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Adrian Richards: Hello, my name is Adrian Richards. Welcome to the classic surgery podcast, providing information for patients, from patients. I'm a consultant classing cosmetic surgeon. During the podcast I'll be talking to specialists in particular fields to get the latest updates on treatments. During the second part of the podcast, I'll be talking to patients who have undergone these treatments to get their opinions and views on how the treatments worked.
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Adrian: Today in the podcast we're going to change from our normal format. In the first part of the podcast, Aggie Oakley who's my specialist nurse who looks after all my breast augmentation patients, is going interview me about breast augmentation surgery. The reason for this is I tend to specialize in breast augmentation, and am actually putting myself up as the expert on this for the podcast.
Then we're goingto be talking to Charley. She's had a breast augmentation a week ago. Then we're just going to be talking to her before the operation, then talk to her seven hours following the operation. I talked to her again yesterday, a week following the operation to see how she was getting on.
We're then going to hear from Pauley, whose one year following a bilateral breast augmentation. Interestingly, her implants were placed behind the muscle, so we're going to hear how she recovered from that, and how she is now one year on following surgery.
So this is a bit of a reverse of what we normally do. So Aggie Oakley, who's actually manager in North Hampton and looks after most of my breast patients, my dorm‑like patients, is going to in tune me about breast augmentation because that's sort of the subject I specialize in. So, over to you,
Aggie: you've prepared some questions, haven't you?
Aggie Oakley: Yes I have, Adrian. Firstly, I think it would quite interesting for people listening in to know a little bit about yourself, know a bit about your background, we know you were a consultant in the NHS up until about four years ago. So if you could just tell us a little bit about yourself.
Adrian: Well, I've actually just had my 20th year reunion following medical school. I left medical school in 1988, and then specialized in plastic surgery. As you know, plastic surgeons have to have long training. So I did all the normal plastic surgical training in Oxford, Salisbury, London and spent time in Australia, New Zealand and London, actually. Then I became a consultant at Stoke Mandeville, in 2001. Spent four years there doing general plastic surgery, and really specialized in cosmetic surgery in the last four years. I still do some other surgery, but mainly I'm cosmetics now.
Mainly, as you know because you look after my patients, who we look after together, I'm mainly controlled breast surgery and faces surgery now.
Aggie: We've seen lots of patients in clinic coming forward for breast surgery, in particular, breast augmentation. Which patients do you think are suitable for breast augmentation and why?
Adrian: I know we've talked about before haven't we Agg? Generally people are in two groups, aren't they? They are either people before they've had children who just never really developed much of a bust, or are very asymmetrical. The other group is people who have had children and have lost volume after their children. Typically, they lose volume from the top of the bust and they're sort of scalloped out at the top of the bust.
So either of those patients is sort of suitable. We've had patients that are daughters, mother and grandmothers who've all had surgery: it's not just for one.
Aggie: We do also deal with a lot of patients that actually have breast deformities, especially younger girls when they actually come to clinic to see you. When you actually examine a patient, how would you determine "Yes, you are suitable for a breast augmentation"?
Adrian: Well, I think most people know if they're sort of suitable. Obviously, we don't do breast augmentation on anyone under 18, other than for asymmetry. If someone's very asymmetrical we tell them to do a breast augmentation when they're still 16, that sort of age, because we know they are not going to develop symmetry. It's very debilitating to be a 16 year old with very uneven breasts.
Basically, anyone over 18, anyone who seems sensible: they've got to have read all the information, they've got to have talked to another patient and really sort of know what's involved. The other question is, another one, yeah ‑ anyone who's really got a lot of breastosis, is not really suitable.
This is important: if anyone has lost a lot of weight, or had babies and their nipples have gone down, their nipples lie, as a rule, below the level of the fold.
The test for that is to put some paper up to the level of the fold underneath your breast. If you look in the mirror and the paper is lower than that, you probably need a breast uplift.
Aggie: Once you've determined somebody is actually suitable for a breast augmentation, other patients will ask, because they obviously read lots of literature: "Where are you going to position the implant?" Pros and cons for in front of the muscle and behind the muscle; how do you determine where you would position that implant?
Adrian: Well, you normally tell me what you think, don't you? [laughs] Basically, the reason for going behind the muscle is with somebody who hasn't got enough natural breast tissue. So the muscle covers the upper half of the implant, and it's muscle that comes down from your arm and sort of slants downwards across your chest called a petroalias major muscles. Now what we tend to do is measure: we've got a special caliper for measuring the thickness of the skin in the upper portion of the breast. If there is less than two centimeters, we tend to go under the muscle because that means there isn't covering to cover the implant.
If it's over two centimeters, we tend to go over the muscle and that's a gentler, quicker recovery: the muscle doesn't contract.
With under the muscle, if you contract the muscle it distorts the breast. We do a lot of both, really. I'll ask you this question ‑ I'll reverse it to you ‑ you look after the patients afterwards, how do you think the unders to overs compare?
Aggie: I do tend to find that the behind the muscle tends to be sore for quite a while after and movement is quite restricted per surgery, so they do tend to need more painkillers afterwards. If they are a very slim patient, the muscle does hide the implant very well.
Adrian: So I think it really depends ‑ I agree with you totally ‑ it depends on the individual and no one thing is right for everybody.
Aggie: Now there are lots of implants on the market, but lots of shape, s different projections ‑ what sort of the implants do you tend to like to use the best?
Adrian: We tend to use cohesive gel implants. They're the ones with the sort of solid gel, and then we chose the level of cohesitivity ‑ difficult word to pronounce, isn't it? So basically, a thicker gel for the patient if someone's got more breast tissue we use a less cohesive gel that's softer. On a very thin person you may use a shaped implant, but on someone with more established breasts you may use a more round implant, which goes tear drop shaped when the patient sits up.
Aggie: With the shaped implants, problems can also happen with the shaped implants. Can you sort of discuss a little but about using a shaped implant as opposed to using a round implant?
Adrian: Yeah, you're absolutely right. Shaped implants sound very good. The problem with shaped implants is number one they're harder than soft, round implants: the second thing is they can rotate. The implants are flat on the back, but they can swivel on themselves and rotate. For that reason, we often use round ones which are very soft and become breast shaped when you sit up.
Aggie: So there's, obviously no problem if they move?
Adrian: No, no much less of a problem. I have seen, occasionally an implant turn upside down: even a round one which can be turned back again, but I think it's more of a problem with the shaped implants.
Aggie: Now risks of surgery: most people know the, obvious risks of surgery are bleeding, infection. What are the risks souly associated with breast augmentation?
Adrian: Well, you are right about this. I do approximately, 200 breast augmentations a year. I normally tell my patients. I have one patient who bleeds in the year and needs to be taken by the theatre, normally within 24 hours to have the blood clot removed. I normally have one infection a year. If you got an implant, basically, antibiotics won't cure the infection. You normally need the implant removed for three months and then the implant replaced. The longer term complications are really capsule formations. And this is when the implant goes hard, because the body forms a wall around the implant.
The implants I use are made by Allergan, and the capsular contraction rate is said to between one and two percent. So that's, extremely low ‑ one or two people in a hundred. No one knows why you get it. It's very unfortunate if you do. It can be treated. But we use obviously the best implants to try and reduce the risk.
Aggie: Patients sizing of implants .Now everybody varies on how they size a patient. How do you feel the sizings that we do in clinic?
Adrian: Well this is a very important thing. I mean breast augmentation, is generally a very straight forward operation, and most people are very happy to have it done. When I see some patients who perhaps have operated elsewhere, they are not happy with the size. And this is really important, that you get this right and spend a lot of time doing it.
So the way we do it is I would see the patient measure them. Its very important to measure the width of their breast, the natural width, because a small person needs a very different implant from a much bigger person.
So you measure the width to make sure that it doesn't go out too much on the side. Doesn't look too bulky in that way. And that bulk conversely gives you a nice cleavage. So you measure the width.
And then there are also projections. As you know we got to discuss what sort of projection a person wants. There are flatter implants and more raised implants. And then we got a computer statistical biodynamic, which allows us to take measurements and actually asses on the computer what's best for the patient.
And then finally what you spend on... I mean, I know you spend at least an hour, don't you, talking to the patients.
Aggie: Yeah.
Adrian: Yeah, tell me about that? I mean we sort of work very much as a team on this.
Aggie: After actually taking your measurements, we do tend to sort of use the sizing charts from the implants companies and determine the implants. So we do, actually have a range of implants for that patient that we can actually fit in that patient basically. The projections are important because that's the final look the patient is looking for, you know, so they can look very voluptuous to being very discreet. So we spend a lot of time with those sizes and we actually try them on the patient as well. So we do actually look at the patients with their different tops on. So if they go to the gym, we can see them in their gym top.
Because what we don't want is patients being very conscious about their breasts being small being very conscious about the after result. And spending the time in getting it right is the most important thing.
At the sizing, we also discuss do's and don't basically, so the patients know what they can do after surgery, before surgery, and they know what's happening through the whole journey of the surgery. Which I think is very important, because quite often the patient will feel very nervous and not know what to expect after surgery.
If they know what to expect...even down to pajamas taking into hospital and what to wear when they leave the hospital is important. And so, they do get a full picture of the whole surgery and thereafter care.
Adrian: And you are quite strict with them post operation period, don't you?
Aggie: I am very strict with them. But we get good results so it does work.
Adrian: Yeah. Again, it's lots of little things that do make a difference in this sort of surgery.
Aggie: It does make a big difference.
Adrian: Right. So have you got anymore questions? You got your listener here Aggie?
Aggie: My listener has finished. And I hope any patients listening in will find it very helpful. And if they ever want to contact me, I am available at the Aurora Clinic at The Gatehouse, and on 01604 875040.
Adrian: I mean, I think it's very important that if you are thinking of this sort of surgery, you really need to do your research. And it's very important if you can, talk to someone who's had it done. If you don't know anyone, we could help you be in contact with somebody, or go on one of the forums that discuss this form of surgery. There's a very good one. We've got one. And what's the other one called? They go to SoFeminine. SoFeminine is a very good one. And there's one in Cosmopolitan, The Daily Mail. So look at the forums. Try and get as much information as possible. It is a very successful operation. Again, you really need to do your research.
So Aggie, thanks for interviewing me, and see you soon.
Aggie: OK. Thank you. Bye bye. [music interlude]
Adrian: So I am here this morning with Charlie. She is just about to have a breast augmentation in about an hour. So Charlie, could you just tell me what did you perceive the problem to be when you started thinking about it, and how you're feeling now?
Charlie: I was about 12, when I first started thinking about having a breast augmentation. I never felt that I fully developed properly during puberty. So 12 years later down the line, I am finally getting it done and fulfilling something that I wanted to do for a while.
Adrian: And how are you feeling now? I mean, the big day has arrived after 12 years. Tell me how you are feeling?
Charlie: I am feeling excited. Slightly nervous now I have seen yourself and the anesthetists and all the nurses. But mainly excited about it.
Adrian: Will it be alright if I come and talk to you later on this evening after you had this operation?
Charlie: Of course it is. Yeah.
Adrian: And then we will sort of follow it through and see how you get on. So, any words of advice to anyone thinking about having the operation?
Aggie: Just to think about it properly and think about it fully. And try not to work yourself up too much. Just relax and take it as it comes.
Adrian: Well thanks for talking to me, and I will talk to you later on today. Good luck.
Charlie: Thank you. [music interlude]
Adrian: So I am here with Charlie. Now it's about seven 'O clock, isn't it, following her operation. Tell me how it was and how it felt for you Charlie? And how you feel now most importantly?
Charlie: I feel really fine within myself, and one of my breasts feels more tender than the other. But other than that I feel absolutely fine. And I have been sleeping on and off. And, yeah, I feel great.
Adrian: So what time did you actually go down in the end?
Charlie: I think I went down about half ten this morning and came back about half twelve after being in recovery. Had a little nap. And like I said, been sleeping on and off the whole afternoon. But I feel fine.
Adrian: Now you managed to eat and drink anything?
Charlie: I have, yeah. I had a little sandwich, and they brought me some dinner as well which I picked up. But, yeah, I have been keeping fluids down and didn't feel sick after the anesthetic or anything.
Adrian: Oh that's good. And we just talked about it we used a 420 cc, the higher profile implants and they look really good at the end. So, if it's alright with you we will talk with you next week and see how you are getting on.
Charlie: Yeah that's fantastic. Thank you very much.
Adrian: Talk to you soon Charlie. [music interlude]
Adrian: So I am here with Charlie. And it's almost exactly a week since you had your operation isn't it?
Charlie: It is, yeah.
Adrian: And the last time we talked to you, you just sort of had your operation, it was the evening of it. Could you tell me a little about, you know, how everything's been since then?
Charlie: Since the operation, the first couple of days were fairly uncomfortable just around the incision side where the bra was ripping on it the surgical bra. But other than that resting is paramount. [laughs] I found myself sleeping a fair bit. And, I couldn't eat for the first couple of days really. I think that was just due to the medication I was on. But other than that it's been really a fantastic experience and definitely worthwhile.
Adrian: So talk me through day one you went home; you stayed the night and then you went home. How did you feel that day?
Charley: When I got home, I took some medication and went straight to bed and rested.
Adrian: And that was the pain killing medication we gave you.
Charley: The pain medication, yeah and the anti-inflammatories, and rested for the majority of the day. To be honest, it got easier every single day I was able to do a little bit more each and every day. I found washing fairly hard for the first few days; I needed to some assistance with that. Hair washing, and obviously washing my body and my armpits: a week later now I've pretty much got full mobility back in my arms and can stretch them right out.
Adrian: So you can move. What sort of symptoms have you got now? Have you got any pain now?
Charley: Around one of the incisions, it's not painful but I notice it's there, but I think that's just due to the bra rubbing on it more than anything. I'm really not in much pain at all.
Adrian: Could you go back to work at this stage, do you think?
Charley: If I worked in an office, I think I could if I had a supportive chair for my back as well. I've had a bit of neck pain, and I don't know whether that's because I've been holding myself differently. Like I said, if I worked in an office I think I could go back to work. It would be advisable though to take two weeks off. With my work, no
I couldn't go back yet.
Adrian: You do a very active job, don't you? I think with you sort of two weeks. See, we normally advise people to be off work for at least 10 days, two weeks. Do you think that's good advice, Charley?
Charley: I do, I think that's a perfect amount of time. Like I said, seven days down the line I feel fantastic.
Adrian: Brilliant. Now we trimmed your stitches today and everything is healing really well. What do you think of your bust at the moment?
Charley: They look very shiny I think that's due to the skin being stretched so much, but I'm really happy with the outcome.
Adrian: Yeah, they look good at you and the scars are healing really well. We've re‑taped them with our tape today, and I believe you're off to look at some bras, is that right?
Charley: Yeah I'm indeed: I'm going to go get them resized and then get some new supportive bras.
Adrian: Brilliant. Perhaps we'll talk to you again and see how getting on in the next installment?
Charley: Definitely.
Adrian: Thanks for talking to me. Talk to you soon, Charley
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Charley: Thank you. [music]
Adrian: So I'm here this afternoon with Pauline who had a bilateral breast augmentation. Was it exactly a year ago?
Pauline: On the 18th of December: exactly a year, bar a week.
Adrian: So was that your Christmas present?
Pauline: It was my Christmas present, yes.
Adrian: I thought it would be helpful just to sort of talk through the operation with Pauline now you're a year post surgery. We used a dual plane position on you because you were very slim. Can you just explain your feelings about that?
Pauline: Fine, when I first decided to have the augmentation, I was less than a AA so I was very, very flat chested. I'd never had any breasts at all, so it wasn't like I had them, and then lost them through having children and things like that: I just had never had them. This was totally new so I was nervous, because I wasn't sure what I actually would look like, but I knew it was something I wanted to have done.
So yeah, we went for it and I've never looked back.
Adrian: Brilliant. You've had children how many children have you got?
Pauline: I've got three.
Pauline: Did you breast feed them?
Pauline: I did try to, but again, because I was so flat chested it was never possible,
really.
Adrian: OK, the reason why we went for the dual plane position as we've talked about before is because you were very flat at the top, and you didn't have enough natural breast tissue to cover the implant. So tell me how the whole procedure was, and your recovery period?
Pauline: Brilliant, once we had it, literally done the week before Christmas, which was great I carried on with Christmas as normal. Obviously it was uncomfortable because it had gone under the muscle. I found that sleeping, sitting up was a little bit unusual because I'm a natural sleeper on my side. That was good. Obviously, because the skin was stretched, when I got goose bumps and things like that I remember it being very uncomfortable, almost to the point where I wanted to put water on them to stop that tender restrictedness. I eased that by putting on lots of moisturizer, constantly doing body moisturizers and things like that.
Within the week on Christmas Eve, we came for my first weeks check up and I left here feeling a million dollars: once my big stitches could come out and then I was left with the plasters.
By six weeks, I left here feeling absolutely couldn't wait to get to the nearest lingerie department to get fitted for my first ever big girl bra.
Adrian: What sort of a size have you gone from and to?
Pauline: I've gone from a AA to a D cup.
Adrian: You're quite sort of tall and slim, aren't you?
Pauline: I'm 5'6" so everything's in well proportion. One of the things that you
wanted me do is when I had them, is that you couldn't see that they still matched my frame: they very much do that.
Adrian: And how do they feel now?
Pauline: Perfect like I've always had them. The novelty factor is still there, too. I still catch myself in the mirror and I'm like "ooooh", you know? I can fit clothes better and I hold myself totally different: where I used to walk with a bit of a stoop, because I was conscious of the fact that I never felt like a woman. Now it's shoulders back and head held high, and I wear the clothes that sort of complement a figure now. Because I am only a size eight, I suddenly have got the perfect woman's figure.
Adrian: Brilliant. Anyone from your experience, if anyone was considering this sort of surgery, what would you say the things are to look out for, and the things to be careful of?
Pauline: Definitely if you were as slim as I was, as flat chested, don't be put off having it under the muscle. I did think "oooh it's going to be," because you did say it would be that little bit more uncomfortable after the operation. Personally, it was worth that natural look, because I don't have the ridge you predominantly see on the glamour models where they've had it over the muscle.
I'm personally glad I went for that, and put up with that extra maybe week or two of more discomfort because of it being under the muscle. I'd say go for it, totally, but be realistic as well. It can be quite addictive, where you may want to go bigger and bigger, but be happy with what looks natural I think, definitely.
Adrian: Brilliant. Well, thank you very much for taking the time to talk to us, and good luck. I'll see you next year.
Pauline: Thank you so much!
Adrian: Bye bye, then. [music]
Adrian: That will do it for today. Thanks for listening to the plastic surgery podcast: providing information for patients from patients. For further information and to leave feedback, please visit the Aurora website, at www.aurora-clinics.co.uk. If you'd like to schedule an appointment with one of our surgeons, please call 01844 214362, or email us on info@aurora-clinics.co.uk.
We are very keen to get feedback. If you are considering any of these treatments, and you'd like me to ask one of the resident experts about any topic, please email us or send us an audio file which we can play on the podcast.
I'm Adrian Richards, and thank you for listening to the podcast, and thank you to all of our guests.
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