Mastopexy (Breast Uplift)

Transcription

1 Mastopexy (Breast Uplift) As we age and as women, our bodies go through pregnancy and breastfeeding, the position of the breasts can change. Typically the nipple and areola sits level with the centre of the upper arm but this is not always the case as we age, have children and gain and lose weight. These factors in combination with a loss of elasticity and volume can result in drooping of the breasts, along with descending of the nipple and areola and the nipple may even point downwards. Unlike breast augmentation or reduction, mastopexy surgery does not seek to change the size of the breasts. It is designed to simply return them to their natural, youthful and better positioned shape. The skin has often lost its elasticity so the surgery is performed through removing sections of the loose skin and then reshaping the breast tissue on the inside. Often uplift surgery is combined with augmentation to return some fullness to the breast but this isn t always necessary. It can be discussed with you if you re considering enlargement as well as reshaping, to see whether it is a good option for your situation. Mastopaxy is something that many younger women consider because the procedure my not interfere with breastfeeding and therefore they could go on to have more children and breastfeed them if they wished. However, an uplift does not mean the breasts will continue to main their shape and they may begin to lose shape and droop again for the same reasons as mentioned before. Are you a suitable candidate for Mastopexy? You could be considered a suitable candidate for mastopexy if: Your breasts do not feel like they are the right shape for yourbody Clothes do not fit comfortably around your breasts Your breasts point downwards Your breasts are lacking in firmness and elasticity Preparing and Recovering from Mastopexy After your consultation and when you have asked all questions and had your worries and concerns dispelled, your procedure can be booked. Breast uplift and reshaping procedure requires a general anaesthetic and usually an overnight stay in hospital. Most patients are able to return to work in around two weeks and return to driving within a week. Most patients can also begin exercising with a month too. Bear in mind these are general guidelines and each individual case is different. Please contact us today to find out more information, discuss your personal situation and arrange your initial consultation. Breast Uplift: Risks & Conditions Please note that whilst in hospital, as part of your treatment plan it may be necessary to provide you with intravenous fluids, antibiotics or even a blood transfusion.

2 1. Pain and Discomfort All patients will feel sore or uncomfortable for several days after the operation, pain killers are prescribed for this period. We should point out that pain thresholds can vary from patient to patient, although it is exceptionally rare for patients to experience extreme pain or discomfort. Rarely neuropathic (nerve) pain can occur for an undetermined period of time. 2. Bruising and Swelling Patients must anticipate noticeable bruising that may persist for a number of weeks, this is entirely normal and will settle down. The results of the operation may be obscured by the swelling for some time. The process of healing cannot be hurried. 3. Bleeding (Haematoma) Occasionally, post operative bleeding may occur which can lead to swelling and pain. It may be necessary to drain this by performing an additional procedure, and this will require a return to the hospital. The nature of this surgery may precipitate the need for a blood transfusion. 4. Seroma In a very small number of patients, a localised swelling of fluid called a seroma can occur. This is comparatively rare and may require a minor drainage procedure and additional medication. 5. Infection It is important to recognise that a surgical incision contributes to a risk of the introduction of bacteria from the patient's own skin. Such infection may be associated with tiredness, weakness, fever and generally feeling unwell. Antibiotics given during your operation reduce this risk to a minimum, however, should you experience an infection, appropriate care and advice will be given. Rarely a patient may require readmission to hospital. 6. Scarring Patients must understand that scarring is an inevitable part of Breast Reduction/Uplift surgery. Your surgeon will describe the location of scars. Generally scarring is acceptable to patients and is usually not visible when wearing normal clothes. Scars will usually fade in time, but, very rarely, a scar does not heal in the normal way. This is known as hypertrophic or keloid scarring and it cannot be avoided or diagnosed in advance. Scarring is patient specific and scar may stretch or become thick, light colored or darker. Some scars may require revision. 7. Loss of Sensation/Nipple Projection As separating the nipple from the breast tissue during surgery disturbs the superficial nerves of the nipples, some patients may experience a decrease or a loss of sensation to the nipple. The length of time for sensation to return varies and in some cases loss of sensation is permanent. If the surgeon performs a "free nipple graft" nipple projection may be affected. 8a.Wound Healing Healing of wounds varies from patient to patient and even from one part of the body to another and is a gradual process. Smoking, (this includes all nicotine based products such as e-cigarettes, gums or patches), for the period leading up to your surgery and afterwards can seriously hinder the healing process. 8b.Necrotic Wounds (dead tissue) Usually black or brown in appearance, this problem may occur (albeit rarely) as a result of healing complications. The wound will not heal until the necrotic tissue is removed and this may mean a prolonged period of wound management and additional visits. Rarely total nipple loss may occur.

3 9. Asymmetry, shape and reduced breast size It is not possible to guarantee a specific bra size following breast reduction and breast size may increase again after surgery if you put weight on. Most women s breasts are slightly different sizes. Breast Reduction is a major procedure involving the removal of large volumes of breast tissue, it is rare that perfect symmetry in size or nipple location will be achieved after such surgery, or following uplift. Breast shape will continue to improve and look more natural but may take several months after surgery. The final shape,volume,size and symmeterisation cannot be guaranteed. Breast Uplift is not a permanent operation and breasts will sag again if they are heavy or not supported with a bra. 10. Ptosis (sagging) A mastopexy (breast uplift) or reduction mastopexy is the specific treatment for ptosis but please note the breasts will sag again with time or bottom out, especially if they are heavy and not supported by a bra. If this occurs the patient may seek a further uplift with associated fees. 11. Breast Feeding Patients may experience an inability to breast feed after such surgery. 12. Fat Necrosis (Death of Fat Tissue) A few days after surgery a clear liquid with a yellow or brownish colour may drain from the wound; this may be due to fat necrosis. The blood supply to fat is always poor and many events around the time of surgery can interfere with this. The inadequate blood supply causes some cells to die and release particles of fat; these drain to the surface. The remaining tissue may become hard or calcified. Fat necrosis is uncommon. The larger the breast the more likelihood there is that fat necrosis will develop. 13. Deep Vein Thrombosis and Pulmonary Embolism This is a rare but serious complication of surgery and anaesthesia, where a blood clot forms in theveins, usually the legs, and then moves to the lungs interfering with their normal function and may be fatal. You may be asked to wear special stockings during your admission and will be actively encouraged to mobilise early following surgery. You can further reduce the risks after discharge by avoiding dehydration and remaining mobile. If you experience sudden chest pain or breathlessness, you should seek medical help without delay. Please note we recommend you do not fly for at least six weeks following surgery and you should not take a long haul flight for twelve weeks. 14. Histology A sample of breast tissue is routinely sent for histology following Breast Reduction surgery. If during the surgery, surgeon finds a suspicious lump, he could stop any further surgery until the histology is cleared for any breast cancer. 15. Allergic Reaction/Retained Sutures Rarely local allergies to tape, suture material or other preparations used in surgery have been reported. Please ensure you inform your surgeon of any know allergies. It is also the case that occasionally dissolvable sutures do not dissolve as intended and may require removal in the future. Rarely the wound healing process can mask the presence of sutures at the time of your nurse appointments and you may need to return for further suture removal in the future. 16. Revision As with any type of surgery, there is always a possibility that your surgeon is of the

4 opinion that you could benefit from some form of revision operation after your original surgery. 17. Subjectivity Patients must recognise that this procedure is performed for cosmetic reasons and because of this, the results can only be assessed subjectively. Therefore, it is important to understand that while you will be advised as to the probable results, this should in no way be interpreted as a guarantee. This list of risks and conditions associated with Breast Reduction/Uplift is not exhaustive. It is important that patients recognise that it is not always possible for the surgeon to predetermine the individual and psychological reaction of patients to postoperative complications. Risks and complications of of General Anesthesia Very Common and common side effects 1. Feeling sick and vomiting after surgery 2. Sore Throat 3. Dizziness and feeling faint Your anaesthetic may lower your blood pressure and make you feel faint. This may also be caused by dehydration (when you have not been able to drink enough fluids). Fluids or drugs (or both) will be given into your drip to treat this. 4. Shivering You may shiver if you get cold during your operation. Care is taken to keep you warm during your operations and to warm you afterwards. A hot air blanket may be used. However, shivering can happen even when you are not cold, due to the effects of anaesthetic drugs. 5. Headache There are many causes of headaches, including the anaesthetic, the operation, dehydration and feeling anxious. Most headaches get better with a few hours and can be treated with pain-relieving medicines. 6. Itching This is a side effect of opiates (such as morphine), but can be caused by an allergy (for example, to drugs, sterilizing fluids, stitches or dressings). If you have itchiness, it can be treated with other drugs. 7. Aches, Pains and Backache During your operation you may lie in the same position on a firm operating table for a long time. Great care is taken to position you, but some people still feel uncomfortable afterwards. 8. Pain During Injection of Drugs Drugs may cause some pain or discomfort when they are injected. 9. Bruising and Soreness This can happen around injection and drip sites. It may be caused by a thin vein bursting, movement of a nearby joint, or infection. It normally settles without treatment, but if the area becomes uncomfortable, the position of the drip can be changed. 10. Confusion or Memory Loss This is common among older people who have had an operation under general anaesthetic. It may be due to several causes. It is usually temporary, but may

5 sometimes be permanent. 11. Chest Infection A chest infection is more likely to happen to people who smoke, and may lead to breathing difficulties. This is why it is very important to give up smoking for as long as possible before your anaesthetic. 12. Bladder problems After certain types of operation men may find it difficult to pass urine, and women tend to leak. To prevent problems, a urinary catheter may be inserted at a suitable time. 13. Muscle pains These sometimes happen if you have received a drug called suxamethonium. This is a muscle relaxant which is given for emergency surgery when your stomach may not be empty. Uncommon Side Effects and Complications 1. Breathing Difficulties Some pain-relieving drugs can cause slow breathing or drowsiness after the surgery. If muscle relaxants are still having an effect (have not been fully reversed), the breathing muscles may be weak. These effects can be treated with other drugs. 2. Damage to Teeth, Lips or Tongue Minor damage to your lips or tongue is common. Damage to your teeth is uncommon, but may happen as your anaesthetist places a breathing tube in your airway. It is more likely if you have weak teeth, a small mouth, a stiff neck or a small jaw. 3. An Existing Medical Condition Getting Worse Your anaesthetist will always make sure that you are as fit as possible before your surgery. However, if you have had a heart attack or stroke, it is possible that it may happen again as it might even without the surgery. Other conditions such as diabetes or high blood pressure will also need to be closely monitored and treated. 4. Awareness Awareness is becoming conscious during some part of an operation under general anaesthetic. It happens because you are not receiving enough anaesthetic to keep you unconscious. Monitors are used during the operation to record how much anaesthetic is in your body and how your body is responding to it. These normally allow your anaesthetist to judge how much anaesthetic you need to keep you unconscious. If you think you may have been conscious during your operation, your anaesthetist should be told about is as soon as possible. He or she will want to know, to help both you and future patients. Rare or Very Rare Complications 1. Damage to the Eyes Anaesthetists take great care to protect your eyes. Your eyelids are held closed with adhesive tape, which is removed before you wake up. However, sterilising fluid could leak past the tapes or you could brush your eyes as you wake up after the tapes have been removed. These could cause damage to the surface of your eye, which is usually temporary and responds to drops. Serious and permanent loss of vision can happen but it is very rare. 2. Serious Allergy to Drugs Allergic reactions will be noticed and treated very quickly. Very rarely, these reactions lead to death even in healthy people. Your anaesthetist will want to know about any allergies in yourself or your family. 3. Nerve Damage

6 Nerve damage (paralysis or numbness) anaesthetic can be due to pressure on a nerve during an operation. It varies with the type of anaesthetic you have but is generally rare or very rare. Most nerve damage is temporary, but in some cases damage is permanent. 4. Death Deaths caused by anaesthesia are very rare. There are probably about five deaths for every million anaesthetics given in the UK. 4. Equipment Failure Vital equipment that could fail includes the anaesthetic gas supply or the ventilator. Monitors give an immediate warning of problems, and anaesthetists have immediate access to backup equipment. Further information regarding anaesthesia is available from the Royal College of Anaesthetists. Website address The Consultation with your Surgeon. The consultation with your surgeon is designed to ensure that you have the time to discuss all aspects of the treatment you are considering and other options if appropriate. In order to achieve this aim your surgeon will:- a. Discuss all aspects of your medical and family history in detail and request any preoperative tests. b. Give you a thorough physical examination of the relevant area. c. Try to ascertain your expectations and then discuss realistically what can actually be achieved. d. Photograph the area to be operated on. (the clinic nurse may take pre-operative photographs). e. Explain the potential dangers of any form of surgery and anaesthesia. f. Advise on all aspects of care both pre and post-operatively. g. Photograph your upper torso from chin to navel area. (Your nurse may take the photographs during your pre-operative screening.) h. Following this discussion and examination, the surgeon may decide it is not in your best medical interest to proceed with surgery. If, for any reason, the surgeon's discussion with you falls short of your expectations, your should meet with another surgeon for a second opinion. What arrangements do I need to make if I decide to proceed with surgery? The process is as follows:- 1. Arrange a suitable date for your operation with your patient co-ordinator or surgeon. Think carefully, taking into account the following:- a. Time required off work. Usually 2 to 4 weeks, depending upon the nature of employment. Please note that some occupations will require a longer period of recovery, for example those which are physically demanding (eg manual working, armed forces), and if you are unable to cease work for the required period of recovery you should defer surgery. This also applies to patients who have similar hobbies (eg riding, gym activities). If you do experience a complication the period to refrain from such activities will be extended until you have recovered. Please note lack of compliance could lead to the readmission policy being voided.

7 b. Childcare. If you have young children you may need help from family or friends. For example, lifting children following surgery can be painful at first and should be avoided. c. Your fees will need to be paid promptly by the required date. Please make sure your funds are properly organised. Last minute delays can cause unnecessary frustration, and possibly cancellation of your operation. 2. Ensure your GP has been informed of your planned surgery. 3. Arrange to attend for your pre-operative screening with a nurse, and any other tests deemed necessary by the surgeon or anaesthetist. 4. Arrange your transport to the hospital and back home again. On no account can you drive or travel home alone. Failure to arrange transport home, by a nominated responsible person, may result in the operation being postponed. 5. Prepare an overnight bag to take with you. Read your pre-operative instruction sheet before the day. This will help prepare you for the operation and suggest what to bring with you and what to leave at home. 6. Please inform your clinic nurse or patient co-ordinator if you feel ill, have a cold or flu or any other signs of an infection prior to surgery. 7. It is not possible to proceed with treatment if you become pregnant. Please ensure you take necessary precautions. 8. Call your patient co-ordinator if you need any help or reassurance. Post Operative Recovery 1. Before your surgeon discharges you from hospital you will be given an instruction sheet explaining what to do and what to avoid doing following your operation. The clinic nurse may give this to you. 2. You may be given medication to take during the following week. 3. You will also be given an "on-call" number of a member of the clinical team in the event of a medical query out of hours. If you have any concerns please do call this number rather than attending to see your GP or your local hospital. The doctor you speak to will be able to contact your surgeon or one of the other surgeons if needed. 4. An appointment will be made for your sutures to be removed, and a check of the wounds for approximately 7-14 days following surgery. 5. An appointment will also need to be made by you for your first review assessment. Thereafter periodic assessments will be required over the following months you will usually be responsible for booking your own appointments and will be told the approximate time line for your next appointment. It is a necessary part of your postoperative recovery programme to attend review appointments. Obviously the number of post-operative appointments will be determined by your own recovery, if you experience a complication we may need to see you very regularly in clinic or we may need you to go back to the hospital. You must follow the surgeon s and clinic s advice on this matter to ensure the best possible recovery. 6. Follow the post-operative instructions given to you by our medical team very carefully. 7. It is important that you allow yourself sufficient time for recovery. Rest is clearly important to this process. However, it is vital that you remain relatively active following your operation. DO NOT RETREAT TO YOUR BED.

8 8. Remember we are always only a phone call away at any stage of the recovery period. Please get in touch today to discuss your circumstances and arrange your initial consultation.