Tuesday 16 January 2018

Dear Dr Nina: 'I want surgery to fix my post-pregnancy body'

A reader is considering cosmetic surgery. Photo posed
A reader is considering cosmetic surgery. Photo posed

Nina Byrne

Dr Nina Byrnes answers your medical queries.

Q: I have hated my breasts since I was a teenager. They are not large, but they have always been saggy. I breastfed my five-year-old son for six weeks and they have become even more flat and empty looking since then. I also have a bit of saggy skin after the birth of my son. I have no weight to lose, so exercise or dieting will make no difference. My question is related to cosmetic surgery. I have been thinking about having a breast lift and a tummy tuck for a while now and I have been saving the money. Can you give me any advice on, firstly the potential health risks, and secondly, how to choose a good surgeon. I don't even know where to start looking.

Dr Nina replies: Cosmetic surgery is usually an elective procedure. This means the surgery is undertaken by choice rather than necessity.

There are many risks shared by all surgical procedures. Risks attributable to receiving a general anaesthetic include an allergic reaction to the anaesthetic, awareness during the surgery (a rare complication) and a risk of death (1 to 2 per 100,000 operations). Infection may occur after any surgery. Bleeding, nerve or blood vessel damage, clots in the leg or lung, and pain are also risks.

Breast implants don't last forever. The longer they are there, the more likely you are to experience problems with them. The average lifespan is 10 years. The most common complications include contraction of the capsule (which alters the appearance), repeat surgery and implant removal. Implants may also rupture, deflate, and wrinkle.

Surgery is not an exact science and there may be asymmetry, scarring and pain. Although many women are delighted with their cosmetic appearance post-implant, others are not so happy. If breast implants are removed, your breasts may be less cosmetically acceptable than they were pre-surgery. Regular breast screening such as mammograms may be more difficult to interpret in those with implants in place. If you plan future pregnancies, your breast may change further and so it is usually best to undergo cosmetic procedures once your family is complete.

Breast implants aren't a fit-and-go solution. Those with implants need to monitor their breasts for change. Tests such as MRIs may be required.

Monitoring may be an expense not covered by your insurance. More recently, evidence has emerged that breast implants (particularly textured ones) may be associated with a very rare cancer called 'breast implant associated anaplastic large cell lymphoma'. This risk is being observed and documented by the WHO and FDA.

Tummy tucks (abdominoplasty) carry all the risks of general anaesthetic along with increased risk of infection, unacceptable scarring, wound complications and altered sensation in the skin.

Those who are obese, smoke and drink excessively are at a higher risk of complications.

When choosing a surgeon, make sure they are registered with the Irish Medical Council in the speciality they are working in. The surgeon should be working full time in Ireland and not just visiting occasionally. Check that they have full medical indemnity to carry out the procedures you are considering.

Surgery is best performed in registered and approved hospitals or clinics. We don't like to think of things going wrong, but if they do, you want to be somewhere where the proper emergency care is available.

You should have a preliminary consult with the surgeon who will be performing the procedure. Ask them what your options are if you are not happy with the results, and have a frank discussion about the cost of treatment and follow up.

Follow-up checks should be arranged as part of the package. Elective surgery of any kind requires a full assessment of the risks, pros and cons.

If proper due diligence is done, then it is more likely you will be happy.

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