It's important not to rush into the decision to have cosmetic surgery. Talk about your options with your GP. They may be able to recommend a surgeon or help you to choose which hospital to be treated in.
It's important that you talk to your surgeon about what you're hoping to gain from the operation and the results you can realistically expect.
Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
You will usually have your breast enlargement under a general anaesthetic. This means you will be asleep during the procedure. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon's advice.
The operation may be carried out as a day case or you may need to stay in hospital overnight.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. If you’re unsure about anything, ask. No question is too small. Being fully informed will help you feel more at ease and will allow you to give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.
Your surgeon will measure your breasts and assess their shape, your skin and the position of your nipples. Your surgeon may also draw on your breasts to mark the operation site. The surgeon will also photograph your breasts for confidential 'before and after' images. Your surgeon may also want you to have a mammogram taken.
Your nurse will prepare you for your operation. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.
Breast enlargement usually takes between one and two hours. Your surgeon will make cuts in the skin on your breast. The exact position of the cuts can vary. They may be in the crease under your breast, around your nipple or towards your armpit.
Your surgeon will then make a space for the implant. The implant usually lies under your breast tissue on top of your chest muscle, but is sometimes put under your chest muscle.
Putting the implant under your chest muscle reduces the chance of the edges of the implant showing. It may also reduce the risk of a complication called capsular contracture, depending on the type of implant your surgeon uses. However, it can make larger implants harder to place and will mean you have more pain afterwards. Your surgeon will decide which method is best for you.
Your surgeon will close the cut with stitches (which may be dissolvable), and may wrap your breasts in a supportive dressing or support bra.
You will be given painkillers to help relieve any pain as the anaesthetic wears off.
You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.
Having a general anaesthetic can really take it out of you. You might find that you're not so coordinated or that it's difficult to think clearly. This should pass within 24 hours. In the meantime, don't drive, drink alcohol, operate machinery or sign anything important.
You may go home wearing a support bra, and you should follow your surgeon’s advice about when to wear this.
The stitches are taken out after about a week. If you have dissolvable stitches, the amount of time they will take to disappear depends on the type of stitches. However, for this procedure, they should usually disappear in about six weeks.
If you need them, continue taking painkillers as advised by your surgeon.
At both your initial appointment and before you leave hospital, your surgeon will advise you about returning to your usual activities. You may need around two weeks off work, depending on the operation you have had and what you do at work or home. You shouldn't do any heavy lifting or arm or chest exercise for around three to six weeks afterwards. If your surgeon placed your implant under your chest muscle, you may need to reduce your activity for longer.
As with every procedure, there are some risks associated with breast enlargement. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
After surgery, you will have some hardness, discomfort and swelling in your breasts. Bruising and pain may last a few weeks. The scarring will usually fade after around three months.
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot. This is usually in a vein in your leg and known as deep vein thrombosis.
Specific complications of breast enlargement include those listed below.
- It's common to have a slight difference in size and shape between your breasts, and this can be highlighted by implants.
- You may get an infection in your breast. If this happens, your surgeon may need to remove the implant to allow the infection to be properly treated.
- Abnormal scar tissue can form around the implant. This can squeeze the implant to make it round and firm. This is called capsular contracture and can be painful. You might need another operation to treat this.
- Your breast skin and nipple may feel more or less sensitive after breast enlargement. This usually improves over a few months. If you lose sensation after breast enlargement, it may be permanent.
- Sometimes scars can become red, thick and painful and may need more surgery.
- Implants can sometimes be seen under the breast tissue. Creases or ripples, or the edge of the implant may be visible. This most commonly happens in women who had very small breasts to start with.
- Implants can leak. This may be a slow seeping or a sudden split. If this happens, your implant may need to be taken out.
Does having a breast implant affect breast screening?
Yes, breast implants can affect breast screening and your nurse or radiographer may need to use different screening techniques. But there is no evidence that breast cancer is picked up any later in women with implants. There is also no evidence that women with breast implants have an increased risk of breast cancer.
Mammography (a low-dose X-ray of the breast tissue) is an effective way to screen for breast cancer in women with breast implants. Women in the UK aged 47 to 73 are invited for screening every three years, as part of the national breast cancer screening programme. It's always important to be aware of any breast changes whatever your age, and whether you have had implants or not, and to get your doctor's advice.
Silicone gel-filled breast implants – the most commonly used type of implant – may interfere with mammography. Silicone implants can make taking an image of the breast more difficult and can also make it more difficult for the radiographer to interpret the results. This is because the silicone in the implant can stop X-rays reaching part of your breast tissue.
The amount of interference that is caused by an implant can depend on how your implants have been positioned. Breast implants can be placed under your chest muscle or under your breast tissue. Having implants under your chest muscle makes it easier for your radiographer to analyse the results of your mammography.
Deposits of calcium salt can build up around your implant. Although they are not a worry in themselves, they can interfere with the findings of mammography.
Always tell your radiographer that you have breast implants and what type they are. Your radiographer can then take extra X-rays using different views of your breasts to get the best image possible. Mobile breast screening units usually don’t have the facilities needed, so you’re likely to need to go to a screening clinic in a hospital. It may be possible to have breast screening done by other imaging techniques such ultrasound instead of or as well as a mammogram.
Although very unlikely, the pressure on your breast during a mammogram may possibly cause an implant to burst.
What are the different types of implant available?
There are two main types of implant available in the UK: those filled with silicone gel and those that are filled with saline (salt water). Your surgeon will discuss the best option with you.
Silicone gel implants are the most commonly used type in the UK. The silicone filler can either be a fluid-like gel or a firmer jelly-like gel. Both of these are surrounded by a firm elastic shell (made of silicone elastomer) that may be smooth or textured.
The more solid gel has the advantage of keeping its shape if the implant shell ruptures. However, the softer silicone gel has a more natural feel than other implants but can show wrinkling on the skin in very slim people. Choosing the more solid gel implants may mean you're left with a slightly larger scar. Your surgeon will advise you on the best type for you.
Saline implants have the advantage of being filled with a substance that is found naturally in your body. However, saline implants may be more likely to rupture and cause wrinkling of your skin, and they may also feel and look less natural. Saline implants may be inserted empty and filled by your surgeon once they are in place.
Both silicone and saline breast implants come in a variety of shapes and sizes. Implants can either be round or teardrop-shaped. Your surgeon will talk through the options with you.
Two types of breast implant are no longer available in the UK. Soya bean oil-filled Trilucent implants and hydrogel implants have both been withdrawn from the UK market. It has been recommended that women who have had Trilucent implants have them removed.
What causes an implant to rupture or leak and how will I know if it has happened to me?
The reasons why an implant ruptures or leaks can vary. If it happens to you, the symptoms you experience will vary depending on the type of implant you have.
Rupture means a hole or split in the shell of an implant. As a result, the implant may either leak slowly or suddenly. Saline-filled implants may be more likely to rupture compared to silicone gel-filled implants.
Causes of rupture can include:
- direct damage to your implant, for example, being thrown against a steering wheel in a car accident
- damage to the implant that your surgeon didn’t notice during surgery
- a manufacturing fault
- deterioration of the implant shell over time
Rarely, the pressure placed on your breast during mammography can cause an implant to rupture, but there is little evidence for this happening.
It's usual for your body to react to a breast implant by forming a capsule of scar tissue around it. If a silicone gel-filled implant ruptures, the silicone gel is likely to stay within this capsule. This is often called a silent rupture, as you or your doctor may not notice it has happened. Your body may react to the leaking silicone gel by forming an even thicker capsule of scar tissue. This may distort your breast shape and cause pain or discomfort.
The silicone gel can spread outside the capsule to form lumps in your breast and, rarely, may move to other parts of your body. As well as pain and discomfort, other signs that a silicone implant has ruptured may include hard knots or lumps around the implant or in your armpit. You may also feel aching, burning or hardness in your breast. You may also notice that your breast has changed shape or size. Leaking silicone implants don't cause serious harm.
Saline-filled implants can rupture through a break in the implant shell or though a damaged or unsealed valve. If a saline-filled implant ruptures, it usually becomes obvious very quickly but it can happen over a number of days. If this happens, you will notice that your breast loses shape and gets smaller.
If you notice any of the signs mentioned here or you are at all concerned, talk to your doctor. A rupture will need to be confirmed by your doctor. He or she may use some form of scanning of your breast, such as ultrasound, an MRI or a CT scan.
If you do experience a ruptured breast implant, your surgeon will discuss what is best for you, which will probably include removing the implant.
What qualifications should my surgeon have?
There is no single qualification for cosmetic surgery so you will need to do your homework. Your GP is a good starting point.
It's best to discuss any sort of surgery with your GP first. He or she may know of surgeons in your area and will also be able to pass on any important health information from your medical records to your surgeon. If you don't want to involve your GP, you can find a surgeon yourself, but it's important to get as much information as possible about your surgeon's qualifications and experience. Don't be guided by price, and be very wary of advertising claims.
There is no central registry of surgeons trained in cosmetic surgery. Doctors performing cosmetic surgery can be trained in any of the nine surgical specialities that are recognised by the Royal College of Surgeons. Most surgeons who do cosmetic surgery have been trained in plastic surgery. Surgeons from other specialities such as ENT (ear, nose and throat), ophthalmology (eyes) may carry out some cosmetic surgery. Doctors with only basic medical qualifications should not do cosmetic surgery (basic qualifications are shown by the letters MBBS or MBChB).
Specialist breast surgeons, as well as plastic surgeons, often carry out breast reduction surgery.
Check that your surgeon is on the General Medical Council's (GMC) specialist register - you can do this by looking at the General Medical Council's website.
Before deciding to go ahead with cosmetic surgery, you should have an initial consultation with your surgeon. Don't be afraid to ask the surgeon questions about his or her qualifications and experience. Ask whether he or she belongs to a professional association, such as the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) or the British Association of Aesthetic Plastic Surgeons (BAAPS).
- Submuscular breast augmentation. Medscape. emedicine.medscape.com, published 28 March 2012
- Breast Augmentation. British Association of Aesthetic Plastic Surgeons. www.baaps.org.uk, accessed 20 August 2013
- Information for women considering breast implants. Medicines and Healthcare products Regulatory Agency. www.mhra.gov.uk, published November 2013
- Breast enlargement - patient information guide. British Association of Plastic Reconstructive and Aesthetic Surgeons. www.bapras.org.uk, accessed 20 August 2013
- Subglandular breast augmentation. Medscape. emedicine.medscape.com, published 29 March 2012
- About breast screening. NHS Breast cancer screening programme. www.cancerscreening.nhs.uk, accessed 20 August 2013
- Can a woman have a mammogram if she has had her breasts enlarged with silicone implants? Breast Cancer Care. www.breastcancercare.org.uk, published March 2012
- Mammograms in special circumstances. American Cancer Society. www.cancer.org, published July 2013
- Silicone Gel-Filled Breast Implants. US Food and Drug Administration. www.fda.gov, published August 2013
- Questions about cosmetic surgery. Royal College of Surgeons. www.rcseng.ac.uk, accessed 20 August 2013
- Why use a BAAPS member? www.baaps.org.uk, accessed 20 August 2013
- Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. National Institute for Health and Clinical Excellence (NICE), 2010. www.nice.org.uk
- Personal communication. Robert Hardy, Consultant Endocrine and Breast Surgeon, BMI Sefton Hospital, Liverpool, March 2014
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