What is breast augmentation surgery?
Breast augmentation surgery is an operation to enlarge the breasts, usually using an implant filled with silicone or with physiological saline (a solution containing salt at the same concentration as in the body).Sometimes, the breasts can be enlarged with fat from another part of the body. This is called lipofilling. Lipofilling is not explained in this leaflet.
Patients are usually pleased with the results of breast augmentation, but first it is important to understand what is and isn’t possible, and what care might be needed in the future.
Why have breast augmentation surgery?
People have this surgery to make their breasts larger and improve their shape.Some women have smaller breasts than they would like. Also, breasts can droop with age or after pregnancy, breastfeeding and weight loss. Breast augmentation can improve both the shape and the droop to some degree.Some women have one breast much bigger than the other. Breast augmentation can balance breasts of different sizes.
What will happen before my operation?
You will meet your surgeon to talk about why you want surgery and what you want. The surgeon will make a note of any illnesses you have or have had in the past. They will also make a record of any medication you are on, including herbal remedies and medicines that are not prescribed by your doctor.
Your surgeon will examine your breasts, and may take some photographs for your medical records. They will ask you if you want to have someone with you, and ask you to sign a consent form for taking, storing and using the photographs. The surgeon may measure your height and weight to make sure that it is safe to do an operation. If you are overweight, or planning to become pregnant, your surgeon may suggest delaying your operation.
How is the procedure performed?
Implants are placed either behind the breast (middle image opposite) or behind the muscle the breast sits on (image on the far right).
Putting implants behind the breast is the simplest option. Putting implants under the muscle gives more padding in very slim women. Your surgeon will discuss which is best for you.
Implants are usually inserted through a cut in the crease under the breast (the inframammary fold). They can also be inserted through a cut in the armpit or around the areola. Sometimes, a drain (a tube attached to a bottle or bag) is left in to drain away any fluid or blood. This is removed after a day or two on the ward.
About the implants
The outer layer of breast implants is made of silicone or, in some cases, polyurethane. Inside this there is either silicone gel (most common) or saline. Silicone implants usually feel more natural than saline ones, and can have different shapes. Saline-filled implants usually feel less natural, have a greater risk of rippling, and can deflate. Breast implants usually last about 10 years, sometimes less, sometimes more.
The size of implants is given in millilitres (ml), in cubic centimetres (cm3) or by weight (grams). When you meet your surgeon before the operation, they will look at your breasts and the size of your ribcage, and check how firm your skin is. They will discuss with you what size of implant will suit you best. Usually, large implants look less natural on slimmer women. Your surgeon will ask you if you want to have someone with you during this examination.Your surgeon cannot promise you an exact cup size, only a range. Tell your surgeon if you would like to aim for the larger or smaller end of the particular range.
Implants can be round or teardrop-shaped (anatomical). Round implants are fuller at the top of the breast. With teardrop-shaped implants, you choose the width and height separately.With both shapes, you can choose for the amount that the implant sticks out (the projection) to be more or less subtle. You and your surgeon will discuss what shape will suit you best.
Is silicone safe?
Medical silicone is used safely in many medical devices, including breast implants. Your body will form a layer, called a capsule, around the implant. Sometimes, the capsule can thicken and tighten around the implant. This is called capsular contracture and it can change the shape or feel of the breast. If this happens, you might need further surgery to remove the capsule.
Breast augmentation is not linked with breast cancer or other cancers. There have been reports of a condition called anaplastic large cell lymphoma (ALCL) occurring with breast implants, but this is extremely rare and does not seem to be as serious as ALCL occurring in other places.
Over time, some silicone may leak out of the implant. This does not cause ill health, but it might cause lumpiness or pain, and you might need surgery to remove and replace the implant. Over time, the implant may become more noticeable, particularly if it is large.
Do I need a breast uplift?
Mild droopiness can be improved by breast augmentation surgery. If your breasts are droopy but the right size for you, you can have a breast-uplift operation without an implant. This surgery is called a mastopexy.
With this surgery, the nipple is lifted and the breast tissue and skin is tightened through cuts around the areola and under the breasts. Sometimes, both implants and lifting are needed, either at the same time or in two separate operations.
Choosing a surgeon
If you decide to have breast augmentation surgery, only go to a surgeon who is properly trained and on the specialist register held by the General Medical Council. They will talk to you about what is possible for you or might give the best results. Members of several different organisations do cosmetic surgery, so your general practitioner (GP) is the best person to advise you on who to see.
You should talk to your surgeon before your operation about when you might need further surgery to have the implants replaced. You should also discuss how to pay.
Breast augmentation is a lifetime commitment. You must be sure that you are making the right choice, and understand the implications of the surgery. You might need more surgery in the future to keep up the results of the breast augmentation, and you should be prepared for this, personally and financially.Nobody needs an urgent breast augmentation. If you are not given time to think about it, you should look elsewhere.
How can I help my operation be a success?
Be as healthy as possible. It is important to keep your weight steady with a good diet and regular exercise. Your GP can give you advice on this.If you smoke, stopping at least six weeks before the operation will help to reduce the risk of complications. Do not worry about removing hair near where cuts will be made, but do have a bath or shower during the 24 hours before your operation to make sure that the area is as clean as possible.
What is the alternative treatment?
A simple alternative to breast augmentation is to wear padded bras. The only alternative surgical technique to enlarge the breast is lipofilling. This is where fat removed by liposuction from another part of the body (such as the hips or thighs) is injected into the breast area. Because only a relatively small amount of fat can be injected at a time, and some of the fat is reabsorbed into the body, you would need several injections to get a permanent enlargement.
Your own fat is the only substance that can be safely injected into the breast. Other materials have been tried, and then banned. Do not allow anyone to inject anything other than your own fat into your breasts.
What are the main risks and complications of breast augmentation surgery?
As with all operations, there are risks involved in breast augmentation surgery. Although the risks are unlikely, it is important to weigh them up against the potential benefit of the surgery. Discuss each of them with your plastic surgeon to make sure you understand the potential complications and consequences.
Complications associated with the surgery
- Scars There will be scars from the surgery. These will usually be red at first, then purple, and then fade to become paler over 12 to 18 months. Occasionally, scars may become wider, thicker, red or painful and you may need to have surgery to correct them.
- Bleeding Bleeding around the implant (haematoma) is unusual but possible, and you may need another operation to stop the bleeding. Bleeding usually happens immediately after, or soon after, surgery. Before the surgery your surgeon will discuss any medicines that increase your risk of bleeding, and it is important to control high blood pressure.
- Seroma This is where fluid collects within the breast cavity. It may need to be drained by having a needle through the skin, or by having another operation, and can affect the final result.
- Infection If you get an infection of the wound or around the implant you may need antibiotics or another operation to remove the implant. It is normal to wait at least three to six months for the infection to clear before a new implant is inserted.
- Extrusion This is where deep stitches poke out through the skin. These can easily be removed.
- Swelling, bruising and pain There will be some swelling and bruising of the breasts after the operation, and this can take weeks to settle. There may be long-term pain, but this is uncommon.
- Asymmetry This is where the breasts are not symmetrical.
- Increased or reduced sensation After the surgery, most patients will get some alteration in the sensation in their breasts, most commonly numbness near the scar and oversensitivity of the nipples. Loss of sensation to the nipple, though rare, may be permanent. Rarely, the loss of or increase in sensation can affect breastfeeding.
- Damage to deeper structures Although rare, the surgery can damage deeper structures, including nerves, blood vessels, muscles and lungs. This damage may be temporary or permanent.
- Unsatisfactory result Sometimes, patients are not satisfied with the result of their breast augmentation surgery. This may be to do with the look or feel of the breasts, or the breast shape not meeting expectations. It is very important that you talk to your surgeon, before you have the surgery, about the size and shape you want, and whether this can be safely achieved with a good outcome.
- Change over time The appearance of the breast will change as a result of aging, pregnancy or other circumstances not related to your surgery, such as putting on or losing weight. You may need further surgery or other treatments to maintain the results of the breast augmentation. Many patients choose breast augmentation because they feel the skin on the breast is loose or saggy, and they want the implant to fill the skin out. You should bear in mind that large implants are heavier and the weight of them can make the breast droopy in the future, and so you may need a further operation. Sometimes, having a breast uplift would be preferable to using an overly large implant.
- Allergic reaction Rarely, local allergies to tape, stitches or solutions have been reported. If you have an allergic reaction you may need extra treatment.
Complications associated with the implant
- Capsular contracture It is normal for a scar or capsule to form around the implant. This usually feels soft and looks natural. In about 10% of patients, the scar contracts around the implant and feels firm. If this happens, the breasts can feel tender and look abnormal, and you may need an operation to replace the implant. After 10 years, about 10 to 30% of women will have had another operation, and painful or unsightly capsular contracture is the most common reason for this.
- Noticable implants Slim patients may be able to see or feel the edges of the implant. With time, ripples or folds may be noticeable. Very occasionally, teardrop implants can rotate behind the breast. These can usually be pushed back into position gently, but if the problem is persistent, an operation may be needed.
- Implant failure Occasionally implants can leak. This can be as a result of their age, an injury or a tight capsule. Normally the leak is contained within the capsule and does not cause a problem. If the size, shape or consistency of the breast changes as a result, a further operation may be needed to replace the implant.
- Breast droopThe breast may droop over time due to the weight of the implant
Risks of anaesthetic
- Allergic reactions You could have an allergic reaction to the anaesthetic.
- Chest infection There is a small risk of chest infection. The risk is higher if you smoke.
- Blood clots Blood clots can form in the leg (called a deep vein thrombosis or ‘DVT’). These cause pain and swelling and need to be treated with blood-thinning medication. In rare cases, part of the clot breaks off and goes to the lungs (called a pulmonary embolus or ‘PE’). The risk of this is higher if you smoke, are overweight or are taking the contraceptive pill.
- Heart attack or stroke A heart attack or stroke could be caused by the strain surgery places on the heart. You will be assessed for the risk of this before your surgery.
- Death As with all surgery, it is possible to die as a result of the operation.
Breast implants do not make it any more difficult for you to check your breasts for lumps. However, they do interfere with mammograms (X-rays of the breast to look for signs of breast cancer). Mammograms are used as a screening test in the UK from the age of 50 years. If you are called for a mammogram, you need to tell the mammography service you have breast implants. They may scan you at a different centre and take special views. The more of your total breast volume that consists of implant, the greater the problem with mammography. Sometimes a different kind of scan (such as an MRI) is preferred for patients with breast implants. You can discuss this with your surgeon.
Breast augmentation does not usually interfere with breastfeeding, and there is no evidence that any silicone is found in breast milk.
Most implants will need replacing at some point, usually after 10 years. For this reason, you should be prepared, personally and financially, to have surgery again at some point in the future. However, it is not recommended to have implants replaced routinely.
This document is designed to give you useful information. It is not advice on your specific needs and circumstances. It does not replace the need for you to have a thorough consultation, so you should get advice from a suitably qualified medical practitioner. We – The BAAPS and BAPRAS – have no liability for any decision you make about the surgery you decide to have.