Breast Augmentation

Breast augmentation is a surgical operation in which an implant is placed behind the breast to increase the breast size or to improve its shape. The operation is also known as a breast enlargement, breast enhancement, augmentation mammoplasty or 'boob job'.

   before breast augmentation             after breast augmentation
   Before                                After

Women have breast augmentations for the following reasons:

  • Feeling that their breasts are too small or out of proportion to their body
  • Following a change in breast size and/or shape following pregnancy or weight loss
  • To balance a difference in size between their two breasts (asymmetry)
  • As part of breast reconstruction following breast cancer surgery.
Women's breast augmentation consultation

The Process

Initial consultation

It is helpful and important to have a clear idea in your mind of what you want your breasts to look like following a breast cosmetic operation. During your initial consultation, I will explore with you in detail the outcome and look that you want to achieve as well as finding out about your general fitness for surgery.

Following this, I will examine your breasts and have a detailed discussion with you about realistic outcomes following the surgery. I will advise you as to whether a breast augmentation will give you the look that you are after or whether another procedure would be more appropriate.

We will then discuss the different implants available, in terms of both shape and size, and the different planes in which they can be placed.

You will be given an information leaflet on breast augmentation to read including a list of potential complications that can occur.

Second consultation

All patients wishing to proceed to surgery are offered a second free consultation in which the size of implants to be used is finalised and where we will talk in detail about the potential complications of this operation. Any further questions that you may have will be answered at this point before consenting to surgery.

An appointment to come in for an anaesthetic assessment prior to your operation will be arranged.

What happens on the day of surgery?

You will be admitted to the ward on the day that your surgery is scheduled. The operation is carried out under General Anaesthetic, given by a Consultant Anaesthetist, and usually takes one and a half hours to perform.

The incision (cut) on your breast is usually placed in the fold underneath your breast but may occasionally be placed around your nipple (this will be discussed with you beforehand). A pocket is made for the implant either underneath your breast tissue (subglandular) or partly underneath your chest wall muscle (submuscular).

After I am happy that the implants are in the best position, the wound is closed with dissolvable stitches and dressings will be placed over the wounds. I will occasionally place a drain into the breast at the end of the operation but don't use drains in the majority of people.

Going Home

On going home, you will be advised to wear a soft supportive bra (with no underwiring) for six weeks. You will need to arrange someone to drive you home the day after the operation and may need some help at home for a few days, especially if you have young children. Your dressings will be removed at 7-10 days and you will be followed up by me in clinic 10 days after surgery, and again after six weeks.

Getting Back To Normal

You will need to take 1-2 weeks off work; usually six weeks if your implants were placed under the muscle. The swelling in yours breasts will gradually lessen over 4-6 weeks and any shooting pains that you experience should settle down in this time.

Although you can start driving a car after 48 hours, most people feel comfortable starting to drive again after two weeks.

You should not exercise (other than walking) for the first two weeks and gently re-introduce exercise after that. Full exercise can be resumed at six weeks.

You can go back to wearing underwired bras after you have seen me six weeks after your operation. You should only allow gentle contact with your breasts for the first six weeks.

Questions About Breast Augmentation

Will I See The Scars?

My preferred method of breast augmentation uses a scar placed in the fold underneath your breast (the inframammary fold). This allows good access to the plane behind your breast, allowing a pocket to be created for the implant under good vision. The scar is usually about 5cm long and is designed to be a short and inconspicuous as possible. Occasionally, your breast anatomy may make it more appropriate to have the scar placed around your nipple and if this is the case we will discuss it at the initial consultation.

Will my implants be over or under the muscle?

I place the majority of implants under the breast and on top of the pectoral muscle (subglandular) as I believe that this gives a more natural look. If you are very slim with very little tissue thickness at the top of your breasts, it may be more appropriate to place them under the pectoral muscle (subpectoral) to make the implant less visible. Each method has its advantages and disadvantages and I will discuss these with you at your consultation.

What types of implant are available?

Implants come in a large range of sizes. Whilst I can advise you of an appropriate size for your frame and help you to decide on the size of implant, you will ultimately need to decide on a size that gives you the look that you are after. Most people choose an implant with a volume in the 250-350cc range.

Implants come in a round or "tear-drop" (anatomical) shape. Round implants give a good result in most people although occasionally it may be more appropriate to place a "tear-drop" shaped implant. The shaped implants can rotate which may mean that you will need further surgery to correct the rotation.

All implants have an outer shell made of silicone. The majority of implants used in the UK are filled with silicone. Implants are available that are filled with saline (salt water). These are more commonly used in the USA. They tend to feel less natural than silicone implants and have a greater tendency to rupture and deflate.

The surface of the implant can be either smooth or textured. Texturing of the surface is thought to reduce the risk of capsular contracture (see below).

What results can I expect after my surgery?

You will feel back to normal after 4-6 weeks. The scars will turn red after 1-2 months and may widen a little before fading after a year. Your scars will always be visible but hidden in the fold under your breast. Once the swelling has gone you can expect your breast size to have increased by 2-3 bra cup sizes.

The majority of women who have a breast augmentation are pleased with the result. Most feel more confident in themselves and more able to buy the clothes they wish to after the surgery. If you have realistic expectations of the outcome following surgery, you are a better candidate for a breast enlargement and are more likely to be satisfied. 
Whilst it is possible that your implants may last for a lifetime, they may need replacing. Implants no longer have a set lifetime and do not need to be routinely exchanged if you have not developed a complication from them. You should however only undergo this operation if you are prepared to undergo further surgery on your breasts should a complication develop.

Risks and complications

All operations carry some element of risk. Common side effects can include nausea and vomiting following general anaesthesia. As mentioned earlier, your breasts will be uncomfortable, and may be swollen and bruised following your operation.

Specific complications

Haematoma - This is bleeding around the implant following your operation. It can occasionally lead to patients having to return to theatre to stop the bleeding and remove the blood clot.

Wound infection - Infection following implant surgery is rare, but it is a distressing complication. You will have received intravenous antibiotics during your operation. Infection can occur following any type of surgery but is a particular risk when putting a foreign material into the body. If this occurs, it is unlikely to respond to antibiotics and may necessitate removal of the implants and then waiting for at least three months for this to settle before considering re-implantation of the implants.

Deep vein thrombosis - This can happen following any operation. It is unlikely, but the risks are increased with smoking and use of the oral contraceptive or hormone replacement therapy. You may be given an anti-clotting injection to reduce this risk.

Nipple complications - Sensation of the nipples may be altered temporarily or permanently following augmentation mammoplasty. There is also a very small risk of nipple loss.

Breastfeeding - It should be possible to breastfeed following breast enlargement. However, your breasts will significantly increase in size and change shape. Once you stop breastfeeding, this may permanently alter the effect of the breast enlargement.

Scarring - Initially, the scars will be fine, bright red lines; in most cases the scars will usually heal satisfactorily and soften, becoming much paler and less obvious after 12 months or so. Some patients have a tendency to form red and lumpy scars (hypertrophy) or keloid scars, which are broad raised scars. The scarring will be permanent.

Capsule formation - Whenever a foreign body is introduced into the body, a layer of scar tissue forms around the implants completely encasing it. In some circumstances, this capsule can harden over a period of time, which may vary from several years to over twenty years later or may never happen. The rate of capsule formation is approximately 16 percent at seven years.

Rupture - All implants have the potential to rupture, the rate of rupture for allergan implants is five percent at seven years. If your implant has ruptured it will need to be removed and/or replaced.

Rotation - With anatomical implants, there is a risk that they can rotate. The use of a firm fitting sports bra, day and night for six weeks post-operatively will help to reduce this.

Rippling and palpability - Depending on how your breasts change with age, they may thin to a point where you can see or feel the implants beneath your breast tissue.

Revision - The implants are unlikely to last for the rest of your life and depending on your age, you may need one or more revisional operations in the future. This may be due to capsule formation as noted above or implant rupture. If you notice any hard lumps within the breast tissue or a rapid change in the shape of the breast, then you should consult your surgeon. There are potential financial implications to this.

Mammography Issues

There is no evidence that silicone implants delay the diagnosis of breast cancer. If you have subsequent mammograms following your breast enlargement, you will need to inform the x-ray department. A Mammogram itself will not damage the implants.

Silicone Issues

The safety of silicone implants has attracted much publicity. The Department of Health asked an Independent Review Group to look at the evidence. The Research found no evidence of any connection between silicone implants and illnesses. The Independent Review Group report and evidence can be reviewed at the Silicone Review Website. Please see our page on Implant Safety for further information.

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