Cosmetic Breast Surgery A Patients Guide

Cosmetic Breast Surgery A Patient's Guide
Edition 1 July 2009 For Electronic Download Copyright 2009 by Allen Rezai MD and Cosmetic Surgery Specialists
Published by Cosmetic Surgery Specialists 40 Harley Street London W G !PP "nited #ingdom
All rights reser$ed% &'cept as detailed belo() no part o* this electronic boo+let may be reproduced in (hole or in part (ithout (ritten permission *rom the publisher) e'cept by re$ie(ers (ho may ,uote short e'tracts in connection (ith a re$ie( in a ne(spaper) maga-ine or electronic publication% .his electronic boo+let can be gi$en a(ay and shared electronically $ia the /nternet) but it can not be sold *or pro*it and it can not be supplied in printable *orm% /n all such cases) the boo+let should be reproduced in its entirety and all authorship and copyright notices should remain intact% While the author and publisher ha$e endea$oured to ensure that in*ormation presented is accurate and up0to0date) they shall not be held responsible *or any ad$erse e**ects or conse,uences sustained by anyone using this material% .he reader is encouraged to see+ competent) pro*essional medical ad$ice (hen considering any *orm o* cosmetic plastic surgery% 1or *urther in*ormation) readers can contact 2r 3e-ai directly at his surgery4 Cosmetic Surgery Specialists 40 Harley Street London W G !PP "nited #ingdom .elephone4 544 60780 9:;0 ;00 Clic+ing the *ollo(ing lin+ (ill ta+e you directly to 2r 3e-ai's (ebsite4
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Contents
Contents................................................................................................................................................3 Introduction..........................................................................................................................................5 About t e Aut or..................................................................................................................................! "reast Au#$entation..........................................................................................................................10 % y &a'e "reast Au#$entation(..................................................................................................10 About )ew *eneration o+ ,ilicone I$-lants.................................................................................10 ,o % at Is ,ilicone(......................................................................................................................11 Co esi'e ,ilicone *el....................................................................................................................11 ,olid Co esi'e ,ilicone *el..........................................................................................................12 &ow Is "reast Au#$entation .sually /er+or$ed(........................................................................12 In+ra$a$$ary Incision.............................................................................................................13 /eriariolar Incision....................................................................................................................13 A0illar Incision.........................................................................................................................13 ,ub$a$$ary /oc1et................................................................................................................12 ,ub-ectoral /oc1et....................................................................................................................15 ,ub+acial /oc1et........................................................................................................................15 Dual /lane /oc1et.....................................................................................................................15 A+ter t e 3-eration........................................................................................................................14 "reast Au#$entation / oto#ra- s.................................................................................................15 "reast .-li+t 6 7asto-e0y..................................................................................................................1! ,o w at can be done about it(.......................................................................................................1! &ow Is "reast .-li+t /er+or$ed(..................................................................................................19 A+ter t e 3-eration........................................................................................................................21 "reast .-li+t / oto#ra- s..............................................................................................................22 Au#$ented 7asto-e0y.......................................................................................................................23 ,o % at Can "e Done About It(...................................................................................................23 &ow Is Au#$ented 7asto-e0y /er+or$ed(..................................................................................23 A+ter t e 3-eration.......................................................................................................................22 Au#$ented 7asto-e0y / oto#ra- s.............................................................................................25 "reast 8eduction................................................................................................................................24 &ow is "reast 8eduction /er+or$ed(............................................................................................25 A+ter t e 3-eration........................................................................................................................2! "reast 8eduction / oto#ra- s.......................................................................................................29 7ale "reast 8eduction.......................................................................................................................30 A+ter t e 3-eration........................................................................................................................32 7ale "reast 8eduction / oto#ra- s..............................................................................................33 Associations o+ Cos$etic "reast ,ur#ery..........................................................................................32 Disco$+ort.....................................................................................................................................32 Itc in#............................................................................................................................................32 Feelin# +aint...................................................................................................................................32 ,wellin#.........................................................................................................................................35 "ruisin#..........................................................................................................................................35 )u$bness.......................................................................................................................................35 &y-eraest esia...............................................................................................................................35 9iredness........................................................................................................................................35 )ausea............................................................................................................................................35 Feelin# low or de-ressed...............................................................................................................34 Co$-lications o+ Cos$etic "reast ,ur#ery........................................................................................35 In+ection.........................................................................................................................................35 &ae$ato$a....................................................................................................................................3! "leedin#.........................................................................................................................................3!
,ero$a...........................................................................................................................................3! "reast Feedin#...............................................................................................................................3! "reast Cancer.................................................................................................................................39 8esidual Asy$$etries...................................................................................................................20 E0cessi'e ,carrin#.........................................................................................................................20 C an#es in "reast ,ensation..........................................................................................................21 C an#es in )i--le ,ensation.........................................................................................................21 /er$anent ,1in Discoloration.......................................................................................................21 .rinary retention............................................................................................................................21 .rinary tract in+ection....................................................................................................................21 9 rus ............................................................................................................................................22 Associations and Co$-lications o+ "reast I$-lants..........................................................................23 :i+es-an o+ I$-lants......................................................................................................................23 Flyin# and di'in#...........................................................................................................................23 "ein# able to +eel -arts o+ t e I$-lant ;i$-lant -rotrusion<.........................................................23 Asy$$etry.....................................................................................................................................22 8i--lin# or wrin1lin# o+ t e i$-lant.............................................................................................22 Dis-lace$ent or $o'e$ent o+ t e i$-lant....................................................................................22 Ca-sule +or$ation..........................................................................................................................25 E0trusion or re=ection o+ i$-lants.................................................................................................25 8u-ture o+ breast i$-lants.............................................................................................................24 *el ;or +illin#< bleed......................................................................................................................24 Anaest etic 8is1s > Co$-lications................................................................................................25 Dee- 'ein t ro$bosis....................................................................................................................25 /ul$onary e$bolis$.....................................................................................................................25 C est in+ection...............................................................................................................................25 Dru# reactions................................................................................................................................2! )ausea............................................................................................................................................2! ,ore t roat......................................................................................................................................2! Dental ealt ..................................................................................................................................2! An Initial Consultation.......................................................................................................................29 ,ur#eon Consultation.....................................................................................................................29 A#e :i$it.......................................................................................................................................50 9i$e +or 8e+lection........................................................................................................................51 ?our /rocedure..............................................................................................................................51 /re@3-erati'e *uidance.....................................................................................................................52 C ec1list........................................................................................................................................52 9 e Day o+ ,ur#ery............................................................................................................................55 /ost@3-erati'e Instructions................................................................................................................54 I$$ediate A+tercare......................................................................................................................54 /ost@o-erati'e Care........................................................................................................................54 A--oint$ents > Follow@.-..........................................................................................................55 /ost@o-erati'e Course....................................................................................................................55 In 9 e E'ent o+ an E$er#ency......................................................................................................40 Contact your ,ur#eon or )urse@Counselor i$$ediatelyA..............................................................40 9i$e 3++ %or1...............................................................................................................................41 Follow@.-......................................................................................................................................41 )otes...................................................................................................................................................42
Cosmetic Breast Surgery
Allen Rezai MD
ntroduction
Cosmetic breast surgery is *ar *rom being a ne( *orm o* surgery% 2ore popular and more a**ordable) yes) but not at all ne(% /n *act $arious *orms o* breast surgery ha$e been carried out *or o$er a hundred years% Ho(e$er) it is in recent years that ma<or ad$ances ha$e been made in surgical techni,ues) technology and materials) all contributing to greatly impro$ed results and thus patient satis*action% .he $ery *act that you are reading this boo+let means that you are probably considering breast surgery o* one *orm or another either no( or in the near *uture% /ndeed there are se$eral reasons or conditions that might lead a (oman 6or man7 to consider that cosmetic surgery might pro$ide the solution to their needs% 1or e'ample you consider your breasts to be either too small or too large= your breasts seem to be disproportionate in si-e to the rest o* your body= your breasts ha$e changed) possibly *ollo(ing pregnancy or signi*icant (eight loss= your breasts are asymmetrical to an e'tent that you *eel uncom*ortable about the situation= you ha$e su**ered some *orm o* in<ury or undergone a mastectomy operation and no( re,uire re0constructi$e surgery to restore your breasts= as a man) you are su**ering *rom gynecomastia) or o$er0si-ed breasts that ma+e you *eel uncom*ortable or embarrassed= or you ha$e undergone pre$ious breast surgery and are simply unhappy (ith the results% Ho(e$er) in spite o* the e$er0increasing number o* breast operations carried out each year around the (orld) the decision to actually proceed (ith surgery is $ery personal to you and you o(e it to yoursel* to ta+e this decision $ery seriously and not be unduly s(ayed by the opinions o* others or by holding unrealistic e'pectations% .he decision should be yours) and yours alone= and this should be *ounded upon appropriate ad$ice *rom a highly e'perienced cosmetic surgeon%
Cosmetic Surgery Specialists Page 5
cosmeticsurgeryspecialists%co%u+
Allen Rezai MD
>ou should bear in mind that there are as many) i* not more) arguments against undergoing cosmetic surgery as there are in *a$our o* it% And o* course there are ris+s% So any discussion (ith a cosmetic surgeon should al(ays include consideration o* any e'isting health conditions you might ha$e) your li*estyle) (hether you plan on becoming pregnant in the near *uture) and your e'pectations concerning the outcome o* the operation% ?nce you ha$e decided that surgery is the right option *or you) o* prime importance is *inding the surgeon (ho is most able to satis*y your needs and pro$ide you (ith the results you desire% .his is no easy tas+) not least because the (orld o* medicine and surgery is one o* (hich *e( amongst us ha$e more than a passing ac,uaintance) and *or many can be something o* a daunting e'perience% But do not be deterred by this%%% a certain amount o* apprehension is only natural% .he ob<ect o* the e'ercise is to *ind a surgeon (ith (hom you *eel com*ortable and (ho is able to demonstrate to your satis*action that he has the e'perience and ,uali*ications to be able to satis*y your re,uirements% .o some e'tent the choice o* surgeon is $ery personal) but at the $ery least a surgeon should be able to demonstrate a long history o* success*ully underta+ing the +ind o* operation you are considering and be able to pro$ide a collection o* photographs o* be*ore and a*ter surgery *or you to study to *amiliari-e yoursel* (ith the +ind o* results he has achie$ed *or pre$ious patients% He should also be (illing to ans(er any and all your ,uestions relating to the operation and your e'pectations in relation to the outcome% He should also discuss (ith you his re,uirements *rom you both pre0 and post0 operation) and be able to demonstrate that an appropriate a*ter0care and *ollo(0up ser$ice is in place% ?* course there is a place *or re*errals *rom *riends) *amily members and ac,uaintances (ho might also ha$e had success*ul cosmetic surgery% >ou (ill soon be a(are as to (hether or not the results are pleasing to you) and they (ill be able to recount their o(n e'periences% @e$ertheless) as already mentioned) selection o* the best cosmetic surgeon is personal to you) and you are ad$ised to *ollo( your o(n instincts) e'periences and research in selecting the right surgeon%
Allen Rezai MD
.here is already plenty o* published material a$ailable to help the potential breast surgery patient in their decision0ma+ing and understanding o* the $arious clinical procedures) some o* it highly in*ormati$e and o* e'cellent ,uality% .he purpose o* this boo+let is not to attempt to reproduce this literature) rather to address some more speci*ic ,uestions a patient might ha$e about the operation and ho( to prepare *or it) any potential associations and complications related to the surgery) and *inally (hat they might e'pect to encounter a*ter the operation% .he reader should be a(are that the material presented herein) the descriptions o* the procedures) the pre0operati$e and post0operati$e guides are based on the standards o* care at 2r 3e-ai's clinic) and that details (ill di**er *rom surgeon to surgeon% .hat being said) (hat you (ill learn about can be considered as a standard o* best practice based upon the e'perience o* 2r 3e-ai in carrying out literally thousands o* cosmetic surgery procedures o$er many years% >ou might there*ore consider this boo+let to be more o* a Abehind the scenesB loo+ at breast surgery *rom the perspecti$e o* both the patient and the surgeon and his team) cutting a(ay all the *rills and glamour) enabling the patient to go in (ith their eyes (ide open to (hat they are about to underta+e% At the $ery least) ha$ing read it through in its entirety) the patient (ill no( be more a(are o* (hat the procedures entail) the ris+s in$ol$ed) and be in a position to pose some use*ul and precise ,uestions to the surgical team% As the saying goes) Ato be *ore(arned is to be *orearmedB% .his is a <ourney *ull o* possibilities) and once on the right trac+) there only remains to (ish the reader (ell in their ,uest *or their ne() impro$ed body%%% the new you%
Allen Rezai MD
About the Author

Allen 3e-ai) 2C% has a distinguished academic record and is the recipient o* many honours% .oday he has a success*ul aesthetic surgery practice in Harley Street) London) attracting patients *rom around the (orld% He has an enormous breadth o* cosmetic surgical e'perience) ha$ing personally per*ormed literally thousands o* the ma<or procedures% He has a particular interest in aesthetic surgery o* the breast and in *acial surgery% /n addition) 2r 3e-ai has both (ritten and presented e'tensi$ely on many aspects o* plastic and aesthetic surgery%
Memberships
Pro*essional associate o* British Association o* Plastic) 3econstructi$e and Aesthetic Surgeons 6BAP3AS7 .he 3oyal Society o* 2edicine 6"#7 G2C 6"#7 Specialist 3egister *or Plastic Surgery &uropean Society *or Plastic and 3econstructi$e Surgery S(edish Society *or Plastic and 3econstructi$e Surgery World Society *or Plastic and 3econstructi$e Surgery American Society *or Plastic and Cosmetic Surgery World Society *or 3econstructi$e 2icrosurgery &uropean Academy o* Cosmetic Surgery American Smile .rain Group
Cosmetic Surgery Specialists Page !
Allen Rezai MD
!ublications
Per*orming Breast Augmentation under Well 2onitored Sedation Anaesthesia 0 2ay 8004 &$aluation and 3esult o* 3eduction Labiaplasty 0 ?ct 800D Aesthetic and *unctional ad$antages o* the antrolateral thigh *lap in reconstruction o* tumour related scalp de*ect 0 ?ct 8008 2odality treatment *or scalp reconstruction 0 2ay 800 3econstructions o* de*ects at the scalp) *orehead and temporal area a*ter tumour therapy 0 Cec 800 Wo$en $ascular microsurgical prostheses 0 Ean 800 3econstruction (ith microsurgery techni,ue a*ter tumour resection in head and nec+ 0 Cec 8000 Scalp de*ects reconstruction by *ree *laps 0 Ean 8000 2ultiple *ree *laps reconstruction in head and nec+ due to cancer demolition 0 2ay !!! Penis reconstruction (ith radialis *ree *lap 0 !!; Acute intra operati$e arterial elongation 0 1eb !!; Al-heimer's disease and associated change 0 Ean !;!
!resentations
Ciagnosis and treatment o* malign melanoma &$aluation o* basic microsurgery techni,ue Breast reduction and mastope'y in local and sedation anaesthesia Breast augmentation using sedation and local anaesthesia Scalp reconstruction a*ter radiotherapy treatment 1ace and nec+ re<u$enation
Allen Rezai MD
Breast Augmentation
/t is e'tremely common *or (omen to be dissatis*ied (ith the si-e and shape o* their breasts% Breast Augmentation 6also +no(n as Breast &nlargement and Augmentation 2ammoplasty7 in$ol$es placing an arti*icial implant into the breast in order to increase the breast si-e and to produce a degree o* li*t (here necessary% Breast Augmentation is by *ar the most popular procedure re,uested by (omen%
"hy #a$e Breast Augmentation%

/rrespecti$e o* anything you may ha$e heard to the contrary) there are absolutely no medicines or e'ercises that are presently a$ailable to increase the si-e o* the breast permanently) e$enly and sa*ely% .he only accepted techni,ue *or increasing breast si-e is to insert an implant into a space created behind the patientFs o(n breast% /t is the si-e o* this space 6determined by your o(n anatomy7) along (ith your o(n (ishes) (hich determines the si-e o* implant used%
About &e' (eneration o) Silicone mplants

Breast implants ha$e come a long (ay since their original inception% 2odern implants are e'tremely sa*e) and youFll be surprised at ho( incredibly strong they are% At many consultations) you (ill be able to see) *eel and e$en try on recommended implants during initial consultation%
Allen Rezai MD
So "hat s Silicone%
Silicones are man0made molecules 6polymers7 that are (idely used in numerous s+in and hair products= in processed *ood and *ood pac+aging= in most baby *oods= in many medicines) syringes and most other types o* medical implants% Conse,uently e$ery day4 We absorb silicone into our body through our s+in We ingest it in our *ood We *eed it to our children We may e$en in<ect it directly into our blood stream
All breast implants come in a $ariety o* si-es) usually e'pressed as a $olume or (eight% 1or e'ample) G0ml (ould be a $ery small implant= (hereas :00ml (ould be a $ery large implant% /t is probably *air to say that the great ma<ority o* (omen ha$e implants in the range o* 800ml to D00ml% /mplants also come in t(o basic shapes) either per*ectly round or tear0drop shaped% Some surgeons pre*er one *orm o$er the other) (hilst others (ill use di**erent types depending on the patientFs o(n characteristics% By and large) both gi$e e'cellent results%
Cohesi$e Silicone (el

/mplants in cohesi$e silicone gel are by *ar the most popular type o* implant) both (ith patients and surgeons ali+e% .he silicone is in the *orm o* a $ery thic+ cohesi$e gel% 2ost modern implants are produced (ith a te'tured silicone shell%
Allen Rezai MD
.hese implants ha$e a $ery long history o* reliability) (ith literally hundreds o* thousands o* (omen (orld0(ide ha$ing had them in place *or many years (ith no problems (hatsoe$er% /n addition) they are generally considered to be the most natural *eeling implant% /n recent years) more than ;:H o* ALL breast implants inserted in the "# ha$e been silicone) !9H o* (hich had te'tured shells%
Solid Cohesi$e Silicone (el

/n this silicone implant) the gel is made to an almost solid consistency% /t is only a$ailable (ith a te'tured silicone shell% .his e'tra *irmness allo(s the implant to be manu*actured (ith a Itear0dropF shape% Some surgeons consider that this results is a more natural shape *or some (omen% Ho(e$er) they can also be associated (ith a much *irmer consistency or *eel%
#o' s Breast Augmentation *sually !er)ormed%

Breast Augmentation is usually per*ormed under general anaesthetic% Ho(e$er) a small number o* surgeons pre*er the use o* local anaesthetic (ith sedation% 2ost patients stay in hospital o$ernight% /* drains are not used then the operation may be per*ormed as a day case% .here are a number o* means to insert a breast implant% .here are three types o* incision% /t is a matter o* patient and plastic surgeon pre*erence as to (hich is used%
Allen Rezai MD
n)ramammary ncision
/n*ramammary is probably the most commonly employed incision% A*ter healing) the scar tends to be (ell hidden under ne( breast crease) although it (ill be more $isible i* the patient is lying do(n% !eriariolar ncision
.his incision is *a$oured by some surgeons% When it heals (ell) the scar is almost in$isible% Ho(e$er) should the patient de$elop e'cessi$e scarring *or any reason) then it (ill be particularly noticeable% A+illar ncision
Allen Rezai MD
A small number o* surgeons *a$our inserting the implants $ia a small incision in the armpit% Clearly) the *inal (ound (ill be generally (ell hidden% /n these circumstances most surgeons (ould place the implant behind the pectoral muscle 6this is +no(n as .rans0A'illary 3etropectoral Augmentation J .A3PA7% Ha$ing made the incision) the surgeon then creates a poc+et into (hich the implant is inserted% Again) some surgeons *a$our one poc+et o$er another% .here are *our types o* poc+et40
Submammary !oc,et
/n this case) the implant is inserted into a poc+et created bet(een the breast tissue and the pectoral muscle on the chest (all% /t is probably the most commonly used procedure%
Allen Rezai MD
Subpectoral !oc,et
n this case) the implant is placed into a poc+et that the plastic surgeon creates behind the pectoral muscle% .here*ore) the implant lies bet(een the muscle and the ribs%
Sub)acial !oc,et n this case) the implant is placed into a poc+et that the plastic surgeon creates behind the pectoral muscle *acia% .here*ore) the implant lies bet(een the muscle and its *acia%
Dual !lane !oc,et n this case) the implant is placed into a dual plane poc+et% .he pectoral muscle co$ers the upper hal* o* the implant) lea$ing the bottom o* the implant *ree to descend into the submammary breast poc+et% .he implant e'ists both under and o$er the muscle at the same time) creating a dual plane approach%
Allen Rezai MD
A)ter the -peration

.he operation typically ta+es bet(een thirty to si'ty minutes to per*orm% 1ollo(ing surgery) most patients (ear a *irm support bra *or up to *our (ee+s .he breasts (ill *eel bruised) tender and s(ollen *or a *e( days Sutures are remo$ed or trimmed a*ter ten to *ourteen days /ce pac+s may be used to reduce the s(elling and ma+e the breasts *eel more com*ortable 2ost patients ta+e one (ee+ o** (or+ @o li*ting during the *irst t(o (ee+s) and no hea$y li*ting *or at least *our (ee+s
2ost (omen can resume normal acti$ity (ithin *our to si' (ee+s As (ith all scars) they (ill slo(ly *ade o$er si' to t(el$e months% Ho(e$er) they ne$er totally disappear%
Allen Rezai MD
Breast Augmentation !hotographs

Pre0?peration Post0?peration
1or more be*ore and a*ter photos) $isit (((%cosmeticsurgeryspecialists%co%u+
Allen Rezai MD
Breast *pli)t . Mastope+y

2any (omen are dissatis*ied (ith the shape or pertness o* their breasts% A signi*icant number o* (omen *ind their breasts change as they de$elop through the $arious stages o* li*e% ?*ten) their breasts (ould originally ha$e been relati$ely *irm or pert) but (hether through signi*icant (eight loss) the a*ter e**ects o* a pregnancy) or the e**ects o* gra$ity and age) the shape or pertness o* the breast alters) lea$ing a droopy or a de*lated appearance% "nderstandably) this change can be disheartening% As a result o* the dissatis*action (ith the appearance o* their breasts) many (omen re,uest surgery to impro$e the o$erall pertness) *irmness) and si-e and shape o* their breasts% Whilst not strictly an accurate e'ample) a good (ay o* understanding the problem is to imagine that a (oman initially has a C0cup si-ed breast) o$er the years) perhaps a*ter the birth o* child) she still has a CJcup si-ed breast) but o(ing to the stretching o* the s+in) to accommodate mil+ and (eight increase during pregnancy that C0cup breast no( resides in &0cup si-ed poc+et o* s+in 6the s+in has been stretched in e**ect7%
So 'hat can be done about it%

1rom the outset) it is important to understand that it is not possible to re0 create or repair the *ibrous bands that originally held the breast in place 6once they ha$e been stretched7% Li+e springs that ha$e been o$er0stretched) once they ha$e been pulled too *ar) they loose their ability to recoil%
Cosmetic Surgery Specialists Page 1!
Allen Rezai MD
Conse,uently the only surgical option is to e'cise the e'cess s+in% Breast "pli*t) also +no(n as 2astope'y) results in a breast that both loo+s more youth*ul and generally *eels *irmer%
#o' s Breast *pli)t !er)ormed%

/n principle) Breast "pli*t consists o* the *ollo(ing4 &'cising the surplus s+in 3emodelling the breast tissue into a more attracti$e shape 3epositioning the nipple K areola comple' to a higher le$el) so that the nipple lies at the point o* the ne(ly tightened breasts 3eshaping or reducing in si-e the areola i* necessary Breast "pli*t is per*ormed under general anaesthetic and most patients stay in hospital *or one night% .here are $arious techni,ues used in speci*ic situations% /n almost all) the surgeon must *irst ma+e an incision around the areola) so that it can be repositioned higher on the breast4
Allen Rezai MD
/n certain circumstances) it may be possible to underta+e 2astope'y utilising only an incision around the areola% .his so called IdoughnutF 2astope'y is an option (here the breast is *airly small and (hen the degree o* sag is minimal% /n certain cases) su**icient s+in may be remo$ed by e'tending the incision $ertically do(n *rom the areola 6lollipop incision7% Ho(e$er) in other cases) the incision must also include a lateral e'tension across the crease belo( the breast 6anchor incision7% .he $ast ma<ority o* (omen undergoing a Breast "pli*t procedure *ind the results $ery satis*ying) resulting in a real impro$ement in ho( their clothes *it) and ho( their breasts loo+ e$en (hen they are undressed% 2ost (omen report a mar+ed impro$ement in their sel*0con*idence and their o(n *eelings about the attracti$eness o* their body% Wearing a good supporting bra (ill help to sustain the result) ho(e$er) it is important to remember that the results o* breast upli*t (ill not last *ore$er and ageing) pregnancy and (eight *luctuation (ill e$entually cause more la'ness o* the s+in) resulting in the re0occurrence o* some droopiness%
Allen Rezai MD
A)ter the -peration

.he operation ta+es bet(een ninety minutes to t(o hours to per*orm% 1ollo(ing surgery most patients (ear a *irm support bra *or up to si' (ee+s .he breasts (ill *eel bruised) tender and s(ollen *or a *e( days Sutures are remo$ed or trimmed a*ter se$en and *ourteen days /ce pac+s may be used to reduce the s(elling and ma+e the breasts *eel more com*ortable 2ost patients ta+e t(o (ee+s o** (or+ @o li*ting during this *irst t(o (ee+s) and no hea$y li*ting *or at least si' (ee+s 2ost (omen can resume normal acti$ity (ithin *our to si' (ee+s As (ith all scars) they (ill slo(ly *ade o$er si' to t(el$e months%
Allen Rezai MD
Breast *pli)t !hotographs

Allen Rezai MD
Augmented Mastope+y
1actors such as ageing) pregnancy) breast *eeding and (eight *luctuations (ill cause the breasts to lose their youth*ul shape) $olume) tone and the s+in's natural elasticity% Breasts gradually hang lo(er and lo(er on the chest (ith loss o* upper breast pro<ection 6per+iness7) elongation and *lattening% /n some cases) the nipples point straight do(n%
So "hat Can Be Done About t%

.his can easily be impro$ed by a combination o* breast augmentation and upli*t 6Augmented 2astope'y7 (hich (ill restore the shape and $olume o* the breast%
#o' s Augmented Mastope+y !er)ormed%

An Augmented 2astope'y is per*ormed in much the same (ay as a standard mastope'y) e'cept (ith an implant inserted belo( the mammary gland or under the pectoral muscle during the breast upli*t procedure% Curing consultation) your surgeon (ill discuss (ith you the type o* incision to ma+e% Whether your surgeon uses the anchor0shaped) doughnut or lollipop incision is dependent on your breast shape and si-e as (ell as the surgeon's personal pre*erence% >our surgeon *irst carries out the augmentation part o* the procedure and subse,uently ma+es an incision to remo$e the e'cess sagging s+in that causes your breasts to droop) and repositions the nipple K areola comple'%
Cosmetic Surgery Specialists Page 23 cosmeticsurgeryspecialists%co%u+
Allen Rezai MD
A)ter the -peration

.he operation ta+es bet(een ninety minutes to t(o hours to per*orm% 1ollo(ing surgery most patients (ear a *irm support bra *or up to si' (ee+s .he breasts (ill *eel bruised) tender and s(ollen *or a *e( days Sutures are remo$ed or trimmed a*ter se$en and *ourteen days /ce pac+s may be used to reduce the s(elling and ma+e the breasts *eel more com*ortable 2ost patients ta+e t(o (ee+s o** (or+ @o li*ting during this *irst t(o (ee+s) and no hea$y li*ting *or at least si' (ee+s 2ost (omen can resume normal acti$ity (ithin *our to si' (ee+s As (ith all scars) they (ill slo(ly *ade o$er si' to t(el$e months%
Allen Rezai MD
Augmented Mastope+y !hotographs

Allen Rezai MD
Breast Reduction
.he si-e o* (omanFs breasts is determined by se$eral *actors4 Her *amily history Her body (eight Her hormonal status .here*ore) the problem o* o$erly large breasts can de$elop and become an issue at $arious times o* li*e% Ho(e$er) at (hiche$er age it a**ects a (oman) there are certain conse,uences that are common to all situations4 Bac+ and nec+ ache Ci**iculty buying *ashionable clothes Problems (ith badly *itting bras &mbarrassment and lac+ o* sel*0con*idence Ci**iculty playing sports S+in rashes under the breasts As a result) $ery many (omen re,uest Breast 3eduction 6also +no(n as 3eduction 2ammoplasty7% Breast 3eduction in$ol$es remo$al o* both e'cess s+in and tissue *rom the breasts) (hich are then reshaped and the nipple K areola comple' repositioned to *orm smaller more naturally shaped breasts%
Allen Rezai MD
#o' is Breast Reduction !er)ormed%

3eduction 2ammoplasty is per*ormed under general anaesthetic
.he patient usually stays in hospital *or at least one night
/n the commonest *orm o* breast reduction) scars (ill result around the areola) then $ertically do(n and sometimes also hori-ontally out along the breast creases% .he operation ta+es bet(een t(o and *our hours to per*orm Liposuction may also be per*ormed to the *atty areas under the armpits Asymmetries in breast si-e may also be corrected
Allen Rezai MD
A)ter the -peration

1ollo(ing surgery) most patients (ear a *irm support bra *or *our to si' (ee+s Some patients continue to (ear a support bra inde*initely .he breasts (ill *eel bruised) tender and s(ollen *or se$eral (ee+s Sutures are remo$ed or trimmed a*ter se$en and *ourteen days /ce pac+s may be used to reduce the s(elling and ma+e the breasts *eel more com*ortable 2ost patients ta+e t(o (ee+s o** (or+% @o li*ting during this *irst t(o (ee+s) and no hea$y li*ting *or at least si' (ee+s 2ost (omen can resume normal acti$ity (ithin *our to si' (ee+s As (ith all scars) they (ill slo(ly *ade o$er si' to t(el$e months) ho(e$er they ne$er disappear% /t is generally ad$ised that most (omen (ill not be able to breast *eed *ollo(ing Breast 3eduction% Ho(e$er) (hen techni,ues are used that preser$e the connections bet(een the mil+ ducts and the nipple) breast *eeding may be possible%
Allen Rezai MD
Breast Reduction !hotographs
Pre0?peration
Post0?peration
Allen Rezai MD
Male Breast Reduction

Gynecomastia is the medical term *or the de$elopment o* abnormally large breasts in males% .he condition can occur physiologically in the ne(0born) in adolescence and in old age% Gynecomastia is the most common *orm o* breast problem in men% /t is generally considered to be o* one o* three types40 Eust made up o* *atty tissue Eust made up o* breast gland tissue 2ade up o* a combination o* both *atty and glandular tissue .he most *re,uently encountered *orm o* gynecomastia is a simple accumulation o* *atty tissue) o*ten related to o$erall obesity% 2ost patients are men in their t(enties to mid0*i*ties (ho are simply embarrassed about the si-e o* their chests% And as long as there is little or no e'cess redundant s+in o$er the breast) all that is re,uired in these circumstances is liposuction% /n a *e( cases4 .here is signi*icant glandular tissue present 6this may re,uire surgical e'cision7 ?r there is signi*icant e'cess s+in o$er the chest 6a *orm o* breast upli*t is necessary7
Allen Rezai MD
.rue glandular gynecomastia is a medical condition and must *irst be in$estigated to *ind its cause% Su**ice to say) in true gynecomastia) there is an imbalance bet(een the normal male and *emale hormones that circulate in all men) (hich may occur4 @ormally) at certain times o* li*e 6ne(0born) puberty) (ith ageing7 J +no(n as Iphysiological gynecomastiaF) or Abnormally) due to a (ide range o* causes 6idiopathic) diseases o* the hormone system) drugs) alcohol7 J +no(n as Ipathological gynecomastiaF Whate$er the cause) medical treatment aimed at the originating condition relati$ely rarely results in *ull reduction in breast si-e% 1or these patients) surgery is the only option% /n the great ma<ority o* patients (ith glandular gynecomastia) it is possible to remo$e the gland through an incision placed around the lo(er hal* o* the areola%
Allen Rezai MD
A)ter the -peration
.he operation is per*ormed under general anaesthetic
/t ta+es bet(een si'ty to ninety minutes Patients stay in hospital *or one night An adhesi$e dressing and a Lycra $est are (orn *or about one (ee+ Any sutures are remo$ed a*ter se$en to *ourteen days /* your (or+ is not physical) e'pect to return to (or+ a*ter one to t(o (ee+s &'pect to be bac+ to normal physical e'ercise (ithin si' (ee+s "nless the operation is per*ormed at a young age) it is $ery unli+ely that your breasts (ill re0gro(% &'cessi$e (eight gain (ill alter the breast shape as in any other men% 1urther) (ith age your breasts are li+ely to sag as normal%
Allen Rezai MD
Male Breast Reduction !hotographs

1or be*ore and a*ter photos) $isit (((%cosmeticsurgeryspecialists%co%u+
Allen Rezai MD
Associations o) Cosmetic Breast Surgery

Cosmetic breast operations are surgical procedures) the same as all other procedures% /t is important you respect them as such% >ou can rest assured that both the plastic surgeon and all o* the ancillary sta** treats them so% Associations o* surgery are those elements that one might consider to be almost Ipart and parcelF o* ha$ing the operation% .hey are not complications) and do not generally mean that there is anything to (orry about% /n almost all cases) a little reassurance is all that is needed%
Discom)ort
2any patients ha$e said that the sensation a*ter cosmetic breast surgery is $ery similar to that they e'perienced (hen the Amil+ cameB *ollo(ing childbirth% /t is more a *eeling o* uncom*ortable *ullness% 2ost also state that the discom*ort is less i* they ensure that they are 6relati$ely7 acti$e% We belie$e that this is because much o* the discom*ort is related to muscle bruising and s(elling% Conse,uently (e ad$ise most patients to 6at least7 underta+e normal acti$ities (here$er possible) especially regular (al+ing% A*ter a *e( days) the pain subsides considerably% 2ost patients describe it no( as a dull ache% 2any do not no( re,uire any *orm o* pain0+iller%
tching
.his is $ery common a*ter the operation) and almost al(ays settles in time% /t is usually related to the dressings%
/eeling )aint
.his is o*ten *ound (hen the patient gets up the *ollo(ing day% /t is entirely normal) and usually subsides relati$ely ,uic+ly%
Allen Rezai MD
S'elling
.his occurs to some degree *or up to 40 8 (ee+s or so% /t merely means that your initial result is to some degree hidden *or a time%
Bruising
S+in bruising may occur *or up to (ee+% 3e*rain *rom sun0bathing or the use o* sun beds (hilst you ha$e s+in bruising% .here (ill be internal bruising and s(elling *or some time longer than this *irst (ee+%
&umbness
Some area o* the operation *ield may be numb *or some time *ollo(ing the operation% .his almost al(ays settles (ith time% Ho(e$er) it is not un+no(n *or a small patch o* s+in to remain numb% .his rarely causes patients undue concern) so long as they understand this pre0operati$ely%
#yperaesthesia
.his means patients ha$ing areas o* s+in that *eel o$erly sensiti$e) occasionally (ith strange sensations% Again) it usually settles (ith time% /t is less common *or areas to remain hypersensiti$e than it is *or them to remain numb%
0iredness
As a*ter any signi*icant operation) a small number o* patients may *eel unduly tired *or some (ee+s a*ter the procedure%
&ausea
.his is not uncommon) especially a*ter general anaesthetics and (ith some medications% /t usually subsides spontaneously or a*ter cessation o* the particular medication%
Allen Rezai MD
/eeling lo' or depressed

.his is relati$ely uncommon *ollo(ing this *orm o* minor surgery% Ho(e$er) it is not un+no(n) especially a*ter general anaesthetics% Patients should be reassured that it tends to pass a(ay ,uic+ly (ith little or no medication%
Allen Rezai MD
Complications o) Cosmetic Breast Surgery

Complications o* surgery are those elements that might be considered to be abnormal reactions to surgery) and (hich (ould not generally be e'pected to occur% /t is common sense that any *orm o* surgery must be associated (ith some element o* ris+% .he aim o* this section is to highlight the more common 6although still unli+ely7 ris+s associated (ith surgery% Curing your consultation) your surgeon (ill discuss the ris+s *urther% Please *eel *ree to see+ his clari*ication on any points% Cosmetic breast surgery has a $ery lo( complication rate in e'perienced hands) so please +eep these complications in perspecti$e% Ho(e$er) it is important to ta+e them on board% n)ection .his is e'tremely rare% Ho(e$er) it is more common) and potentially much more serious in diabetics and smo+ers% Acute early in*ection is $ery uncommon *ollo(ing breast surgery% /t usually a**ects only one breast% Any surgical implant may be associated (ith chronic lo(0grade in*ection% /t is most li+ely that it is this phenomenon that causes the tiredness) occasional *e$ers) muscular aches) etc% that patients tend to ascribe to Asilicone poisoningB% All patients recei$e intra$enous antibiotics during the procedure% /n addition) all patients recei$e oral antibiotics *or : days a*ter the operation% "sing this Abelt and bracesB regime) signi*icant in*ection is almost unheard o*% .he important point here is that) no matter ho( rare it may be) in*ection is potentially $ery serious%
Allen Rezai MD
/n (omen (ho ha$e undergone breast augmentation) a signi*icant in*ection (ill mean that there is e$ery li+elihood that the implant in ,uestion (ill ha$e to be remo$ed% ?nce this is done) the in*ection is usually relati$ely easy to treat% ?nce the in*ection is clear) most surgeons (ould recommend that the breast is not re0implanted *or D to G months% 1or this period) the patient (ould ha$e to use a bra *iller or e'plant to match the non0in*ected side% #aematoma Appro'imately 0%: to H o* patients may de$elop a collection o* blood or haematoma (ithin the breast poc+et% /t almost al(ays occurs (ithin the *irst *e( hours o* surgery) and almost al(ays only one breast% /n certain circumstances) it may be necessary to drain the collection% .his may in$ol$e an e'tra night in hospital% Bleeding Serious bleeding is rare% Bleeding may ta+e se$eral *orms% 1irstly) serious immediate bleeding *rom the operation site can occur) resulting in shoc+% .his is almost unheard o*% All patients are as+ed about any history o* bleeding disorders% Whene$er necessary) blood tests are underta+en to test a patientFs ability to clot their o(n blood% .here ha$e been no such patients (ithin our series% Seroma .his is a localised s(elling (ithin the tissue that is comparati$ely rare *ollo(ing cosmetic surgery% ?ccasionally) it may be necessary to per*orm a relati$ely minor procedure to drain the collections o* *luid% Breast /eeding /n general terms) the ability to breast0*eed remains unaltered a*ter most breast surgery% Ho(e$er) remember the *ollo(ing40
2any (omen re,uesting breast augmentation ha$e $ery little breast tissue) and so are probably more li+ely than most (omen @?. to be able to breast *eed%
cosmeticsurgeryspecialists%co%u+ Page 3!
Cosmetic Surgery Specialists
Allen Rezai MD
/rrespecti$e o* the amount o* breast tissue) not all (omen are able to breast *eed any(ay% 2any (omen ha$e implants prior to ha$ing their *amily% .here*ore) they cannot +no( (hether they (ould e$er ha$e been able to breast *eed had they not had implants%
Some (omen are able to breast *eed one or more children) but are unable to *eed later babies%
.here is no e$idence that children (ho ha$e been breast *ed by mothers (ith A@> type o* implant ha$e any increased li+elihood o* any medical illness or condition%
Breast *eeding is generally a**ected a*ter breast reduction and breast upli*t
Breast Cancer
Breast implants do @?. cause breast cancer in (omen (ho (ould not other(ise ha$e de$eloped it%
.he /3G *ound that there is a slightly reduced incidence o* breast cancer in (omen (ith breast implants%
.here is no e$idence that breast implants increase the ris+ o* any other cancers%
Breast implants do not ma+e breast cancer more li+ely to occur in (omen (ho may ha$e a susceptibility to breast cancer% Breast implants do not ma+e any breast cancer that a (oman might de$elop more aggressi$e% Breast implants do not generally ma+e most breast lumps harder to *eel% Breast implants may ma+e certain breast cancers harder to detect on L0 3ay 2ammography%
Allen Rezai MD
2odern imaging techni,ues enable doctors to use mammograms to Iloo+ aroundF implants% /n addition) techni,ues such as ultrasound) C. scans) and 23/ scans can be used to produce e'cellent assessment o* implanted breasts% L03ay specialists tell us that) by and large) implants are not a great problem (hen it comes to imaging the breast% .his (as con*irmed by the /3G) (hich concluded that Abreast screening arrangements are not a**ected by the presence o* an implantB% Ho(e$er) they as+ that upon boo+ing a mammogram) you in*orm the 3adiology Cepartment or Screening "nit that you ha$e breast implants% Residual Asymmetries /n cases (here there e'ists signi*icant asymmetries pre0operati$ely) these (ill o*ten be $ery much impro$ed *ollo(ing surgery% Ho(e$er) there can be no guarantee that the areas (ill be identical *ollo(ing surgery% 1+cessi$e Scarring >our plastic surgeon (ill ma+e e$ery attempt to ma+e your scar as neat) short and inconspicuous as possible% Please remember that the crease underneath the breast is greater 6and hence the scar better hidden7 i* the breast is larger or more sagging pre0operati$ely% .he breast is generally a $ery good area o* healing o* scars% Ho(e$er) i* the scar remains raised) reddened) or hypertrophic then it may re,uire surgical re$ision) steroid in<ections) or special dressings% .his is uncommon *ollo(ing cosmetic surgery% /t is most common in those (ith a *amily history o* e'cessi$e scarring) in patients that already ha$e such scars) and in people *rom A*ro Caribbean descent% Ho(e$er) generally a patientFs indi$idual tendency to such scarring cannot be diagnosed in ad$ance% /t is important to realise that the rate at (hich scars heal and *ade $aries considerably *rom patient to patient% Such e'cessi$e or hypertrophic scars may re,uire treatment) but may remain permanently e'cessi$e%
Allen Rezai MD
Changes in Breast Sensation Post0operati$e s(elling) as a result o* the implant itsel* and normal tissue s(elling may alter the sensation to parts o* the breast itsel*% .hese almost al(ays return to normal completely (ithin *our to si' (ee+s o* surgery% Changes in &ipple Sensation .he a*orementioned s(elling may a**ect nippleKareola sensation% Within a *e( months) normal sensation has either returned or become (hat it (ill probably remain as% /n most (omen this is bac+ to normal% A small percentage o* (omen report that these areas are more sensiti$e% By and large) most o* these (omen *ind this an ad$antage% An e'tremely small percentage o* (omen su**er *rom some slight permanent sensory0loss% /t is e'tremely rare) but not unreported) *or total permanent loss o* nippleKareola sensation to occur% !ermanent S,in Discoloration .his is rare a*ter most *orms o* surgery% Permanent staining may result i* the patient sunbathes or uses ultra$iolet sun beds (hilst any $isible s+in bruising remains% *rinary retention .his is $ery uncommon a*ter cosmetic surgery) e'cept in any male patient +no(n to ha$e prostate problems (ho might be con*ined to bed *or a *e( days% *rinary tract in)ection .his generally occurs in (omen (ho might be prone to them in any e$ent) and (ho are con*ined to bed and not drin+ing normally% /t is relati$ely uncommon a*ter cosmetic surgery%
Allen Rezai MD
0hrush .his is again uncommon% /t tends to be commonest in (omen prone to recurrent candida in*ections) especially i* they are prescribed antibiotics% /* you +no( that you are prone to thrush) in*orm your surgeon% /t may be considered better to a$oid antibiotics in such circumstances%
Allen Rezai MD
Associations and Complications o) Breast mplants

.he *ollo(ing associations and complications relate speci*ically to the use o* breast implants%
2i)espan o) mplants
Consumer Protection la(s relating to general manu*acturing co$er all implants% .his is not because (e are sure that implants must (ear out) since at the present time there is insu**icient data to ma+e any de*initi$e statement *or any gi$en implant% 2anu*acturers o* implants do not pro$ide any ad$ice as to (hen) i* e$er) implants should be replaced% 2any thousands o* implants ha$e been in place *or more than 0080 years and are still Agoing strongB% A small number o* (omen ha$e had their implants replaced be*ore 0 years has elapsed% /t is our ad$ice) as has been *or many years) that any (omen ha$ing breast implants be*ore the age o* 40 should ha$e them e'pecting that at some time in the *uture) she may ha$e to ha$e them remo$ed or replaced% As (omen continue to li$e longer) this li+elihood (ill probably increase% /t is our e'perience that most (omen in their t(enties and thirties are more than happy to accept this possibility%
/lying and di$ing

/t is per*ectly sa*e to *ly or to go deep sea di$ing a*ter breast augmentation%
Being able to )eel parts o) the mplant 3implant protrusion4

Some implants *eel more li+e breast tissue than others% Ho(e$er) gi$en that they are not Imade to measureF ) they are most unli+ely to *eel e'actly the same as your breast tissue% 1urther) as you +no() your o(n breast tissue changes in its consistency throughout your normal cycle) and throughout your li*e% /t is relati$ely common *or (omen to be able to *eel small areas o* their implants) usually around the periphery o* their breasts% .hese are *elt as small
Allen Rezai MD
so*t lumps) mostly along the inner and outer aspects o* their breasts% .his is more li+ely i* the patient had $ery little breast tissue to start (ith) or re,uested larger implants% With reassurance) almost all patients accept this phenomenon% Mery rarely (ill surgery be either o**ered or re,uested *or this situation%
Asymmetry
Please remember that it is $ery unusual *or t(o breasts to be symmetrical% /t is our e'perience that most (omen ha$e ne$er noticed that their breasts are *ar *rom identical% /t is important to understand that) *ollo(ing breast augmentation) any such asymmetry may be ampli*ied% /n general terms) asymmetry is li+ely to be e'aggerated a*ter complications such as capsular contraction%
Rippling or 'rin,ling o) the implant

Certain implants are +no(n to *old and (rin+le more than others) /n some circumstances) any implant may *old in their poc+et% Ho(e$er) this is relati$ely unusual) and rarely re,uires *urther surgery% /t is more common in patients (ith little breast tissue) those re,uesting larger implants) and those (ith mar+ed e'cess sagging s+in (ho might be better ad$ised to ha$e a breast upli*t%
Displacement or mo$ement o) the implant

.his is relati$ely uncommon) and may be associated (ith discom*ort in the a**ected breast% /n the unli+ely e$ent that it should be necessary) the implant may be repositioned surgically%
Allen Rezai MD
Capsule )ormation
All tissues *orm a *ibrous shell or scar around any *oreign body% .hat the breast does so around an implant is an entirely normal body reaction% /n essence) the breast is trying to I(all o**F or isolate and protect the body *rom the outside agent% .his process commences once the implant is inserted) and continues o$er the *irst *e( (ee+s% .he great ma<ority o* capsules are so*t) and other(ise *eel li+e breast tissue) so the patient is completely una(are it is there% "n*ortunately) a $ery small proportion o* capsules ha$e a tendency to progressi$e thic+ening% /n doing so) as (ith scars else(here in the body) they also tend to shrin+ and contract% .his phenomenon may a**ect one or both breasts% .his phenomenon may occur shortly post0operation) or de$elop suddenly a*ter many years% .he clinical e**ects are a mi'ture o* any or all o* the *ollo(ing4 $arying degrees o* *irmness= intermittent or constant pain= alteration in shape% .he cause is mostly misunderstood% Ho(e$er) it is (ell accepted that the incidence has decreased dramatically (ith the use o* implants (ith te'tured shells% /n the absence o* signi*icant symptoms) the $ast ma<ority o* capsules re,uire little management other than regular massage or manipulation by the plastic surgeon% Ho(e$er) appro'imately H o* patients may re,uire *urther surgery to remo$e the capsule% /n spite o* the best e**orts o* both patient and plastic surgeon) capsules may recur a*ter treatment) and a $ery small number o* (omen may re,uire permanent remo$al o* their implants i* se$ere symptoms persist% Compared (ith ten or more years ago) this is no( comparati$ely rare%
1+trusion or re5ection o) implants

.his is rare) and may result *rom (ound in*ection) (ound brea+do(n) se$ere capsule *ormation) etc% /t re,uires surgical e'ploration o* the breast% .he implant may be reinserted at the same time) or remo$ed% /* remo$ed) another implant (ill be inserted some (ee+s later%
Allen Rezai MD
Rupture o) breast implants

Whilst there is little good e$idence regarding the precise incidence o* implant rupture) the general consensus bet(een e'perienced plastic surgeons is that it is $ery rare% 2odern breast implants are e'tremely strong robust ob<ects% .hey (ill more than (ithstand most normal day to day acti$ities% 3upture in this sense means actual physical disruption or tearing o* the shell% /n theoretical terms it may arise in any o* the *ollo(ing circumstances4 A manu*acturing *la( Accidental and undetected damage during insertion Cirect and se$ere trauma to the breast With age
.o reiterate) all (ith the e'ception o* age are $ery rare% 3upture may theoretically occur either4 Without breaching the breast capsule 6intra0capsular rupture7% /n this circumstance there may be little change in breast si-e) shape) etc% Without rupture also o* the breast capsule 6e'tra0capsular rupture7% /n most o* these cases) the contents o* the implant are still *ound (ithin the breast and may be remo$ed at the same time as the ruptured shell itsel*% 3arely) the *illing may be *ound in the lymph glands and around ner$es in the armpit% /n these areas) lumps and discom*ort may be *elt% .hey may $ery rarely re,uire surgical incision% /n any circumstance (here direct trauma has occurred to the breast) or i* rupture is suspected) then modern imaging techni,ues 6especially 23/ scanning7 (ill usually be able to detect it%
(el 3or )illing4 bleed

.his describes the phenomenon o* microscopic amount o* the contents 6(ith or (ithout similar microscopic particles o* the silicone shell7 bleeding out into the tissues in the absence o* rupture% All modern implants) including silicone) ha$e been designed to minimise gel bleed%
Allen Rezai MD
Anaesthetic 6 Ris,s 7 Complications

2odern day anaesthetic is e'tremely sa*e% /t is important to understand that general anaesthetic carries slightly higher ris+ than local anaesthetic% Ho(e$er) the ris+s o* both are e'tremely small in cosmetic surgery patients% /t is o* paramount importance that you are al(ays open and honest about your past medical history) and undergo any in$estigations that your surgeon andKor anaesthetist might re,uire prior to your operation% Potential complications 6although e'tremely rare7 include4
Deep $ein thrombosis

.his occurs (hen a blood clot *orms in the $eins) usually o* the cal* or thigh% Clearly) this is potentially serious% Ho(e$er) it is rare *ollo(ing this *orm o* surgery% /t is generally associated (ith longer operations) sic+ patients and periods o* immobility a*ter(ards% /n order to reduce your ris+ e$en *urther) you may be as+ed to (ear special pressure stoc+ings during your time in hospital% Additional special boots may be used (hilst you are undergoing the operation% /t is important that you are mobile *or the *irst *e( days a*ter your operation and drin+ plenty%
!ulmonary embolism
.his occurs (hen the type o* blood clot discussed abo$e tra$els in the blood stream to the lungs (here it pre$ents their normal *unction% /t is a $ery serious and potentially li*e threatening condition) but is e'tremely rare a*ter this *orm o* surgery% Again) it is mostly associated (ith longer operations) sic+ patients) periods o* immobility) and dehydration
Chest in)ection
.his is unusual in healthy patients ha$ing relati$ely minor surgery% /t is more li+ely *ollo(ing general anaesthetic in smo+ers% Ho(e$er) many patients (ill recei$e antibiotics during their operation) (hich *urther reduces the ris+%
Allen Rezai MD
Drug reactions
.hese are generally uncommon in patients (ho do not ha$e a history o* drug allergies or a *amily history o* problems (ith anaesthetic% Ho(e$er) $ery occasionally patients may ha$e unpredictable reactions to drugs% >our anaesthetist is a(are o* this possibility) loo+ing *or it) and (ill treat it%
&ausea
.his is not uncommon *ollo(ing some *orms o* anaesthetic% Some patients also e'perience $omiting in the immediate post0operati$e period% 2ost anaesthetists administer anti0nausea drugs at the start o* your anaesthetic) and there are other drugs that can be gi$en to you should you continue to *eel nausea *ollo(ing the operation%
Sore throat
.his is not uncommon *ollo(ing anaesthetic (here a tube has been placed in your throat to help you breath% Any discom*ort is usually short0term%
Dental health
Cental problems are rare in patients (ith good dentition% >ou must in*orm you anaesthetist o* any loose teeth) cro(ns) bridges) etc% that you may ha$e%
Allen Rezai MD
An nitial Consultation
So you ha$e studied in detail this boo+let) you ha$e perhaps read one or more other boo+s on the sub<ect) you ha$e tal+ed (ith *riends and *amily) and you might ha$e some initial idea as to li+ely cost% >ou are all setN So (hat is ne'tO 1ind the surgeonN .he importance o* your selection o* the right surgeon to carry out your operation has already been mentioned to be o* utmost importance) and to a great e'tent a $ery personal decision that should ta+e into account many *actors% By all means get opinions and ad$ice *rom *riends and *amily (ho ha$e perhaps had such an operation themsel$es) but the ultimate decision should be yours and yours alone% @o matter (hich surgeon you choose *or your operation) you should al(ays be able to chec+ his or her o**icial registration 6licence7 permitting them to carry out cosmetic surgery in the country in (hich they are located%
Surgeon Consultation
At your consultation (ith the surgeon) you (ill ha$e the opportunity to discuss your procedure in order that heKshe can ascertain your e'pectations as to (hat can realistically be achie$ed% /t also gi$es you the opportunity to as+ any *inal ,uestions and get to +no( the surgeon and the e'perience that they ha$e (ith patients undergoing similar procedures%
Allen Rezai MD
/n addition) prior to any cosmetic treatment or surgical operation being per*ormed) the surgeon (ill4 Ciscuss your and your *amilyFs medical history and any pre0operati$e tests that (ill need to be conducted% 2a+e a detailed and thorough physical e'amination o* your area o* concern% &'plain the surgical options a$ailable and (hich (ould be most suited to you% .al+ you through in detail all aspects o* the procedure such as (here and ho( each incision (ill be made) an o$er$ie( o* the procedure and (hatFs in$ol$ed) li+ely complications and possible conditions) reco$ery and healing times and stages) dressing and a*ter care) pain and (here it is li+ely to be *elt) and speci*ic care details%
Age 2imit
.he minimum age *or any consultation or surgical procedure in the "nited #ingdom is ; years%
Allen Rezai MD
0ime )or Re)lection

All aesthetic cosmetic procedures are electi$e operations) meaning that you choose to ha$e such an operation% 1ollo(ing your consultation it is recommended that you ta+e a period o* *ourteen days to consider all the bene*its and ris+s o* the procedures) and see+ more in*ormation i* necessary) be*ore you decide%
8our !rocedure
Should you decide that a procedure is right *or you) your surgeon (ill arrange a date (ith you *or your procedure and (ill support and guide you throughout the entire process%
Allen Rezai MD
!re9-perati$e (uidance
Prior to your surgery) you (ill be as+ed to sign consent *orms *or your proposed operation and the anaesthetic to be employed% By signing these *orms) you ac+no(ledge that you *ully understand the potential associations 6side0e**ects7 and complications *or your operation) and also o* the anaesthetic% /n the days leading up to your operation) you should *eel *ree to contact your surgeon at any time% Cosmetic surgeons are (ell a(are that) (hilst your operation might be routine *or them) this is li+ely to be a (hole ne( e'perience *or the patient%
Chec,list
/* you are ha$ing a general anaesthetic) do @?. eat or drin+ anything *or G hours prior to your admission time% /* you are ha$ing a local anaesthetic (ith sedation) do not &A. *or G hours prior to your admission time% Ho(e$er) clear *luids 6e%g% (ater) blac+ tea) blac+ co**ee7 are permissible up to 8 hours ahead o* your admission% /* you de$elop any medical problem at all in the (ee+ or so be*ore your operation) you should contact the clinic immediately% /t is best to a$oid alcohol and tobacco *or at least t(o (ee+s prior to your operation% /t is also best to a$oid ta+ing $itamin & or garlic *or operation% (ee+ prior to your
/* you regularly ta+e an Aspirin and K or other non0steroidal anti0 in*lammatory medicines) *ollo( your Surgeon's ad$ice (ith regard to (hether you must stop ta+ing them% Prepare a suitable o$ernight bag% .his is recommended e$en i* you are ha$ing day case surgery% /t should include night(ear) slippers) dressing go(n) toiletries) glasses) sanitary to(els 6i* appropriate7) etc%
Allen Rezai MD
3emember to include some reading material) a 2PD player or similar i* you so (ish) and telephone numbers *or your transport home% &nsure you pac+ any clothing you ha$e been speci*ically as+ed to bring 6e%g% loose *itting garments) an old bra) a Lycra or sportFs bra) a so*t to(el etc%7% Generally) it is probably better not to (ear e'pensi$e clothes% Similarly) it is generally ad$isable to lea$e e'pensi$e <e(ellery at home% /* you ha$e been re,uested to sha$e a particular area) you should do so 4; hours be*ore the operation) and bathe the area regularly (ith antiseptic) such as Sa$lon% /* you ha$e been re,uested to remo$e any body piercing *rom areas to be operated upon) do so at least 84 hours be*ore the operation) and bathe the area regularly (ith Sa$lon% Any body piercing should be remo$ed at least 84 hours be*ore the operation) and bathe the area regularly (ith Sa$lon% /* you are ta+ing A@> medicines at all) please bring them all (ith you on the day o* your operation% >our anaesthetist (ill need to see them% /mportantly) i* you use an inhaler) please bring it (ith you% /* you ta+e regular medication) you 2"S. chec+ (ith your surgeon as to (hether you should ta+e the morning dose on the day o* surgery% /n most instances the ad$ice (ill be to continue (ith your normal regime% Please ad$ise your anaesthetist andKor surgeon i* your last menstrual period (as delayed or other(ise unusual%
Be*ore you come into hospital) ensure that you ha$e a supply o* simple pain+illers at home% >ou (ill be prescribed stronger pain0+illers *or the *irst *e( days a*ter the operation% Ho(e$er Paracetamol is usually su**icient therea*ter% Be*ore you come into hospital) ensure that you ha$e a supply o* *ood and drin+s 6especially still mineral (ater7 that (ill last at least a (ee+%
cosmeticsurgeryspecialists%co%u+ Page 53
Cosmetic Surgery Specialists
Allen Rezai MD
>ou may bring your mobile phone) but may not be allo(ed to ha$e it s(itched on inside the hospital itsel*% /t is better to (ear glasses rather than contact lenses% 1or many procedures including all general anaesthetics) you (ill be as+ed to remo$e your lenses% 3emember to bring your lens +it (ith you% /* you ha$e any special dietary or religious needs) contact your surgeon ahead o* time) and in*orm himKher% /* you ha$e any special needs 6e%g% a colostomy) etc%7 contact your surgeon ahead o* time and in*orm himKher% Bring any special de$ices) creams etc% (ith you%
Allen Rezai MD
0he Day o) Surgery

>ou (ill ha$e been gi$en an admission time (hen you boo+ed your operation% Lea$e home in plenty o* time because you do not (ant the added stress o* (orrying about being late% /t is $ery important to note that the admission time is @?. @&C&SSA3/L> the time o* your operation% .his is the time at (hich it is anticipated that you (ill be able to be admitted and prepared *or theatre% Also) some surgeons pre*er all o* their patients to be admitted at the same time early in the morning% .his means that their operating list 6and hence your o(n operation7 is not delayed i* an early patient is late) or i* an operation is cancelled or delayed *or any reason% .he nurses also ha$e se$eral necessary tas+s to per*orm in the period prior to your operation% .hey ha$e to *ormally admit you to the hospital) ta+e your blood pressure) pulse) and temperature) get you (ashed and prepared as necessary) as+ you to put on a go(n K anti0embolism stoc+ings) etc% >our surgeon (ill also see you again% >ou may ha$e *urther ,uestions that you might (ish to as+ him% He may ha$e to ta+e photographs) complete his pre0operati$e mar+ings etc% >ou (ill also ha$e to read and sign the Consent 1orm% /t is important that you are relati$ely settled prior to going into the operating room% >our anaesthetist may re,uire you to ha$e a pre0med% .his (ill ta+e some time to ta+e e**ect% >our surgeon and his team (ill do their best to ensure that your (ait is not too long) and generally the organisation (ill (or+ (ell% Ho(e$er) (ith any surgical hospital) delays can occur *or any number o* reasons% &mergencies may be admitted *rom time to time) and (e merely ad$ise that you are patient) and that you understand that the nursing and other sta** are doing their best%
Allen Rezai MD
!ost9-perati$e nstructions
Be*ore going any *urther) it can not be emphasi-ed too much the e'treme importance that you should care*ully read) and (here necessary adhere to) the ad$ice and instructions pro$ided *or you by your surgeon and his team% 1ailure to do so may at best <eopardi-e the *inal result o* your surgery= at (orst be detrimental to your health%
mmediate A)tercare
1ollo(ing the operation) you (ill be returned *rom the operating room) (here the theatre nurse and consultant anaesthetist (ill trans*er your care bac+ to your allocated nurse% >ou (ill be allo(ed to gently reco$er *rom the procedure% /* you *eel sleepy) then you (ill be allo(ed to sleep% Ho(e$er) it is important that the nurses continue routine post0operati$e recordings o* your pulse) blood pressure etc% 1urther) any other rele$ant obser$ations (ill also be continued 6e%g% blood sugar le$els in diabetic patients) etc%7 /t is li+ely that you (ill continue to recei$e intra$enous *luid during the post0 operati$e period% .his is to ma+e up *or the *act that you ha$e been Anil by mouthB *or some time both prior to and during the operation) and also because o* the nature o* the procedure itsel*% /t is routine to administer this *luid) and results in a much speedier reco$ery *rom the operation% Soon a*ter returning *rom the operating room) you (ill be o**ered something to eat and to drin+% 2ost patients are more than ready *or this% Ho(e$er) there is no rush% /* you do not *eel li+e eating) or i* you *eel at all nauseous) then you (ill be gi$en more time to reco$er% /* necessary) the consultant anaesthetist (ill prescribe and administer any *urther necessary medicines to combat any *eelings o* sic+ness that you might ha$e%
!ost9operati$e Care
/n most cases) upon discharge *rom the clinic) you (ill be gi$en antibiotics and pain+illers to ta+e home (ith you% Whene$er appropriate) your *irst post0 operati$e re$ie( (ill also be arranged *or you%
Allen Rezai MD
>ou (ill then be trans*erred into the care o* (home$er you ha$e designated to ta+e you home% A responsible adult must escort you home) and there must be a similar person able to loo+ a*ter you on the *irst post0operati$e night% /* you ha$e not arranged these things) then your operation (ill be postponed%
Appointments P 1ollo(0"p
1ollo(ing discharge *rom the hospital) you may be telephoned by your nurse counselor o$er the *irst *e( days) to put your mind at rest% &nsure that you +eep any appointment *or either remo$al o* your sutures or *or any change o* dressings prescribed by your surgeon% /* your dressings are becoming soiled prior to their remo$al) please contact your nurse counselor during o**ice hours% She (ould be happy to change them *or you i* it is appropriate% /n most instances) you (ill be seen at your clinic by a nurse a*ter 9 to 0 days% .his is merely to chec+ that all is progressing as it should) to change dressings) to remo$e some or all sutures as directed) and to gi$e you *urther ad$ice and reassurance%
/n most instances) your surgeon (ill re$ie( you in his clinic a*ter 4 to G (ee+s% 6Cepending upon the nature o* the operation) he may discharge you at this time%7 >our surgeon (ill continue to re$ie( you periodically therea*ter as necessary%
!ost9operati$e Course
>ou should complete the prescribed course o* any tablet and K or topical cream antibiotics) or any other medications gi$en to you% Pain and discom*ort are almost uni$ersal a*ter all surgery% Some operations generally hurt more than others% PatientsF pain thresholds also $ary considerably% .here*ore) e'pect some pain and discom*ort post0operati$ely% A*ter a *e( days) the pain should be more li+e an ache%
Allen Rezai MD
.a+e the prescribed stronger pain0+illers *or the *irst *e( days and simple pain0+illers 6e%g% Paracetamol7 (hene$er necessary therea*ter% Should these pro$e insu**icient to signi*icantly relie$e your pain) or i* your pain gets (orse o$er a number o* days) please contact your nurse counsellor% Co @?. ta+e aspirin or medicines containing aspirin unless directed by your surgeon% Co @?. ta+e non0steroidal anti0in*lammatory medicines 6e%g% @uro*en) /bupro*en) etc%7 unless directed by your surgeon% &'pect a little nausea *or a day or so% /* it *ails to subside) please contact your nurse counselor% .a+e things easy *or a *e( days% Ho(e$er) do @?. retreat to your bed% Prolonged bed rest increases your ris+ o* thrombosis and chest in*ections% .here*ore) gently mobili-e during this initial period% Arrange *or help (ith child0care i* necessary% Crin+ plenty% ?rdinary still mineral (ater is best% /t is important to a$oid becoming dehydrated) especially in hot (eather% .ry to get bac+ to your normal diet as soon as possible% &'pect the (ounds to itch as they continue to heal% A$oid getting the (ounds or dressings (et% 2erely sponge bathe and (ash care*ully around the dressings until they are remo$ed%
A*ter a (ee+ or so) gradually start (or+ing yoursel* bac+ to relati$ely normal acti$ities% >ou should be bac+ to your normal routine (ithin 4 to G (ee+s%
.a+e as much time o** (or+ as your surgeon has speci*ied% Be prepared to ta+e longer o** i* necessary% Co not e'ercise (ithin the *irst 4 (ee+s or so% Clearly) larger operations re,uire longer periods o* recuperation% /* you e'ercise regularly) gradually build up your e'ercise regime again% @e$er *orce yoursel* through any pain barrier% /* your body says IStopF) then stop% Co not s(im *or si' (ee+s%
Cosmetic Surgery Specialists Page 5! cosmeticsurgeryspecialists%co%u+
Allen Rezai MD
Co not be alarmed i* you see some $isible s+in bruising% Bruising is again relati$ely common a*ter all surgery% /t $aries bet(een patients) and bet(een di**erent operations% Where possible +eep these areas co$ered until bruising *ades% Misible bruising (ill usually *ade (ithin 08 (ee+s% Co not sunbathe or use sun beds at least *or 8 (ee+s% S(elling is the natural body's natural reaction to any in<ury) including surgery% Some operations induce considerable s(elling= some are associated (ith $ery little% /t may also $ary bet(een patients% .here*ore) e'pect some s(elling) (hich usually settles o$er G to 8 (ee+s% &nsure that you *ollo( any and all instructions gi$en to you (ith regard to massage) use o* moisturi-ers etc%
Scars undergo a long period o* healing% /nitially) you must e'pect them to be red) raised) lumpy and une$en% .his is normal% .he scars (ill continue to heal o$er a period o* many months 6sometimes e$en up to 8 years7% Curing this period) they generally become paler) *latter) narro(er) and shorter%
All patients are di**erent% /t is common +no(ledge amongst the lay public that some people heal *aster and better than others% Conse,uently) some patientsF scars heal to barely $isible thin (hite lines) (hilst others are some(hat more noticeable% >our surgeon is generally completely unable to diagnose (hich type o* patient you are be*ore the operation unless you ha$e had pre$ious surgery% Some areas o* the body are +no(n to be more prone to pronounced or e'cessi$e scarring than others% Conse,uently) i* you ha$e scars on $arious areas o* your body) they may not heal to the same *inal result% ?perations in$ol$ing bilateral structures 6e%g% the ears etc7 generally heal at di**erent rates on each side% /t is almost is i* you ha$e had t(o operations) one on the le*t and one on the right% .here*ore) discom*ort) s(elling) scarring) altered sensation or numbness etc may not settle at e,ual rates on both sides% Ho(e$er they generally both settle do(n *airly e,ually in the end%
Allen Rezai MD
Mery *e( patients are totally symmetrical% /* you loo+ closely) most bilateral structures 6especially the breasts7 are *ar *rom identical% "nless discussed (ith and con*irmed by your surgeon at consultation) the aim o* the operation is generally not to ma+e you totally symmetrical% .here*ore) e'pect some degree o* residual asymmetry (here such asymmetry e'isted be*ore the operation% /t is relati$ely common *or certain areas to ha$e altered sensation or e$en numbness a*ter the operation 6particularly around the nipple a*ter breast surgery) or around any scars7% Any areas o* altered sensation or numbness may ta+e se$eral months to resol$e% .hey al(ays resol$e at di**erent rates in di**erent patients) and usually at di**erent rates on the t(o sides o* the body% ?ccasionally) areas may remain permanently numb or ha$e altered sensation% >ou should put s+in0*riendly adhesi$e tape on your scars (ithin G (ee+s o* the operation%
n 0he 1$ent o) an 1mergency

@e$er sit at home (orried or *rightened about any aspect o* your operation% Please do not hesitate to contact your surgeon about any concern% /n almost all instances your *ears are per*ectly natural) and re,uire nothing more than a *e( (ords o* encouragement and reassurance% Mery rarely (ould you need to be seen as a matter o* urgency%
Contact your Surgeon or &urse9Counselor immediately:

/* the operation area begins to *eel hot) tense) or increasingly s(ollen% /* you start to *eel generally un(ell or *e$erish% /* the dressings de$elop an odor or there appears to be a green or yello( discharge on them%
1or any medical emergency 6*or e'ample) sudden signi*icant increase in pain) increasing s(elling) sudden discharge o* blood or pus *rom the (ound) *e$er) (ound opening) etc%7
Allen Rezai MD
Co not panic% Whilst it is (holly understandable that you (ill be concerned) these complications are e'tremely rare a*ter cosmetic surgery) and the $ast ma<ority are resol$ed in a relati$ely short period o* time% 3arely do they ha$e any long0term implications *or either your health or your operation itsel*% 3est assured that your surgeon (ill ha$e seen it all be*ore% But do ma+e note o* any and all emergency numbers gi$en to you%
0ime -)) "or,

2ost patients are *ully able to return to (or+ (ithin 0 days to 8 (ee+s% @ot(ithstanding this) patients are ad$ised @?. to ha$e the operation in the (ee+ preceding a $ital (or+ or li*e e$ent% Gi$e yoursel* the potential o* a (ee+ o** almost e$erything to recuperate) should it be necessary% "se common senseN /* your (or+ is $ery physical) be prepared to ta+e longer o** (or+%
/ollo'9*p
/t is typical *or nursing sta** to re$ie( you a*ter about 9 to 0 days% At this time they (ill inspect your (ounds) remo$e or trim sutures) and re0apply any dressings as directed by your surgeon% >ou (ill then be re$ie(ed during the *ollo(ing months% 2ost patients are re$ie(ed at about 8 (ee+s) and again therea*ter as necessary% .he $ast ma<ority o* patients are discharged *rom routine *ollo(0up at about D months) ho(e$er those re,uiring *urther *ollo(0up (ill be seen periodically as necessary%
Allen Rezai MD
&otes
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Cosmetic Breast Surgery A Patients Guide

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Cosmetic Breast Surgery A Patients Guide

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Cosmetic Breast Surgery A Patient's Guide

Cosmetic Breast Surgery

Cosmetic Surgery Specialists Page 5

Cosmetic Breast Surgery

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Cosmetic Breast Surgery

Cosmetic Surgery Specialists Page 5

Cosmetic Breast Surgery

About the Author

Cosmetic Surgery Specialists Page !

Cosmetic Breast Surgery

Cosmetic Surgery Specialists Page 9

Cosmetic Breast Surgery

"hy #a$e Breast Augmentation%

About &e' (eneration o) Silicone mplants

Cosmetic Surgery Specialists Page 10

Cosmetic Breast Surgery

Cohesi$e Silicone (el

Cosmetic Surgery Specialists Page 11

Cosmetic Breast Surgery

Solid Cohesi$e Silicone (el

#o' s Breast Augmentation *sually !er)ormed%

Cosmetic Surgery Specialists Page 12

Cosmetic Breast Surgery

Cosmetic Surgery Specialists Page 13

Cosmetic Breast Surgery

Cosmetic Surgery Specialists Page 12

Cosmetic Breast Surgery

Cosmetic Surgery Specialists Page 15

Cosmetic Breast Surgery

A)ter the -peration

Cosmetic Surgery Specialists Page 14

Cosmetic Breast Surgery

Breast Augmentation !hotographs

1or more be*ore and a*ter photos) $isit (((%cosmeticsurgeryspecialists%co%u+

Cosmetic Surgery Specialists Page 15

Cosmetic Breast Surgery

Breast *pli)t . Mastope+y

So 'hat can be done about it%

Cosmetic Surgery Specialists Page 1!

Cosmetic Breast Surgery

#o' s Breast *pli)t !er)ormed%

Cosmetic Surgery Specialists Page 19

Cosmetic Breast Surgery

Cosmetic Surgery Specialists Page 20

Cosmetic Breast Surgery

A)ter the -peration

Cosmetic Surgery Specialists Page 21

Cosmetic Breast Surgery

Breast *pli)t !hotographs

1or more be*ore and a*ter photos) $isit (((%cosmeticsurgeryspecialists%co%u+

Cosmetic Surgery Specialists Page 22

Cosmetic Breast Surgery

So "hat Can Be Done About t%

#o' s Augmented Mastope+y !er)ormed%

Cosmetic Breast Surgery

A)ter the -peration

Cosmetic Surgery Specialists Page 22

Cosmetic Breast Surgery

Augmented Mastope+y !hotographs

1or more be*ore and a*ter photos) $isit (((%cosmeticsurgeryspecialists%co%u+

Cosmetic Surgery Specialists Page 25

Cosmetic Breast Surgery

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