Breast enlargement

It’s an operation to make your breasts larger by inserting an implant – made of either silicone or saline – under your breast tissue or your chest muscles. It can also be done to correct different-sized breasts or to change their shape.

You might be considering breast enlargement surgery because:

• You feel your breasts are too small or out of proportion with the rest of your body
• Your breasts are different sizes
• Your breasts have drooped or changed after pregnancy, weight loss or with age
• How you feel about your breasts is affecting your confidence

You might benefit more from a breast uplift instead – a procedure to combat drooping and improve the shape of your breasts.

Deciding whether to have breast enlargement

Choosing to have breast enlargement surgery is an important decision. Take your time to think about why you want the surgery and research what it involves – now and in the future. It’s also important to remember that all surgical procedures have some risks.

Before you decide to go ahead, make sure that you:

• Research the different techniques and types of implants
• Speak to a professional (such as a GP or surgeon) to discuss why you want breast enlargement and what you hope to achieve because they can help make sure your expectations are realistic
• Know all the costs required, including aftercare and future procedures you might need

Choosing your surgeon

You should choose a surgeon who has the correct training and experience to perform breast enlargement. As a minimum, cosmetic surgeons need to be registered with and licensed by the General Medical Council (GMC) as a doctor and many will also be on the GMC's specialist register, although doctors can sometimes practice in a specialty not shown on their Specialist Register entry. You can check this register to see a doctor’s specialties (and sub-specialties) that they are qualified in and the date they joined the specialist register in each specialty.

You can find a cosmetic surgeon on a specialist registers provided by:

• The British Association of Aesthetic Plastic Surgeons (BAAPS)
• The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS)
• The Royal College of Surgeons: Certified Cosmetic Surgeons

As an example, all BAAPS surgeons have the highest level of training and qualifications, are on the GMC’s specialist register and are committed to excellence in aesthetic surgery.

When researching a surgeon, you may want to find out:

• How many operations they’ve performed
• Their patient satisfaction scores
• What complications have occurred
• What follow-up they offer if things go wrong

Your initial consultation

At your initial consultation with your surgeon, you should:

• Discuss what you want to achieve
• Understand what techniques are available and discuss what implants may be best for you
• Find out what will happen during the procedure and any potential complications
• Ask questions, such as what aftercare will they provide and how long can you expect the results to last

Your surgeon will also examine your breasts and may ask to take confidential photos for your medical records.

You’ll then have a cool-off period of at least two weeks before having surgery. This will give you time to ask any further questions, have another consultation if you wish or change your mind if you choose not to proceed.

Your consultant will explain the different implants available and the pros and cons of each.

Types of implants

Silicone gel (soft)

• Less likely to wrinkle or ripple than saline
• The most natural feel out of the three types of implant
• If they rupture, they’re the most likely to spread into the breast tissue – this can cause lumps (siliconomas) and implant removal will be needed
• Pre-filled with gel

Silicone gel (firm)

• Less likely to wrinkle or ripple than saline
• Less likely to result in hardening or rotation of the implant than soft silicone
• A more natural feel than saline but not as natural as soft silicone
• Pre-filled with gel

Saline

• May be less likely to harden than silicone
• Feel less natural than both types of silicone
• More prone to wrinkling than silicone
• More likely to rupture or deflate than silicone but if they do rupture, they’ll safely pass out of the body
• Inserted while still empty and then filled with sterile salt water once they’re positioned correctly

Size

Breast implants are measured by volume and not bra size. Your consultant can help you choose the most suitable implant size for you based on:

• The size of your rib cage
• Your existing volume of breast tissue

Shape and projection

• Teardrop shape – you can choose the height and width separately, so there’s more control over the shape
• Round shape – there’s a bigger volume at the top
• Projection – you can choose how much the implant sticks out to give a subtle or a more obvious look

The surgery: what happens?

The operation will be performed by your surgeon under general anaesthetic, so you’ll be asleep. Once you’re asleep, your surgeon will make an incision (cut) either:

• In the crease under your breast – the scar may be more visible with this technique
• Under your armpit – there’s no scar around your breast, but a small scar may be visible under your arm
• Around the areola, the coloured area of skin around your nipple – scarring may be less obvious with this technique, however it’s more likely that you may have problems with breastfeeding or loss of sensation

Your surgeon will then create a pocket inside the breast for the implant by separating your breast tissue from the muscles and connective tissue in your chest. They’ll then insert the implant through the cut, positioning it as agreed. Implants can be placed:

• Under your breast tissue – the simplest method that’s good if you have slightly drooping breasts and is less likely to cause discomfort
• Under your chest muscle – better for those with very little breast tissue to avoid the edge of the implant being visible through the skin but may cause more discomfort in the short-term
• Using dual plane augmentation – may be used for those with little breast tissue and slightly drooping breasts by combining the techniques so the implant is partly under breast tissue and partly under your chest muscle

Once the implants are placed as agreed with your surgeon before your operation, they’ll close up the incision with stitches. Dissolvable stitches disappear in around seven to ten days while non-dissolvable stitches are removed by a nurse or doctor around a week after surgery. Dressings will be placed over your stitches to protect them. Your surgeon may also put in a drain (a tube attached to a bag or bottle) to take away excess fluid or blood – a nurse will remove this before you go home.

To find out more about how breast enlargement is carried out at your local Spire hospital, find your nearest hospital.

You’ll have a pre-operative assessment with a nurse to check your general health before having an anaesthetic and having surgery. Most breast enlargement operations are performed using general anaesthetic which means you shouldn’t eat or drink anything in the hours before surgery – your consultant will give you clear instructions which you should follow. Typically, you must not eat for about six hours or drink for two hours before general anaesthesia. However, you'll be told to avoid certain fluids (milk) and water or black tea or black coffee is usually recommended.

Your consultant will also give you specific instructions if you take certain medications so make sure you tell them if you’re taking anything during your pre-operative assessment. Stopping smoking and drinking alcohol can reduce your risk of having complications after surgery.

Preparing for an overnight stay

If you need to stay overnight, you should pack an overnight bag with some essentials that you’ll need. This includes:

• Any medications you’re taking
• Dressing down and slippers
• Post-surgery support bra
• Something to read or do
• Toiletries and sanitary products

At hospital

Your surgical team will get your ready for surgery. You may need to wear compression stockings to prevent blood clots forming while you’re lying still during the operation and initial recovery. Your surgeon will assess your skin and nipples and may mark your skin where the cuts are to be.

How long does a breast enlargement take?

Breast enlargement normally takes between 60 and 90 minutes.

Pain after a breast enlargement

It’s normal to experience some pain, including a tight feeling in your chest, for some time after a breast enlargement. Your healthcare team will give you pain relief medication to help you manage this.

Your hospital stay

You may go home the same day or the next day if your surgery was scheduled later in the day. You should have someone take you home and stay with you for 24 hours afterwards.

You may be able to leave hospital on the same day or the next day, but it’ll be three months before you make a full recovery. You’ll need to have someone take you home and stay with you for the first 24 hours after having the general anaesthetic. Side-effects of general anaesthetic are common but usually don’t last long. These include:

• Bruising around the area where you were injected or had a drip fitted
• Confusion and memory loss
• Difficulty passing urine
• Dizziness
• Feeling cold
• Nausea and vomiting
• Sore throat if you had a tube inserted to help you breathe

Your surgeon may recommend that you wear a support bra for 24 hours a day for the first three months. It’s common to experience pain, swelling and bruising after breast enlargement. Your chest may also feel tight for a few weeks after your operation.

You should take one or two weeks off work to recover. You should also avoid driving for at least a week and avoid strenuous exercise and heavy lifting for at least a month.

Although everyone’s different, here’s a rough guide to recovery after breast enlargement surgery:

• Same day or next day – you’ll be able to leave hospital and should take one to two weeks off work
• One to two weeks – stitches removed unless they’ve dissolved
• One to two weeks – may be able to drive (check with your car insurance company)
• One to two weeks – back to work, depending on your job
• Six weeks – back to normal activities, including exercise
• Six to 12 weeks – your breasts will start to look and feel more natural
• Up to 12 weeks – wear a support bra for 24 hours a day
• Up to one year – keep your breast scars out of direct sunlight

Breast enlargement aftercare

Before you go home, your nurse will give you advice about caring for your wounds, hygiene and showering. You may be given painkillers to help relieve any pain once the anaesthetic wears off. You’ll be given a date for a follow-up appointment so your consultant can make sure that everything’s as it should be. At home, you can also take over-the-counter painkillers if needed.

Scarring after breast enlargement

You’ll have some scars after surgery where the surgeon made cuts to insert your implants. They’ll be quite red at first, and usually turn purple after about six weeks. Your scars should then fade after 12 to 18 months.

Your lifestyle after surgery

As with any big operation, you’ll need someone to help you with light errands for the first few days. However, you should be back to normal activities within six weeks. You should avoid heavy lifting for the first few weeks.

Mammograms

You should be aware that mammograms, which is an X-ray used to screen for breast cancer from the age of 50, are less accurate after implant surgery. The X-rays can’t pass through the implant and so some of your breast tissue won’t be visible on the X-ray images. You’ll need to tell your mammography service so they can take special views and possibly screen you at a different centre. Mammograms are safe and don’t cause implants to rupture.

It’s also important to know that your breast implants are unlikely to last for life and will probably need replacing, at some point.

Most people have breast enlargement surgery without complications, but all surgery carries some risk and your consultant will explain these to you before you go ahead.

Although rare, breast enlargement complications can include:

• A build-up of fluid in the breast or capsular contracture – hardening of the breast tissue around the implant
• Bleeding into the cavity created around the implant
• Changes in sensitivity to the nipple – nerve problems can be temporary or permanent
• Difficulty breastfeeding or producing enough milk
• General change in shape over time or creases, folds or ripples in the implant, affecting appearance
• Infection
• Implant rupture – which leads to small lumps (siliconomas) and implant removal
• Red and raised scars
• Rotation of the implant – affecting the shape or rupturing of the implant
• Temporary skin reaction (from silicone gel)
• The breast feeling hard

UK advice on Anaplastic large cell lymphoma (ALCL) - as at July 2019

Research suggests that patients with breast implants may have a very small but significant risk of anaplastic large cell lymphoma, (ALCL), a very rare type of cancer, in the scar capsule next to the implant. However, ALCL is very rare (the estimated risk is 1 case per 24,000 implants sold). As of February 2019, the Medicines and Healthcare products Regulatory Agency (MHRA) had received 62 reports of ALCL in patients with breast implants, of which 52 meet the World Healthcare Organisation diagnostic criteria for breast implant associated ALCL.

As a result of this risk, the French regulator restricted use of certain macro-textured and polyurethane (PU) covered breast implants in France in April 2019. These implants continue to be available in the UK and breast cancer experts from across the UK have been working together to look at the risk to people with breast implants of developing this form of cancer. If you are worried following your breast implant surgery, please contact your GP or the surgeon who placed the implant. This is particularly important if you notice swelling around your implant more than six months after having the breast implant (regardless of how many years later).

Further information is available at gov.uk and the Statement from the Chair of the PRASEAG.

At Spire hospitals, your safety is our top priority. We have high standards of quality control, equipment and cleanliness and an ongoing system of review and training for our medical teams.