glossy magazine.

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Special Announcement re: Breast Implants

You may have heard news about a recent decision by the French authorities to withdraw certain types of breast implants from the market.

The implants affected are textured silicone and polyurethane foam implants.

The decision has been made because of a link between this type of implant and a rare form of cancer called ALCL.

Because the risk of ALCL seems to be related to the textured surface of the breast implants, they are suggesting that smooth implants should be used instead.

ALCL is not breast cancer and I wrote a blog post about it two years ago.

Our plastic surgery associations have produced a press release that you can read here.

There is no suggestion that anyone with breast implants should have the implants removed but they do say that patients should be informed of the symptoms of ALCL, which are a lump or swelling of the breast and if this occurs, to seek the help and advice of the implanting surgeon.

I would always encourage our patients to keep under regular follow up with us and if you have any symptoms or concerns, please get in touch as we would be happy to see you.

We have known about ALCL for some time and you may ask

‘why do we continue to use textured and polyurethane foam implants?’

This is a question that I will talk about in person on my Facebook Live broadcast at 7pm, so please join me and feel free to ask me any questions directly, or email me back and I will be happy to discuss this.

My personal view and the view of ISAPS (the International Society of Aesthetic Plastic Surgeons) is that it is the wrong decision to withdraw these implants from the market because they have well proven benefits over smooth implants.

 

“We believe that this is the wrong approach and less satisfactory for our patients”

Dirk Richter, MD, ISAPS President

 

Smooth breast implants were the first generation of breast implants and since their development, they have undergone many generations and improvements, largely in terms of their texturing and coating.

Textured and polyurethane foam implants have proven benefits in terms of greater stability, less chance of movement and rotation and less chance of capsular contracture.

These benefits should be weighed against the risk of ALCL, which is extremely small and studies have shown that the risk of ALCL is much less than risks that we all take daily like driving a car or going skiing on holiday.

We constantly weigh up risks in our lives and should be given enough information in order to make a balanced decision.

This is the basis of informed consent.

UK and the rest of Europe will continue to offer textured and polyurethane foam implants as well as smooth implants to patients and this is the practice we will follow at The STAIANO Clinic.

I believe that we should offer all options to our patients and allow them to make a balanced decision about what is right for them.

I hope that we can maintain an educated and informed response to this situation and not lose sight of the tremendous benefits associated with breast implants and the extremely low risk of ALCL as well as its very good prognosis in the rare cases where it is diagnosed.

I will keep you informed of any updates or developments as I hear about them.

Who makes the best breast implants?

The Best Breast Implant?

Patients do a huge amount of research about the best breast implant.  It is good to be informed before having breast augmentation and in this day and age with the internet and information that is freely available, it is reasonable to come to the clinic armed with ideas and expectations of which implant you would like.

We encourage this and one of the unique things about the clinic is that we are all fully trained plastic surgeons, so I feel that we appeal to a group of patients who do tend to research things a bit more and will choose a clinic based on the experience, expertise, and aftercare, rather than purely the price.

However, when it comes to the ‘best breast implant’, I do think that patients can tend to over-estimate the importance of certain aspects.

I often hear them asking for a certain make of implant because they have been told they are the best.

Now if you think about what a breast implant is, it is a silicone shell filled with silicone gel, the gel inside the implant comes from one factory in Texas, so regardless of the make they all have the same gel and the shell is either textured, smooth or polyurethane foam.

There is not a great deal to distinguish between different makes of smooth implants, and whilst there are some differences in the texturing between different makes of implant, I am not sure whether it would be enough to say that one is the better than another.  If you want polyurethane implants, then there is only one manufacturer in the world who makes them, Polytech, so you have no choice!

If there was one manufacturer that was best, we would all use it, but the reality is that there are several very good well-respected manufacturers all of whom make high quality implants.

Trust me, if one make was the best we would be using it.

It is a bit like suggesting that one make of car is better than another.

Is BMW better than Mercedes?

What it often comes down it is actually a model.

It is hard to compare a two-seater sporty BMW with an enormous Mercedes 4 x 4 SUV, but just like choosing a car, you need to think about what sort of model you want, what sort of shape you want, and what sort of look you are trying to achieve, and this is going to affect the outcome much more than the actual manufacturer of the implants.

You can see in the video below, I discuss the importance of the shape and profile of the implant in achieving the final result.

It is not enough just to choose a certain shape and profile for an individual, because that shape and profile has to be matched to your body frame in terms of the dimensions of your chest and the shape and volume of the breasts that you have currently.  The best breast implant for one person may not be the best breast implant for you, even if you think that person has a great result.

This is why it is so hard to give an opinion to someone in an on-line chat or in a forum, because we would need to see you, measure you, and formulate a plan to decide on the best breast implant which is unique to you.

We won’t tell you what implant to have, but we will help you come to a decision as to what implant might be the best for your frame.

In fact, I always say that the most important decision is not about choosing the best breast implant.

The most important decision is your surgeon; it does not matter what make or shape of implant you have, if it is not placed correctly it will not look good.

If the implant is placed too high or too level, too wide apart or too close together, you will be unhappy with the result regardless of the make, shape, profile, or texturing.
This is the decision that is going to make a tangible difference to the outcome that you get.

So, choose your surgeon wisely, both in terms of their qualifications and experience, but also in terms of their personality and your rapport with them.

I do not think you can underestimate the gut feeling that you get when you see a surgeon, because whilst it is only a one-off operation, we do like to keep an eye on you and see you for months and years afterwards.

It is important that you feel you can talk to us, raising any questions or concerns, and convey your desired results to us.

If you do not feel that you can, then I suggest you keep looking.

There are plenty of fully qualified plastic surgeons around.

As long as you choose someone who is or has been an NHS consultant in plastic surgery, then you can be sure they are fully trained.

If you want to know more about what is involved in plastic surgery during the training and how to choose a plastic surgeon, you can get a free copy of my book from my website entitled ‘Never Accept A Lift From Strangers, and if you have any questions, you can find me on Facebook every Tuesday night at 7 o’clock and I would be happy to answer them.

But whilst it is important that you are happy with the manufacturer, shape, the texture, and the profile, and all the aspects of your implant choice, please try not to worry about it too much as it might not be as important as you think.

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Panorama and the breast implant scandal

There has just been a Panorama documentary on about the ‘scandal around breast implants‘.

This is obviously of great interest to us because we specialise in cosmetic breast surgery and use a lot of breast implants.

I certainly do not want to appear that I am trying to play down any adverse reports or cover up what is purposed to be issues associated with breast implants.

However, as someone who is closely involved with both the science and the practical aspects of breast implant technology, I want to ensure you that we are up-to-date with the latest information and that we are not doing anything to put patients in harm’s way.

I am constantly trying to combat the stereotype of the plastic surgeon who is arrogant and does not care about his patients’ wishes.

This is not a stereotype that I recognise in my own practice or my colleagues.

They have to remember we are doctors first and most of us went into medicine because we want to help people.

I find plastic surgery an immensely rewarding speciality, and now that I sub-specialise in cosmetic surgery rather than reconstructive surgery, I do not find it any less worthwhile or indeed challenging.

The goal is, and always has been, to have a happy patient and I would never do anything if I thought that the patient be anything less than completely over the moon with the results that I have given, and so the suggestion that there is some kind of scandal or cover up about harmful effects of breast implants, is something that I find difficult to reconcile.

We frequently turn patients away who come seeking treatments if we do not feel that they would benefit from them.

There is no doubt that there are risks with breast implants as there are with any surgery, and these are fully discussed at the consultation and in the literature that we give the patients at every step of the proceedings.

The issue of ALCL, a type of breast cancer associated with breast implants has been raised and this is something that we have known about for some time and we discuss fully with patients during the consultation.
The concept of breast implant illness has also been highlighted, and this is something that has been talked about ever since breast implants came out, and there has not been any scientific backing found to support the causation of systemic illnesses due to breast implants.

However, there is no doubt that there is anecdotal evidence and patients coming forward saying that their implants have made them feel ill and they feel better with their implants removed.

There is also now some statistical evidence to suggest there are increased rates of some illnesses in patients with breast implants (there are also significantly decreased rates of other illnesses in patients with breast implants), but these are difficult to interpret because there may be other variables, such as an increased risk of melanoma in patients with breast implants, which may be due to an increased tendency to sunbathe in the population of patients who have breast implants.

I have been asked about breast implant illness in the past and I give my honest answer, which is that I have never experienced it in a patient of mine having done hundreds of breast implant operations, but I have one patient who has had her implants removed due to pain and the pain was relieved with the implant removal.

I have also seen patients who have had surgery by others surgeons who have described feeling unwell and then feel better when the implants are removed.

However, this evidence has to be taken on the background of the many hundreds of patients in my practice, and many thousands, and tens of thousands of patients world-wide who have experienced tremendous benefits from having implants, which outweigh any small risks.

There is no doubt that we have to give information to patients so they can make a balanced and informed decision, but I am concerned that patients may feel that the risks are greater than they are, so a balanced and informed decision cannot be made.

There are risks with everything we do from crossing the road to frying an egg, which need to be balanced against the benefits so we can make our own mind up as to whether the risk is worth taking.

It is important that we put statistics in ways that people can understand, but at the same time we need to avoid putting them in a way that serves our own needs.

For instance, I hear that the risk of having rheumatoid arthritis in patients with breast implants is seven times that of the normal population which is alarming, but in fact the risk of getting rheumatoid arthritis is a fraction of a percent in patients with or without breast implants, so it is all a question of context.

The risk of developing lung cancer is nine times lower in patients who have breast implants in.

Again I do not think there is any suggestion that breast implants are protecting patients from lung cancer, more that the demographic of people having breast implants, may be inherently somehow the less likeliest to develop lung cancer, and so it is not an effect of the implants themselves, just of the type of person who has breast implants.

It is a difficult area because we have not found any cause or relationships and it is not that we are covering anything up, it is that we do not know.

Only recently has a National Implant Registry been re-introduced.  Before then, it was hard to get a handle on what was happening to patients with breast implants.

As doctors we are here to serve patients and improve quality of life and there is no way we would be doing things if we thought patients were going to come to harm or be unhappy.

It is a testament to the huge success of cosmetic surgery because it does, by and large, create a huge amount of happiness, self-esteem, and self-confidence, despite the media trying to portray it as being unnecessary and unsuccessful.

There is no question that we need to continue researching different ways of doing things and making sure that the things that we are doing are safe and effective.

As plastic surgeons we will be at the forefront of that research and will inform patients as and when we know the results, but we will try to avoid making alarmist conclusions on complex data and continue to do what is in the best interests of the patient.

If you have breast implants, whether you are a patient of mine or not, we would be very happy for you to get in touch if you have any questions or concerns.

You can also join me on Facebook where I do a live Q and A on Facebook every Tuesday at 7 p.m. where I will be available live to interact and discuss any issues and to answer them to the best of my knowledge and abilities.

Feel free to leave a comment below, or drop us an e-mail.

If you want to come for a free no obligation consultation with one of our plastic surgeons, please call or email us or fill in the on-line contact form.

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What causes rippling of breast implants?

Rippling of breast implants is one of those things that patients fear because it can cause an unsightly look and feel to the breast.

The cause of rippling is relatively simple.

If you look at any breast implant and hold it up vertically you will see that the shell will naturally cause ripples in the upper pole as the gel falls into the lower part of the implant and the upper part empties.

This is because there is an element of fluidity in the gel which makes the implant feel soft, and so without this attribute the implants would feel very hard.

Indeed if you look at a solid silicone prosthesis such as those used in calf implants or testicular implants, they do not show any signs of rippling but they feel very hard.

And so it is a balance between the composition of the implant and the amount of cover over the implant.

Some implants have softer gel than others, which you may think would be a good thing, but we are actually moving more towards firmer gels these days.

In medical terms this is known as cohesive gel or ‘form stable’.

These types of gel are safer if the shell ruptures because they do not leak liquid silicone and they are less prone to rippling.

The other element that is important to consider when thinking about rippling is the amount of soft tissue cover over the implant because all implants have this rippling in the shell to a greater or lesser degree, and the question is whether you can see the ripples and that is dependent on the amount of skin, fat, and breast tissue that is covering or ‘hiding’ the implant.

What can I do if I have rippling?
 
Rippling is actually quite a difficult problem to treat.  The two main areas to focus on are:

  1. The implant
  2. Soft tissue cover

The implant “ if you have a less cohesive implant and particularly if you have the saline filled implant which are the least cohesive of all, it may be possible to use a more cohesive filling which would feel firmer and ripple less.  Obviously the downside is that it may feel firmer and you might possibly be able to feel the edges and so there is a balance to be had.

Soft tissue cover “ it can be difficult to get more soft tissue cover particularly in a slim individual.

The first thing to consider is whether the implant is on top of or beneath the muscle.

If the implant is on top of the muscle, it would be possible to change the plane into a submuscular underneath the pectoralis major muscle, although the muscle only covers the implant in the upper part.

If there is visible rippling on the lateral aspect of the breast, then it is not really possible to cover this with muscle, and so this option is unavailable.

Of course the implant might be already under the muscle and so you might want to look at other options.

The best option in this situation is to perform fat grafting over the top of the implant to give it some more cover (of course you could put on weight, although I would not necessarily recommend this).

Fat grafting (link to the fat grafting page or the blog post) is a technique that involves removing fat from one area and then injecting it to another area.

It is particularly useful for localised areas of deformity or loss of soft tissue cover.

It can be tricky to inject the fat over the implant because the space between the implant and the skin is very small, which is why you have the rippling in the first place.

Nevertheless it is something that could be possible, although you would have to be aware of the risks and complications of this surgery because you would be injecting very close to the implant so there is a risk of damage to the implant shell and there is a risk of introducing infection, which could require the implant to be removed and so this is not to be taken on lightly.

Unfortunately there is no simple and quick fix for breast implant rippling, and so it needs a full and frank discussion with your plastic surgeon because it may be that leaving things as they are is a viable option.

If you have any questions about rippling of implants, then download our guide or contact us on the website or on Facebook where our director does a live Q and A on Facebook every Tuesday at 7 p.m.  Please visit our Facebook page if you would like to put a question directly to me.

Feel free to leave a comment below, or drop us an e-mail.

If you want to come for a free no obligation consultation with one of our plastic surgeons, please call or email us or fill in the on-line contact form.

When can I go back to work after surgery?

 The major surgery which we do at the Staiano Clinic, such as breast augmentation, breast reduction, breast lifts, gynaecomastia and tummy tucks have a dramatic effect on your body both physically and mentally and you should allow enough time to recover from them.

Surgery often involves tightening or stretching the skin, so it can feel tense and swollen for some time and you should avoid exerting yourself.
Not only does this run the risk of putting tension on the wound and the possibility of the wound not healing up as well as we would like, but it will also increase the swelling and the swelling can take some time to subside.

If you overdo it in the early stages then it can be a false economy in the long run and you would have been better off giving yourself more time to let things settle to start off with, and although cosmetic surgery has an image of a lunchtime procedure with no downtime, if you are seeking a dramatic change in the shape of your body then you should expect and plan for a period of rest and recuperation.

The First Week

The first week after surgery is always uncomfortable.

Everything feels tight and tender and you will not feel like doing much.

You will be able to potter around the house and look after yourself, but you should plan for little more.

After the first week you will come back to have the dressings removed and you usually do not need any dressings after this time.

However, everything will still be quite fragile and you should continue to take things easy in the second week, although you may be able to work from home for short periods.

Depending on the procedure you have had done and how you are feeling, you should be able to drive after two to three weeks although occasionally you are able to drive after one week.

You should always check with your car insurance company to make sure you are insured and talk to us as we will be able to guide you.

Every individual is different and you should listen to your body, so that if things are uncomfortable or start to swell, then you should ease off and rest.

It is important not to be too immobile and we always encourage you to keep your legs and arms moving, either by walking around or gently exercising while sitting, as well as taking deep breaths to expand up your lungs.

We encourage you to cough if you feel like you have anything on your chest.

After Two Weeks

After two weeks you may be able to resume gentle activities and you may be able to go back to work as long as it is not too strenuous.
If you have had surgery to your upper body, now is the time you can start exercising your lower body on the exercise bike or the stepper at the gym, but you should avoid too much activity with your arms.

Two To Four Weeks

Between two and four weeks you will start to feel better, although the scars will still be quite fragile and the tissues will still be quite swollen.
We normally advise people to wait at least four weeks before starting to massage their scars with cream, as they might be quite red and firm at this stage.

Four To Six Weeks

After around four to six weeks you can start engaging in more strenuous activities including heavy lifting or upper body exercises at the gym.  I would stress that this is the time to start these activities which does not mean that you should go straight in, doing the same level that you were pre-operatively.  It is merely that you can start to gently see how you feel and gradually build up.  If it is uncomfortable or the tissues swell then you should stop and give yourself more time to rest.

Three Months

It takes about three months before the shape and the scars really start to settle and there can be numbness or altered sensation, which can take many months to subside.

Twelve Months

At around twelve to eighteen months, you will be getting an idea of what the final results should be like, but it is not uncommon to still have some degree of settling after this.

We keep a close eye on you in the clinic and encourage you to get in touch if you have any concerns about how you are healing.  We realise that everyone is an individual and this is just guidance.
If you have any questions or concerns then we’d love to hear from you.  You can e-mail us or call us.
Or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.

Tuberous breast deformity

Tuberous Breast Deformity

 
Tuberous breast deformity is a term that I see quite a lot, particularly on blogs and forums.

It is used as a label to encompass quite a wide range of breast deformities.

Patients can get quite upset and anxious when they hear the term and think that there might be something wrong with them when they are given this diagnosis, but it is really just a term used to describe a combination of features of the breast and it is nothing to fear.
In fact, I often see people who have been labelled as having a tuberous breast deformity, when in its mildest forms, it is simply a variation of the normal breast shape.
At the end of the day, it does not really matter what label you are given and as doctors, we are beholden to treat the patient rather than the condition.
This means that if you are unhappy with the size and shape of your breasts it might be possible to do something to improve them, but if you are happy with things it does not matter whether you are told you have a tuberous breast deformity or not and I would suggest you are best off leaving things well alone.

Features Of The Tuberous Breast

The features of a tuberous breast deformity include deficiency in the lower pole of the breasts, so that the line from the nipple to the chest wall is much shorter than normal and the breast lacks the natural fullness in the lower part.
This often goes along with a raised or ill-defined inframammary fold (the fold where the bra sits).
The base of the breast is said to be constricted and the nipple areola complex is often enlarged and herniated, which means that the areola (the pigmented area around the nipple), can look puffy and prominent.
It is also often associated with breast asymmetry. 

Treatment Of The Tuberous Breast

Treatment, as with any form of breast re-shaping is aimed at targeting the patient desires.

In its mildest forms, breast implants alone may restore volume to the breasts and careful selection of shape and profile can restore a natural contour to the breast.
In more severe cases of tuberous breast deformity, expansion of the lower pole may be required.
This can be performed internally by using the same incision as used to put the breast implants in and releasing the lower gland to help the implant to expand the deficient lower pole.
It might also be necessary to perform some scoring internally to help expand the herniation of the nipple areola complex to give a smoother shape to the breast.
There is only so much that can be done by internal scoring and implants, and if a more comprehensive correction of the breast shape is required, then a breast lift can be performed to re-arrange the breast tissue, and it might be necessary to combine this with implants to add the volume.

In order to address the herniation of the nipple areola complex, an areola reduction might be required which is an integral part of a breast lift and this will leave a scar circumferentially around the areola.
It is hard to encompass all of the surgical options for tuberous breast deformity, particularly since in cases of asymmetry, different things may be required to be done to each breast.

Cost Of Correction Of Tuberous Breast Deformity

This means that it is difficult to provide an accurate quote for patients asking about the cost of correction of tuberous breast deformity as I discuss below (starts at 4;04):

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There is no substitute for a personal consultation with a Consultant Plastic Surgeon, and it is cases like these that are often best treated by surgeons who specialise in cosmetic breast surgery.

For more information about finding such a surgeon you can read my book ‘Never Accept a Lift from Strangers‘, which is available from Amazon or my website.

If you have any questions we’d love to hear from you.  You can e-mail us or call us.
Or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.