What scarring can I expect after a breast augmentation?

This is one of the most frequently asked questions during a breast augmentation consultation at my Nuffield Warwickshire Cosmetic Surgery Clinic. The breast augmentation operation is the most popular cosmetic surgery procedure in the UK, favoured by younger women who are unhappy with their lack of breast development or older women, who may have seen changes to their breast size, shape and volume as a result of pregnancy, breast feeding, weight fluctuations or the effects of gravity.

The good news is that breast augmentation incisions usually heal well and are positioned so they are often quite difficult to detect once fully healed. Theoretically, there are four incision approaches that can be used during a breast augmentation procedure and there are benefits and limitations to each.

The patient’s frame and amount of existing tissue is taken into account as well as the type and size of implant to be used and where it will be placed. For example, polyurethane-coated implants (use currently suspended which I’ll be taking a look at in next month’s blog) needed a longer incision than the smooth or textured surfaced implants, as they are more difficult to insert and to position. Once I have taken into account all these factors, I can advise patients on which is the best incision approach for them.

These four breast augmentation incisions are:

1. Inframammary incision

This is by far the most commonly used breast augmentation technique, with the incision made where the bottom of the breast meets the body. Once the implant has been inserted, the scar usually ends up very slightly above the inframammary crease but still well concealed on the undersurface of the breast and when wearing a bikini.

Pros of this technique are that it allows easiest surgical access , allowing most accurate implant positioning, and it may cause less difficulties with future breast feeding. It is also my preferred approach.

2. Periareolar incision

In this approach, an incision is made around the edge of the areola (the coloured area around the nipple), so that the scar is more or less ‘camouflaged’ in the change in colour and texture between the areola and the breast. Deep to the incision, access continues through the breast tissue, which may mean a higher chance the patient will not be able to breast feed in the future (although breast feeding is not always possible even for women who haven’t undergone cosmetic breast surgery). It can also affect sensation in the nipples and breasts as the nerves can be damaged during this approach.

Access is less easy than with the inframammary incision and I only ever agree to use it for relatively small implants. If you have a light-coloured areola area then the scars will be more visible.

3. Transaxillary incision

This incision is made in the armpit, allowing access to the chest muscle. However, the incision point is a long way from the inner part edge of the breast and the risk is that too lateral a pocket will be created, producing a less than optimal appearance.

Once again, unless a small implant is placed, the scar may be quite obvious, particularly when the arms are raised. Scarring in this area tends not to fade as well.

4. Periumbilical incision

During this procedure, an incision is made in the edge of the belly button. Personally, I have never performed this approach. A long way tunnel has to be developed to the placement site, making accurate siting more difficult and with a greater chance of implant damage during insertion. Additionally, bleeding is more difficult to control.

How to improve scarring after a breast augmentation

Normal scar maturation takes approximately a year. Typically, you can expect the colour to go from red to pink to pale in Caucasians but it may stay pinkish or even slightly purple. In Asian or black skin, the scar colour may end up paler, the same or darker than adjacent skin. Scars may stretch sideways and therefore not end up in an absolutely fine line.

I recommend that my breast augmentation patients massage the scars daily with a hydrating cream, such as E45, Cetraben or Diprobase, for at least a few months. BioOil, known by so many through well directed marketing and the catchy name, can also be used if desired.

It is essential to wear a postoperative surgical bra (external link:www.royce-lingerie.co.uk) to support the whole bust area for up to three months after your procedure, as, quite apart from controlling swelling and early natural healing round the implant, it can also help prevent scar hypertrophy, where the scars can thicken and ridge. Application of topical silicone gel strips, such as Mepiform or Cicacare and/or the rubbing in of silicone-based ointment, like Kelocote or Dermatix, for several months may also hasten improvement in scar hypertrophy.

True keloid scar formation, where thickening and ridging of excess raised scar tissue occurs, progressively extending out beyond the line of the original scar, is most common in black skin and is very uncommon in Caucasian patients. It is notoriously difficult to treat if it occurs; steroid injection into the scar tissue can sometimes be helpful, together with the use of pressure garments if possible. I have never seen true keloid formation in a breast augmentation scar.

Any surgical procedure will result in scars, but it is important to understand that they are a necessary accompaniment for positive change. No scars equals no change: when that is accepted and understood, it is possible to properly focus on the new shape and appearance of the breasts.

The Truth About Botox

The term ‘Botox‘ has entered common parlance in recent years, becoming almost a must have for any woman – or man – wanting to stave off the inevitable signs of ageing. So well-accepted is this magic anti-wrinkle bullet that it seems that patients are now seeking it out at a younger and younger age. Probably because they have read somewhere that starting Botox early can prevent ageing before it even occurs. In fact, the American Society of Plastic Surgeons statistics show that patients in their 20s make up approximately 30 per cent of Botox users.

So, what’s the truth about long-term Botox use?

Myth # 1: Botox isn’t safe in the long term

A leading neurophysiologist, Dr Peter Misra, of the National Hospital for Neurology and Neurosurgery in London, warned in an editorial in the British Medical Journal, that Botox was being used ‘ahead of clear scientific evidence’. His view is that the cosmetic applications of Botox have trivialised the use of what is actually a potent neurotoxin and that the long-term effects are still not known and ‘robust evidence for the action of botulinum toxin on sensory neurones is lacking’.

However, Botox has been used for many years to treat a range of medical conditions in far greater quantities that the amounts used to treat facial wrinkles. Botulinum toxin is used therapeutically to treat eye disorders such as strabismus (crossed eyes) and blepharospasm (uncontrolled blinking).

Botox can also reduce muscle spasms disorders, such as cervical dystonia or torticollis. It can also treat an overactive bladder, reducing leaking of urine or needing to urinate frequently. It can be injected intramuscularly, interdermally or directly into the bladder.

Myth # 2: Botox eradicates expression

For many years, the joke was that Botox equalled a frozen face, but is there a serious downside to this lack of expression, particularly in the trend for Botox use among the younger generation? A recent study in the Journal of Aesthetic Nursing claims that Botox use could actually cause developmental issues for younger patients. The researchers behind the study pointed to the possible problems that a ‘growing generation of blank-faced’ young people could give rise to and that therapy to build confidence should be the preferred option.

Cosmetic surgery procedures, such as a rhinoplasty or breast augmentation, can be hugely beneficial for a young person that may have suffered from lack of breast development or have a nose that is drastically out of balance to the rest of the facial features. However, this is not a step to be taken lightly and I always ensure that patient expectations are realistic and there are no psychological concerns that must be addressed. I would certainly not perform an anti-wrinkle treatment on a patient that had no need for it.

Myth # 3: Botox can actually make you look older than you are

Botox is an incredibly effective treatment, particularly for softening wrinkles in the upper third of the face. However, it is important to realise that it isn’t always our lines that makes us look older. Neglecting skin quality can actually be more ageing.

Overuse of Botox that creates the mask-like look favoured by some celebrities actually upholds this – they don’t look younger, they just look done. However, it is possible to create a perfectly subtle and natural rejuvenation with Botox but this is where practitioner choice becomes incredibly important. Discuss with your practitioner what you’re hoping to achieve and it should be obvious if they share your views on cosmetic intervention.