Breast Augmentation

Implant Choices

• Silicone gel filled implants are most commonly used in breast augmentation surgery. They contain a gel which is usually termed ‘cohesive’; Mr Banwell specifically uses the latest generation Ergonomix gel implants from Motiva
• Textured implants are still the most commonly used surface although recent technology nano-surfaces are associated with the lowest complication rates
• Round or tear-dropped (anatomical) shape including the latest generation TrueFixation devices
• Range of different projected implants (commonly called profiles)

Incision Choices

The incision can be made either in the axilla (arm-pit), circumareolar (around the lower half of the nipple/areolar) or infra-mammary (underneath the breast in the breast fold). In the USA there was also a vogue for trans-umbilical surgery (saline implants only) but this is very rarely used. The infra-mammary approach is associated with the lowest complication rate and Mr Banwell uses a short scar, minimal access, minimal touch approach (+/- Keller funnel) .

Pocket choices

The implant can be placed on top of the pectoralis major muscle (subglandular) or underneath the pectoralis major muscle (submuscular/dual plane).

The choices are dependent on specific patients’ needs and expected outcomes. Mr Paul Banwell will assist you in making an informed and appropriate choice of implant, incision site and pocket placement that is tailored to best suit you (Bespoke Breasts by Dr Paul). Most girls are aiming for a natural breast enlargement or augmentation that gives them confidence in their clothes and underwear/swimwear. Complimentary 3D computerised sizing with Mr Banwell’s team is also available – please call 01342 330302 for further information.

During your consultation we will discuss the size which may suit your height, body shape, breast width and existing breast tissue, while explaining the process of breast augmentation. However, the final decision regarding exactly what size breast implants are used is up to you, the patient. The Rice Bag Technique is usually very effective in helping patients make the decision for sizing but we also offer 3-D computerised imaging using Motiva Imagine technology incorporating the latest state of the art Crisalix Imaging software

Download the rice bag trick sizing sheet.

Mr Banwell recommends a general anaesthetic undertaken by a specialist anaesthetist. The operation is generally performed either as a day case or an overnight stay. The use of surgical drains may or may not be required after the operation.

Mr Paul Banwell generally likes to see you at least twice prior to your surgery, although he welcomes and encourages you to visit as many times as you require to allay any concerns you may have about your surgery and at the same time confirm the size, look and expected outcome you are trying to achieve. The consultations are also to ensure that you are fully informed of what the procedure involves and the potential risks.

After the operation there are no stitches to remove as they are all internal. Our office or the private hospital staff will contact you after the operation to ensure that you have no medical problems during your convalescence. There will be post-op visits at approximately one week (with nurses), 2 weeks (Mr Banwell) 8 weeks and six months. A crop-top/athletic support bra is to be worn day and night for eight weeks unless otherwise advised by Mr Banwell. We recommend no driving for one week post-operatively and no rigorous exercise for a few weeks weeks. At the 2 week post-operative visit, we will discuss the best way to achieve the optimum scar result with massage.

Pain varies greatly from person to person; however, it is usual for most patients to have some effects and discomfort in the first seven to ten days. Following surgery the RMO will give you a prescription for pain relief medicine or tablets, and encourage you to rest as much as possible in the first seven days. If at any time post-operatively you have any fears or concerns regarding your recovery you can contact Mr Banwell’s team or the hospital staff during office hours. The Resident Medical Officer is available 24/7 for emergencies

Breast implants are not permanent lifetime devices and it is likely at some time in your life that they may need replacing. Some need to be replaced in only a few years and some not for many years. In the world literature the average life expectancy varies between 8 and 16 years. Sometimes the replacement of implants is by choice (eg. to change size) although sometimes they need to be replaced because of complications, such as a symptomatic capsule forming around the implant or perhaps rupture of the implant.

Various large international studies which have been critically evaluated have up until recently shown no increased risk of malignancy within the breast or anywhere within the body. They have also shown no increased risk of auto-immune disease (joint and soft tissue) problems.

However, in recent years it has come to light that certain texturing techniques may pre-dispose to increased ongoing inflammation around the breast implant which could lead to a rare condition called ALCL. The incidence of this is around 1:25,000 compared to the risk of breast cancer which is around 1:8. In other words this condition is very rare indeed. Latest generation SilkSurface Motiva implants have been shown to minimise inflammation and capsular contract rates are in the order of 4% and no reported cases of ALCL.

Many women are also potentially interested in alternative methods of natural breast enlargement or natural breast augmentation. The appeal of breast enlargement pills and breast enlargement cream is very strong but unfortunately, in Mr Banwell’s opinion, these do not really work.

Injections into the breast with fat  (fat transfer / lipofilling /lipostructure) is currently very popular although there are limitations in terms of volume. Modern techniques including Mr Banwell’s HYBA technique (hybrid breast augmentation) combine breast implants and fat transfer and offer greater flexibility. Mr Banwell will discuss this should you wish in his breast enlargement clinic.

There are both general and specific risks and Mr Banwell will talk to you in detail regarding these. General risks include bruising and swelling, bleeding, wound infection, problems with general anaesthetics, abnormal scarring and keloid scarring, and clots in the legs and lungs. Specific risks of breast augmentation include capsule formation and capsular contracture, fluid accumulation around the implant, changing in feeling around the nipple and areolar and skin of the breast, leakage or breakage of breast implants, silicone granulomas for silicone gel implants, implant movement or extrusion, palpability, visibility, wrinkles, ripples, wide cleavage, bottoming out, double bubble, need for secondary mastopexy and asymmetry.

Women with breast implants can undertake mammograms but must make their radiographer aware of their presence prior to the mammogram. There is no evidence that breast implants increase the risk of breast cancer.

However, there is some evidence that certain types of macrotexturing can increase the risk of a rare condition called ALCL (anaplastic large cell lymphoma) which affects the capsule. The risk of this condition is about 1:30,000; in contrast the general risk of breast cancer is 1:6/1:8.

Whilst multiple scientific studies have confirmed no association between implants and connective tissue disorders, in a small number of individuals with hypersensitive immune systems, breast implants (and dental implants/ coils/ orthopaedic metalwork/ heart valves) may cause local and systemic symptoms. This is termed Breast Implant Illness (BII).