PRE-OPERATIVE CONSULTATION

Before you decide on breast enlargement surgery with implants, you must meet with our surgeon for a pre-consultation. During this meeting, you will discuss your expectations, and the surgeon will evaluate what will yield the best results for you.

You will also receive a thorough overview of your options, and the risks associated with each surgical option. The surgeon will ask about your health to ensure you are suitable for surgery.

Based on your expectations and the surgeon’s recommendations, you will plan your surgery together. You are welcome to bring another person to the pre-consultation, as there is a lot of information to consider.

According to the law, you must have a 7-day reflection period after the pre-consultation before you can give your final consent to cosmetic surgery.



EXPECTATIONS

For breast enlargement surgery with implants at Caolín, the surgery is tailored to your individual shape and desires. After the surgery, the breasts will be tight and swollen, but the tissue will settle over time, and the breasts will take on a more natural shape.

Over time, the breast tissue will gradually begin to sag, especially after pregnancies and breastfeeding. This is completely natural and expected. In other words, it is not possible to achieve a result after surgery that lasts a lifetime.

It is important to be aware that the results of cosmetic surgery are not permanent. The natural aging process and the rate of body aging are influenced by both genetic factors and lifestyle factors such as smoking, sun exposure, and weight changes.

Additionally, it is important to understand that surgery always carries a risk of complications, and the result may not always match your or the surgeon’s expectations completely. If you are significantly overweight or underweight, there is an increased risk of complications with anesthesia and wound healing. If your BMI is over 30, we may not be able to offer you surgery.



CHOICE OF IMPLANTS AND SCAR PLACEMENT

At Caolín, we only use implants of the highest quality. When inserting breast implants, we have several approaches to choose from: We can make an incision at the edge of the nipple, in the armpit, or the most common method, where the implants are inserted through the fold just below the breast.

The placement of the scar depends on which technique best suits your anatomy and preferences. The simplest and safest method is to insert the implants through the breast fold, as this approach minimizes the risk of bleeding and risk of damage to the sensory nerves of the nipples.

An incision at the nipple may be a good option if you normally heal with small scars. Otherwise, the scar may become very visible. There is also an increased risk of nerve damage, which can cause sensory disturbances in the nipple, and an increased risk of bleeding. In very rare cases, blood supply to the nipple may be damaged, which can lead to tissue death.

If the implants are inserted through the armpit, there will be no visible scars on the breast, as the scar is located in the armpit. However, it is important to be aware that some people may develop unsightly scars that will be visible when wearing clothing that does not cover the armpits. This method also has an increased risk of infections and cannot be used if you have had previous surgeries.

The approach through the breast fold often results in a thin, white scar that becomes almost invisible over time, as it is hidden in the fold under the breast. Even if the scar heals poorly, it is usually hidden and only visible when the breast is lifted.



MAMMOGRAPHY

If you are over 40 years old or have a family history of breast cancer, a mammogram is recommended before the surgery.

PREPARATION

Before the surgery, you must:

Stop taking medication containing acetylsalicylic acid such as Magnyl, Aspirin, Ibuprofen, and Treo one week before the surgery.

Avoid natural medicines, especially fish oil, ginger, and vitamin D, as they can increase the risk of bleeding. Stop all natural medicines three weeks before the surgery.

Any blood-thinning medication may need to be paused. This will be discussed with the surgeon during the pre-consultation.

Smoking must be paused least 4 weeks before and 6 weeks after the surgery. Smoking can negatively affect the cosmetic outcome, increase the risk of infection, and is generally bad for your health. We often choose not to offer surgery to active smokers.

Avoid getting tattoos, piercings, or undergoing major dental work such as fillings one month before and one month after the surgery. This is because tattoos, piercings, and dental work can introduce bacteria into the bloodstream, which can settle around the implant.It is a good idea to shop and prepare meals before the surgery, so you can focus on your recovery afterward.

On the day of the surgery, you should take a shower with thorough cleansing of your body and hair. Avoid using body lotion or other products on the area to be operated on.

Wear loose, comfortable clothing, preferably a zip-up blouse, loose fitting pants, and flat shoes. Remove all jewelry and any piercings and leave them at home.



ANESTHESIA

The surgery is performed under general anesthesia. You must fast for 6 hours before the surgery (no eating, chewing gum, smoking, or similar). You may drink clear fluids like water and sugary drinks in small amounts until 2 hours before the surgery; do not drink milk, juice, etc.

It is crucial to adhere to the fasting rules, as anesthesia can be dangerous if you are not fasting, and the surgery is canceled, if you are not fasting.



SURGERY

On the day of the surgery, arrive at the clinic at the scheduled time. A nurse will greet you and you will be shown to your room, change clothes, and have an intravenous line placed. The anesthesiologist will discuss the anesthesia with you, and finally, you will meet with the surgeon, who will ensure you feel comfortable and well-informed. The surgeon will also mark the area to be operated on.

The surgery is performed under general anesthesia and lasts about 1-2 hours, depending on the chosen technique. The implants can be placed above or below the breast muscle, or only under the upper part of the breast muscle (dual plane); this depends on anatomy, implant choice, and desired outcome.

In some cases, the surgeon may place one or two drains (small plastic tubes). These are inserted through the skin to remove any blood and wound discharge from the areas that need to heal. To reduce the risk of infection, you will receive antibiotics during the surgery.
The wounds will be sutured with self-dissolving sutures, and tape and an absorbing bandage will be placed over the wounds. Finally, you will be given a bra and a mammastrop.



AFTER THE SURGERY

After the surgery, you will be taken to the recovery room where the nurse will monitor you. You will receive something to drink and eat and pain reliefers if needed. Depending on the extent of the surgery, you may be discharged after a few hours.

Before you go home, the plastic surgeon and nurse will review the post-operative precautions with you and answer any questions you may have to ensure you feel comfortable. You should arrange for someone to pick you up, as you will not be able to drive yourself.

DAYS AFTER THE SURGERY

Since the surgery was performed under general anesthesia, you will be tired and sluggish on the first day, and you may experience nausea and dizziness. We recommend having an adult at your side for the first 24 hours.

It is important to take it easy for the first days after the surgery and generally listen to your body’s signals to reduce the risk of bleeding and swelling. Make sure to stay well-hydrated and consume a sensible protein-rich diet.



PAIN

After the surgery, the breasts will often feel tight and firm, especially in the first few days. It will typically feel as though something heavy is on your chest or like after a strenuous workout. This is completely normal as the tissue needs to expand after the implants are placed.

The breasts may continue to feel tight, swollen, and have different shapes in the first few weeks.It is important to take the prescribed medication. The medication will reduce pain, but you should expect some discomfort during the first 3-4 days.

Many people experience stabbing and sharp pain in the operated area. This is normal and occurs because the nerves are re-establishing connections. These sensations can last for up to 1 year after the surgery.

You will be prescribed Paracetamol tablets and Ibuprofen tablets to be taken together 4 times a day. Additionally, you will receive a stronger painkiller, a synthetic morphine tablet, which you can take if you experience severe pain.

The nurse will thoroughly review the medication with you before you leave, and you will also receive written material describing everything.



DRAINS

If drains are placed during the surgery, they are often removed before you are discharged. If they are not removed, you will be given detailed instructions on how to care for them and when they are to be removed.


ACTIVITY

In the initial days after the surgery, getting out of bed might be difficult, so having someone to assist you is a good idea. It is important to get up and move around quickly to reduce the risk of blood clots. Engage in light activity, such as short walks, but take breaks when needed. For the first 1-2 weeks, avoid any strain on the wounds.

Avoid strenuous exercise for the first 6 weeks after the surgery. If you have anatomically shaped implants, this restriction may be extended to 3 months. However, it is important to keep your body active with light activities, such as short walks.

We recommend not lifting more than 2 kg per arm in the first 6 weeks after the surgery and to avoid lifting your elbows above shoulder height during this period. You must avoid driving until you can handle the vehicle safely and no longer need strong painkillers. Always use a seatbelt, whether you are driving or a passenger.



WORK

You can resume sedentary work after 1 week. For the first 6 weeks, avoid using your arms too much. Remember to move your shoulders to prevent stiffness.



SLEEPING POSITION

We recommend sleeping on your back for about 4 weeks after the surgery. You may lie slightly on your side, perhaps with a pillow behind one shoulder.



BATHING

You can take a shower 24 hours after the surgery or when there is no longer any discharge from the wounds (unless you have drains). Before showering, remove the compressive bandage and the absorbing dressing. The brown plaster must remain until your follow-up appointment. It can withstand water.

Take a gentle shower, rinse the wounds to wash away soap residues (do not wash or scrub the wounds), and pat dry with a clean towel before putting the compressive bandage back on.



BLEEDING

It is important to monitor for bleeding from the breast in the first few days. If there is bleeding around the implant, which is a rare complication, the breast will become hard and swollen. If you experience sudden or severe swelling and pain, contact us immediately.



BRA

After the surgery, you will receive a supportive bra anda breast strap to wear for 6 weeks. You can remove the bra and strap when bathing or when they need to be washed.
Underwire bras must not be worn for the first 3 months.

You can, of course, purchase an additional bra and strap at the clinic if you want more to switch between.



SCARS

The scars from the surgery will typically be red and swollen but will improve over 6-24 months. Over time, scars usually become narrow and lighter I color, but in some cases, they may become wide and darkly pigmented.

You may apply a soothing cream to the scars once they are completely healed. Avoid smoking, as it increases the risk of infection, slow healing, and unsightly scars.



CONTACT WITH THE CLINIC

You will receive a phone number upon discharge so you can contact the clinic 24/7 in case of an emergency.

The day after your surgery, a nurse will call to check on your well-being and answer any questions you may have.



FOLLOW-UP

Approximately 14 days after the surgery, you will have a follow-up appointment with the nurse. The dressings will be removed, and the wounds will be examined. There is no need to remove sutures, as they are self-dissolving.

New tape will be applied and provided, which you should change yourself every 10-12 days for about 3 months after the surgery. The tape helps keep the scars narrow, flat, and level with the rest of the skin.

We will discuss how to care for the scars, any potential pain, etc. You will be offered an appointment with the plastic surgeon 3-6 months after the surgery. If you experience any issues before then, feel free to contact us.

COMPLICATIONS

Capsular Contracture: Occurs when the capsule that the body naturally forms around the implant tightens around it, resulting in a hard and possibly painful breast.

Hematoma: Rarely (less than 1% of cases), bleeding may occur after surgery. This may require temporary removal of the implant during a subsequent operation to stop the bleeding before re-implantation.

Infection in the Wound: Rare but an infection may occur in the wound. This is treated with antibiotics.

Infection around the Implant: Can occur at any time but is most often seen within the first 14 days. Treated with antibiotics, it may be necessary to remove the implant temporarily (about 3 months) before placing a new one.

Implant Rupture: If a silicone implant ruptures, it will need to be replaced. If this happens, the product warranty will be activated.

Sensory Changes: The nipples may become more or less sensitive, and in rare cases it looses sensitivity completely.

Rippling and Visible Implant Edge: In very slim women with small original breasts and little subcutaneous fat, the implant edge may be noticeable and sometimes visible under the breast and to the side. Wrinkles or folds in the skin over the implant, known as rippling, may also occur. The risk of this is lower with cohesive implants compared to those with liquid silicone or saline.

Implant Rotation: With anatomical (drop-shaped) implants, there is a risk of rotation. If this occurs, another surgery may be necessary to reposition the implant.

Swelling and Discoloration: This is normal and expected in the first few months after surgery.

Pain: Post-surgical pain is normal and expected. While it typically subsides gradually, in rare cases, it may be long-lasting or even chronic.

Stretch Marks: Rarely occur but can happen when the tissue is expanded.

Scarring: Thickened or widened scars can occur. Scar formation is individual and unpredictable. Initially, most scars will be prominent and red but will fade and become lighter over time. Some people tend to develop red and thick scars, known as hypertrophic scarring. Scar maturation can take several years for some patients.

Symmastia: When the breastsmerge into one across sternum. This is extremely rare.

Seroma: Fluid accumulation that may sometimes require drainage.

Tissue Necrosis: Refers to parts of the skin losing their blood supply and dying. If this occurs, it may require surgical removal or waiting for the body to heal the area from within. This is extremely rare but more likely in individuals who are overweight or smoke.

Breastfeeding: Generally, you are able to breastfeed without issues after breast augmentation with silicone implants, though a small percentage may find they are unable to breastfeed.

Blood Clots: There is always an increased risk of blood clots associated with surgery. This risk increases if you take birth control pills, are over 40 years old, have a BMI over 25, or have a genetic risk factor (e.g., Factor V Leiden mutation).

Breast Implant-Associated Lymphoma (ALCL): ALCL may present as persistent swelling of one breast, typically several years after surgery. It can also present as nodules in the capsule around the implant or swollen lymph nodes. If you experience these symptoms, consult a plastic surgery clinic or your doctor. However, most symptoms are likely due to benign conditions.

Please note that the risk of all the above complications increases with the size of the implant.