What happens on the day of my Breast Augmentation surgery
What happens on the day of my Breast Augmentation surgery (BA or Boob Job)?
Morning of your Breast Surgery
Patients often have a mixture of emotions on the morning of their surgery. It has often been something that they have been thinking about for some time so please be assured that you are not the only one. You will have had at least 2 consultations where you will have had a large amount of information to process, plus the excitement of trying different sizes of breast implants via our new Crisalix software. On the day though, patients can feel a strange mixture of excitement and nervousness.
The surgery is done as a day case so you don’t have to stay overnight and generally you will be in just for the morning or afternoon. It is best to bring some toiletries and prepare for an overnight stay just in case you should want it. If you have children then it is important to make sure that there is someone to help you with them in the first couple of days after your surgery as you will be a little tired and sore in the first 2 days.
Arriving at the Hospital
When you arrive at the hospital you will be informed which ward to go to and then the Reception staff will take your paperwork and book you in. You will have a private room and a nurse is allocated especially to you. The nursing staff will check all of your details and will prepare you for Theatre. (This is the name of the operating room and not a show!) All patients have an ID bracelet and this is an extra safeguard to ensure that we know who everyone is when asleep in theatre. You may look completely different when you are without your makeup, clothing and hair styled in your normal way! You will wear a hospital gown (not the most stylish attire!) and you will be given TED stockings. These are a brand of white stockings that improve blood circulation in the leg veins by applying graduated compression and therefore reduce the risk of blood clots during surgery.
I will come and see you on the morning of your surgery and go through any last minute questions or concerns you may have. I will then take your pre operative photos and make marks on the area(s) of your body to be operated on, using a special felt tip pen for the skin. This process is called “marking up”.
When you are having a General Anaesthetic (GA) in which you are put to “sleep”, the Anaesthetist will also see you and this is the time you can talk to them about any issues with needles or sickness. I only work with a select few Anaesthetists who are very calm and caring and I am confident will look after you to the highest standard.
When it is time for your operation, you will either walk or be wheeled down in a chair to the Theatre. You will go into the anaesthetic room first and there will be usually one or two other people in the room who are there to help the Anaesthetist with getting you off to sleep in the calmest and most relaxed way. Normally it is at this time that the Anaesthetist will put a small cannula in the back of your hand The team are excellent at chatting and relaxing you while this is done and often patients don’t even notice it has been done! The Anaesthetist will then give you some oxygen through a mask and a small injection that puts you off to sleep very quickly.
The Operation Itself
After that it is over to me. You are moved into the Theatre and checks are done to make sure that we have everything correct (now standard practice in all hospitals). The skin is then prepared (or prepped) using an antiseptic. It is coloured orange so that the areas treated can be clearly seen by al involved so when you wake up with some orange marks you know what they are and why you have them. Sterile drapes are then used to cover the areas of your body that we are not operating on and I will re-measure and mark carefully before I start. Local anaesthetic is also put into the wounds so that you are comfortable when you wake up.
Then the operation begins. I make a small incision with the knife in the fold of the breast (where the breast meets the chest) and after that all dissection is done using an electric needle, known as a Monopolar Cautery. This seals any bleeding as it goes the area being operated on. I use a lighted retractor that also helps me to see everything clearly as I dissect.
The majority of patients will have a “pocket” made under their breast tissue (sub glandular) but sometimes with patients who are very slim on their top half, I place the implant in a sub-muscular or dual pocket plane. Sub-muscular involves lifting the muscle alone and placing the implant behind it and dual plane is a method that uses both pockets by first dissecting under the breast and then lifting the muscle. The dual plane technique then has the advantages of both procedures by anchoring the breast partly under the muscle but then allowing part of the implant to be placed under the breast tissue (breast glands) to lift the breast and give it volume at the top half of the breast.
The pocket is checked for any bleeding and then left while I move to the other side to do the same procedure. Making the pocket is crucial to achieving a good result. A small pocket will make it difficult to insert the implant and it can then lead to implant rupture or ripples and knuckles in the implant. An oversized pocket leads to risk of rotation or malposition of the implant and so I take a lot of time to make sure that the pocket is just the right size for the implant I am using.
After rechecking for any bleeding, the implant selection is checked again and I prepare the skin again and change my gloves to maintain absolute sterility, which reduces the chance not only of infection but also of capsular contracture.
All surgery using implants is now done in Theatres which have a special sterile airflow, known as laminar flow. This has also been used by Orthopaedic surgeons when doing joint replacements because they want to reduce the rate of infection to the absolute minimum. The implant is then placed in a Keller funnel using a non-touch technique. The funnel looks like an icing bag and prevents the implant touching your skin as we believe this can cause capsular contracture. The result is then carefully scrutinised to make sure all looks perfect before closing the wound with 3 layers of dissolving stitches.
A light dressing is then applied and we are finished. Overall, on average, the operation takes between 60 and 90 minutes. You are then moved into the recovery area where you will wake up. You are looked after by different nurses here and they ensure that you are comfortable and wide awake before you return to your ward. You may feel a little sleepy when you get back and patients often say that the implants initially feel a little heavy and sometimes the skin feels a little tight but these feelings subside over the next 48hrs.
Once you are awake, comfortable and have been to the toilet, you will be allowed to go home and this is usually 4-5 hrs. You should not drive yourself home so please arrange for a lift or taxi.
Post Operative Care
When you are at home, please take the opportunity to again read both the information sheets and FAQs that you will have been given that are specific to your surgery, to maximise your chances of the best recovery and result.
I will then see you at 10-14 days to check your wounds. While at home you should rest but keep mobile by walking as this reduces the risk of any complications.
I will then see you again at 6 weeks and 3 months then 12 months.