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Breast Augmentation

Olivier Branford is one of the UK’s leading plastic surgeons for breast enhancement and works with patients to create a totally bespoke result, with each procedure tailored meticulously to the individual’s vision.

Breast augmentation can be undertaken for a number of  reasons and it’s essential to have a clear understanding of your aesthetic goals.

Dr Branford was the first surgeon in the UK to use the augmented reality Crisalix device, an innovative 4D imaging simulator which shows how you will look with different sized breasts as you move around in front of a ‘mirror to the future’.

Who is a good candidate for Breast Augmentation?

► Those who are bothered by the feeling that their breasts are too small, or are dissatisfied with their breasts having lost shape and volume after pregnancy, weight loss or as a result of ageing.

► Those who are physically healthy and not pregnant or breastfeeding, and whose breasts have finished developing.

► Those with asymmetrical breasts or in whom one or both breasts have failed to develop normally.

OB

Olivier Branford 
Plastic Surgeon
London
olivierbranfordltd@gmail.com
0203 432 3009

What can I expect in the initial consultation?

An initial 1-hour consultation will detail your goals, full medical history and includes a 4D augmented reality scan using Crisalix to visualize your results with you. Instead of being given an implant in a bra, a crude way to gauge size, you’ll see yourself from all angles as Mr Branford increases the size in real time. Until this revolutionary imaging software, there wasn’t an accurate way to show what implants would look like in patients’ bodies. If you require additional consultations there is no extra charge for this.

Mr Branford has conducted extensive and renowned studies that have helped to define breast beauty by outlining key parameters that contribute to breast attractiveness. The “ICE” principle is a formula for achieving the 45:55 ratio identified as fundamental to beautiful natural breast appearance and favours enhancement over distortion. The formula is: implant dimensions (I) − capacity of the breast (C) = excess tissue required (E). This allows predictable results to be achieved with careful placement of the scar in the fold under the breasts.

The aim of the consultation is to identify your goals and support your decision making rather than to dictate your size. As everyone’s bodies are different, the same sized implant can look very different on different people. Mr Branford always aims to achieve a natural look by combining his artistic eye with his repertoire of techniques. The 4D imaging is invaluable for communicating an accurate visual portrayal of the results – a true ‘try before you buy’ experience.

Mr Branford will also:

► Assess for preoperative asymmetry
► Discuss any underling chest-wall abnormalities and how these will affect the outcome
► Obtain several breast and chest measurements, with careful documentation of nipple position, and assess skin and tissue quality and laxity.

► Take standard clinical photographs

►  Discuss any procedure-related risks or potential complications.

►  Outline that there is no shelf life for implants and these only need to be replaced if they become symptomatic. The Sebbin implants that he uses are guaranteed for life against capsular contracture and rupture.

►  Discuss the ability to breastfeed after breast augmentation. Not all women can breastfeed before augmentation and a similar proportion can breastfeed after.

►  Explore how the implanted breasts are likely to look over time, and after pregnancy and breastfeeding.

►  Advise that patients should arrange for someone to drive them home from surgery and to stay with them for at least the first night following surgery.

Want to know more about Breast Augmentation?

Breast augmentation can increase your self-confidence and remains a safe, effective procedure. There is an increasingly greater emphasis on achieving natural-looking results, as requested by patients, which can be achieved with careful planning, to give longevity and aesthetically pleasing results both in and out of clothes. Get in touch with us with any questions that you might have about the procedure.

Results

FAQs

What the Consultation will cover

The consultation will

►The patient’s desired aesthetic outcome

►Medical conditions, risk factors, medical treatments, and any drug and dressing allergies

► Medications (patients should avoid taking aspirin or other blood-thinning drugs, as well as anti-inflammatory drugs, as they increase bleeding)

► Vitamins and herbal supplements (which should be stopped 2 weeks preoperatively due to often poorly studied or unknown effects on post-surgical bleeding)

► Alcohol, tobacco and drug use

► Previous surgery

► Family history of breast cancer and
results of any mammograms or biopsies.

► The surgeon should also:
Assess for preoperative asymmetry

► Discuss any underling chest-wall abnormalities and how these will affect the outcome

► Obtain several breast and chest measurements, with careful documentation of nipple position, and assess skin and tissue quality and laxity

► Take standard clinical photographs, which may include three-dimensional images which can be morphed to assist in understanding the patient’s goals and how realistic their expectations are. In the author’s experience, four- dimensional imaging has been invaluable. Here, a woman can see her predicted postoperative result with different implant choices as she moves around in front of a full-length ‘virtual mirror’. This is far superior to the traditional method of using implant sizers in a bra

► Discuss any procedure-related risks or potential complications

► Look at what implant shape, size, surface texturing, incision site and pocket placement site are recommended for the patient

► Outline how many additional implant- related operations the patient can expect to undergo over their lifetime. There is no shelf life for implants and these only need to be replaced if they become symptomatic

► Discuss the ability to breastfeed after breast augmentation. Not all women can breastfeed before augmentation and a similar proportion can breastfeed after

► Explore how the implanted breasts are likely to look over time, and after pregnancy and breastfeeding

► Patients should arrange for someone to drive them home from surgery and to stay with them for at least the first night following surgery.

Breast implant types

Saline breast implants are filled with sterile salt water. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body.

Silicone breast implants are filled with silicone gel, which feels a bit more like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or could escape into the breast implant pocket.

Form-stable implants are sometimes referred to as ‘gummy bear’ breast implants because they maintain their shape even when the implant shell is broken, similar to cutting a ‘jelly baby’ in half. The consistency of the silicone gel inside the implant is thicker than traditional silicone gel implants. These implants are also firmer than traditional implants.

Shaped (teardrop or anatomical) gummy bear breast implants have more projection at the bottom and are tapered towards the top, giving a more natural shape, especially in those with little breast tissue. If a shaped implant rotates, it may lead to an unusual appearance of the breast, which may require a separate procedure to correct. Specific indications for anatomically-shaped devices

include limited soft-tissue coverage (slim patients with small breasts), those who desire a full but natural result, breast and chest wall asymmetry, constricted breast type, and short nipple-to–inframammary fold distance.

Round breast implants have a tendency to make breasts appear fuller in their upper part, meaning they look less natural than teardrop implants when undressed. Because round implants are the same shape all over, there is less concern about them rotating out of place. However, in the author’s experience, if the patient follows a 6-week protocol for recovery, there is an extremely low risk of rotation of shaped implants.

Smooth breast implants may have some palpable or visible rippling under the skin. Textured breast implants offer some advantage in diminishing the risk of a tight scar capsule.

Steps of the procedure

After discussing the implant size, 99% of patients opt for teardrop implants and dual-plane surgery –  the most superior version of insertion which allows the breast to look more perky. Dual-plane gives the most natural looking results but is exclusive to only the most skilled of surgeons.

In the dual-plane approach, there is a pocket above and below the muscle with the implant going below the muscle, and the dissection above the muscle allowing the breast to ‘redrape’. The pocket is dissected in an atraumatic way.

The implant pocket is irrigated with 50% povidone-iodine. A ‘Keller funnel’ is used to insert the implant without touching it, and nipple guards used, as well as gloves changed before implant insertion, all designed to reduce biofilm, which is implicated in both capsular contracture and breast implant-associated anaplastic large-cell lymphoma (ALCL).

Incisions are closed with three layers of absorbable sutures, skin adhesive and surgical tape.

Silicone form-stable implants are sometimes referred to as ‘gummy bear’ breast implants because they maintain their shape even when the implant shell is broken, as would occur cutting a ‘jelly baby’ in half.

Shaped (teardrop or anatomical) gummy bear breast implants have more projection at the bottom and are tapered towards the top, giving a more natural shape, especially in those with little breast tissue and who are of slim build.

Round breast implants have a tendency to make breasts appear fuller in their upper part, meaning they look less natural than teardrop implants when undressed. Because round implants are the same shape all over, there is less concern about them rotating out of place. However, if the patient follows a 6-week protocol for recovery, there is an extremely low risk of rotation of shaped implants.

Smooth breast implants may have some palpable or visible rippling under the skin. Textured breast implants offer some advantage in diminishing the risk of a tight scar capsule and are often firmer resisting rippling.

Breast augmentation patients receive general anaesthesia supplemented by local anaesthesia, as the procedure is performed as day case surgery.

Recovery

Total intravenous anaesthesia (TIVA) gives an almost immediate recovery.

Ache subsides after 1–4 days as the chest muscle relaxes and breasts are fairly symptom-free by 1 week. Patients are fitted with a post-surgical garment with a strap across the upper breasts to avoid the implants healing too high up on the chest. This is worn day and night for 6 weeks to ensure the best long-term results and to reduce the risk of shaped implant rotation. Strenuous upper-body exercises should be avoided for 6 weeks. Complications will be discussed at length.

Complications

Possible complications include (reference):

► Those related to anaesthesia

► Bleeding or haematoma

► Infection

► Changes in nipple or breast sensation

► Poor scarring—poor incision placement or overactive scarring (it can take 12– 18 months for scars to fully mature and appear less pink and flat)

► Wrong or faulty position of the implant

► Asymmetry

► Implant leakage or rupture (1% per year)
(reference)

► The formation of tight scar tissue around the implant (capsular contracture) in 3–5% of cases (reference)

► Fluid accumulation (seroma)

► Visible rippling of the skin over the implant

► Persistent pain

► Possibility of revision surgery.
Reviews of scientific research by independent groups in large-scale, long- term studies have found no link between breast implants and autoimmune or other systemic diseases (references).

There is a rare documented association between breast implants and a typically indolent form of lymphoma (breast implant-associated ALCL), which appears to occur more frequently with certain implant types (coarsely textured breast implants), possibly as a result of biofilm production, and hence many surgeons are moving to microtextured breast implants. However, the cause of the disease does appear to be multifactorial, with some genetic predisposition. Because of the potential inflammatory pathway, and prevention of capsular contracture in general, Adams (2016) recommended a 14-step plan to minimise pocket contamination.

Contra indications

► Breast augmentation is contraindicated in smokers due to the higher risk of wound breakdown, implant infection and the need for implant removal. Smoking should be discontinued for 6 weeks before surgery and 6 weeks after. Those who are not fit for general anaesthesia are also advised not to have breast augmentation.

► Blood thinning medications (patients should avoid taking aspirin or other blood-thinning drugs, as well as anti-inflammatory drugs, as they increase bleeding)

► Herbal supplements (which should be stopped 2 weeks preoperatively due to often poorly studied or unknown effects on post-surgical bleeding)

Conclusion

Breast augmentation can boost people’s self-confidence and remains a safe, effective procedure. There is an increasingly greater emphasis on achieving natural-looking results, as requested by patients, which can be achieved with careful planning, to give longevity and aesthetically pleasing results both in and out of clothes.

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