Breast enlargement

Published by Bupa's Health Information Team, July 2011.

This factsheet is for women considering having a breast enlargement operation.

A breast enlargement (or breast augmentation) usually involves putting an artificial implant either under the breast tissue, or under the chest muscle behind the breast.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About breast enlargement

You may choose to have your breasts enlarged because you feel that they are too small. Some women feel that their breasts are too small after losing weight or after a pregnancy. You may want to have a breast enlargement to correct a difference in size between your two breasts.

You may also consider breast implants if you're having surgery as treatment for breast cancer or other conditions that may have affected the size and shape of your breasts.

Breast implants are made of an outer layer of firm silicone, and are usually filled with silicone gel or salt water. Your surgeon will discuss the size, shape and type of implants that are most suitable for you. Manufacturers of breast implants say that they last for at least 10 years, but they may last for longer than this without problems.

You may still be able to breastfeed with breast implants, and silicone hasn't been found in breast milk.

Breast implants can interfere with mammography. If you're going for breast screening, tell your radiographer or nurse that you have breast implants.

Getting advice about breast enlargement

It's important not to rush into the decision to have cosmetic surgery. Discuss your options with your GP, who may be able to recommend a surgeon or help you to choose which hospital to be treated in.

It's important that you discuss with your surgeon what you're hoping to gain from the operation and the result you can realistically expect.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop, as 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. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do 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.

What happens during breast enlargement

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. This reduces the chance that the edges of the implant will show, and may reduce the risk of a complication called capsular contracture, depending on the type of implant your surgeon uses. It makes it harder to place larger implants 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.

Animation - how breast enlargement is carried out

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What to expect afterwards

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.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

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.

Recovering from breast enlargement surgery

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 a month afterwards. If your surgeon placed your implant under your chest muscle, you may need to reduce your activity for longer.

What are the risks?

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

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 to pink after around three months, and then fade to white.

Complications

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, usually in a vein in the leg (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 affect the skin on your breast and you may find your skin has ripples and creases. This most commonly happens in very thin people or after sudden weight loss.
• Implants can leak. This may be a slow seeping or a sudden split. If this happens, your implant may need to be taken out.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.