How is it performed? of Breast implants

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The first step is to arrange an appointment with your GP. Your GP will be able to answer any initial questions you may have about what the operation involves and advise you on the best course of action taking into consideration your personal health and medical history.

Your GP will then refer you to a surgeon who will be able to answer your questions in more detail and provide you with all the information you need to make a final decision. It is a good idea to take notes or even record the conversation at this stage, and a good surgeon will not mind you doing this.

Your surgeon will then usually send the details of the intended operation to your GP and to the National Breast Implant Registry, who record information about breast implant surgery in the UK.

The operation will be carried out while you are under general anaesthetic. It may be performed as day surgery (you will be allowed to go home the same day), but usually you will need to stay in hospital overnight.

The following is a general guide to how the operation takes place, although individual surgical practice may vary.

During the surgery, an incision (a surgical cut) is made in or near the breast and the implant is inserted either between the breast and the chest muscle or behind the chest muscle.

Subglandular

Implant placement between the breast and the chest muscle is called a subglandular placement. The main benefits of this type of procedure are that the surgery and recovery are shorter and less painful, and further operations to remove or adjust the implant are easier. However, this type of placement carries more risk of the implant hardening and deforming (capsular contracture) and can cause difficulties with mammography imaging.

Submuscular

When the implant is placed behind the chest muscle, the procedure is called a submuscular placement. This type of surgery may be more uncomfortable and the recovery time may be longer. However, the breast appearance is often more natural and problems during mammography are less likely.

Types of incision

You may also choose, in consultation with your surgeon, what type of incision to have. This will depend on the shape of your body and where you would prefer the scars to be. The are three types of incisions commonly used to insert breast implants:

Â· Periareolar.

This incision is made around the nipple and leaves minimal scarring. However, women who have periareolar incisions are more likely to experience difficulties breastfeeding at a later stage.

Â· Inframammory.

The inframammory incision is used most often and involves making a small cut underneath each breast. While the scarring may be more obvious, the incisions are very small and should not appear unsightly. The inframammory incision should not cause any problems with breastfeeding.

Â· Axillary.

An axillary incision is made in the armpit area, around the side of the breast. Axillary scars can be more visible than with alternative types of incisions, although they do not generally cause difficulties when breastfeeding.

Breast implant surgery for reconstructive purposes is slightly different than implant surgery for cosmetic reasons. For example, the surgeon may decide to use a tissue expander, a silicone outer shell that is inserted under the chest tissue and gradually inflated with injections of saline (sterile salt-water solution). Once the expander has stretched the skin and muscle enough to create plenty of healthy new tissue, it is replaced with a permanent implant.

Women who have had a single (one breast) or double (both breasts) mastectomy may choose to have immediate or delayed reconstruction. Immediate reconstruction involves implant surgery at the same time as the mastectomy is performed. Some women prefer this as it can help them to recover faster, psychologically. However, there are often increased risks of infection and other complications such as deflation and the operation and recovery times may be considerably longer.

Delayed reconstruction is carried out some time after the mastectomy is performed. This often provides women with the opportunity to consider their options more carefully and can be advisable if your surgeon thinks that there may be complications with the initial surgery. You may be advised to consider delayed reconstruction if you are still undergoing other treatment such as chemotherapy or radiotherapy.

It may be possible for women who have had a mastectomy to have reconstructive surgery without the use of implants. This type of reconstruction is called tissue transfer surgery and involves using tissue, skin and muscle from another part of the body to mould a new breast.