Breast augmentation is an operation that happens under general anaesthetic. Usually patients will come into hospital on the morning of surgery, having nothing to eat or drink the night before, they’ll meet the anaesthetist, who’ll discuss the anaesthetic with them. They’ll already have their preoperative assessment by the plastic surgery nurse usually and then they’ll meet their breast surgeon who’ll come in and deal with the consent form, draw some lines on them potentially and have a brief discussion about exactly what we expect to get out of the surgery and what type of implants might be used. The patient is then taken to the operating theatre, put to sleep, and on the operating table, to begin with, we prepare the patient by cleaning the skin and draping them so that we create a sterile field and then we mark where we’re going to make the incisions and with a scalpel we make a cut through the skin, usually in the crease beneath the breast, but there are other areas we can use also. Through that small hole, which is usually four and a half centimetres long, a pocket is dissected either under the breast itself or under the pectoralis muscle that we can put the implant in. The pocket is adjusted to get it to the right size, the bleeding is stopped, we carry out a wash-out, and then the implant is prepared and inserted into the pocket, spread out and orientated in the right direction. There’s quite an art to getting the implant in the right place so it sits, with respect to the nipple, in the right place so that when the patient is all healed up, the breast shape looks good, the volume is behind the nipple, not too high and not too low, and the fold beneath the breast sits in the right place where the scar is. So there’s a bit of an adjustment on the table, and we’ll sometimes sit the patient up during the operation, so that we can see the effect of gravity to make sure both sides are the same, everything’s matched. Some surgeons would then use a drain, which will be a tube that comes out through the armpit that will drain off any extra fluid that builds up overnight and then the wound is sutured up. The patient then goes back to the ward with some drapes and strapping on and is looked after overnight, before being discharged home the next day.
