You may choose to have your breasts enlarged because you feel that they’re 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 breasts.
You may also consider breast implants if you’re having surgery to treat breast cancer or other conditions. This is because the size and shape of your breasts may be affected.
Your surgeon will discuss the size, shape and type of implants that are most suitable for you. See our FAQ on types of implant below for more information.
It’s important not to rush into a decision to have any cosmetic procedure, including breast enlargement surgery. Spend some time looking into the type of surgery you’re thinking about. Discuss your options with your GP. They may be able to give you advice about how to choose an appropriate hospital and surgeon. You can also check the relevant qualifications of surgeons online – see our FAQ on choosing a surgeon below.
Before opting for a breast enlargement operation, discuss with your surgeon what you’re hoping to gain from the procedure. Ask about the result you can realistically expect and the risks and possible complications of the surgery. Remember, it’s OK to take a list of questions with you when you meet your surgeon. This is your chance to get all the information you need to make the decision whether to have surgery or not.
A good surgeon will encourage you to take a few weeks as a ‘cooling off’ period before you go ahead with your surgery. If you still have questions, a second consultation with your surgeon may help.
Have a look at websites such as The British Association of Aesthetic Plastic Surgeons and the British Association of Plastic Reconstructive and Aesthetic Surgeons. And you can get good general advice on cosmetic surgery from the Royal College of Surgeons. Don’t forget – if you still have questions, ask your surgeon.
Your surgeon will explain how to prepare for your operation. For example, if you smoke, you’ll be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
You’ll usually have your breast enlargement under a general anaesthetic. This means you’ll be asleep during the procedure. You’ll 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. Make arrangements beforehand to have someone drive you home afterwards.
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. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to have it, you’ll be asked to sign a consent form.
Your surgeon will measure your breasts and assess their shape, your skin and the position of your nipples. They’ll probably draw on your breasts to mark the operation site. Your surgeon may also photograph your breasts for confidential ‘before and after’ images. They may recommend that you have a mammogram taken.
Breast enlargement usually takes around one and a half hours. You’ll probably have a general anaesthetic, which means you’ll be asleep during the operation.
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.
There are pros and cons to putting the implant under or over 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 (see our section on complications below). However, it may mean you have more pain afterwards. Your surgeon will discuss with you 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.
After your breast enlargement surgery you’ll be given painkillers to help relieve any pain as the anaesthetic wears off. If you have pain, tell your nurse. It’s normal for your chest to feel tight after your operation. You may have fine tubes running out from the wound to drain excess fluid into a bag or bottle. These will be removed before you go home.
Your nurse will give you advice about caring for healing wounds before you go home. You’ll also get advice on how to care for your breasts, hygiene and showering. You’ll be given a date for a follow-up appointment.
Someone else should drive you home – don’t try and drive yourself. Try to have a friend or relative stay with you for the first 24 hours.
The medicines used for general anaesthesia can stay in your body for a while. Because of this it’s safest not to drive, drink alcohol, operate machinery or make important decisions for 24 hours after your anaesthetic. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations. 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’ll take to disappear depends on the type of stitches. However, for this procedure, they should usually disappear in about six weeks.
You’ll probably need one to two weeks off work after breast enlargement surgery. How long you need may depend on what your job involves and what type of surgery you had. You shouldn’t do any strenuous exercise or lift heavy weights for around three to six weeks. Your surgeon will give you advice about exercise, driving and returning to work in your particular circumstances – it’s important to follow this.
You may be given some painkilling medicines to take home with you. If not, and you feel you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Some women find it more comfortable to wear a sports bra for a month or so while they heal. Ask your surgeon whether they would recommend this for 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 some pain may last a few weeks.
Your breast enlargement operation will leave scars. These may be quite red for the first six weeks, then fade to purple after around three months. Your scars will eventually fade to white.
Complications are when problems occur during or after the operation. As with every procedure, there are some risks associated with breast enlargement. You can ask your surgeon to explain how these risks might apply to you.
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 (DVT).
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 bleed into the space around the implant. Your breast may become swollen and tight as a collection of blood called a haematoma forms. You may need to have a further procedure to remove this and stop the bleeding.
- 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 nipple sensation after breast enlargement, especially if it lasts for more than six weeks, this 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 (see our FAQ on rupture of implants below). If this happens, your implant may need to be taken out.
Breast enlargement surgery, like many other types of cosmetic surgery, is not usually available on the NHS. It may, however, be offered in a few circumstances for health or psychological reasons. These might include if your breasts are very underdeveloped. Breast implants might also be available on the NHS as part of reconstructive surgery after breast cancer.
So if you decide to have breast enlargement surgery you’ll probably be doing so privately, covering all the costs yourself. The costs of breast enlargement vary from surgeon to surgeon and clinic to clinic. Never base your decision on costs alone when deciding where to be treated. It’s important to consider the quality of your surgeon and the hospital or clinic when making your decision. Remember, this is a major surgical procedure.
When you’ve chosen who will do your surgery you should be able to get an approximate cost before your consultation. (See our FAQ below for advice on how to choose your surgeon). After your consultation, your surgeon will send you a written quotation. This may be a ‘package’ price for all the care you’ll need, including treating any complications after the operation. You must make sure that it’s clear what is, and what isn’t included in the package. If in doubt, ask.
Be wary. Avoid any deal where you’re asked to pay a non-refundable deposit, or even where the cost of the consultation is refunded if you go ahead. These are considered to be financial inducements.
When thinking about whether you can afford a breast enlargement procedure you should also take into account the fact that implants don’t last forever. Consider whether you’ll be able to afford further surgery in the future. See our FAQ below on the lifetime of an implant.
Yes, breast implants can affect breast screening. Your radiographer may need to use different screening techniques which can’t be done in a mobile screening unit. So if you’re offered screening, let them know before your appointment that you have breast implants.
But you can be reassured that breast cancer doesn’t seem to be picked up any later in women with implants. And having breast implants isn’t linked to an increased risk of breast cancer.
If you’re a woman in the UK aged 47 to 73, you’ll be invited for screening every three years. This is part of the national breast cancer screening programme. You’ll be offered a screening test called mammography, which is an X-ray of your breast tissue.
Silicone gel-filled breast implants – the most commonly used type of implant – may interfere with mammography. How much interference they cause 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 causes less of a problem with mammography.
Deposits of calcium salt can build up around your implant. Although they’re 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. They can then choose the best method for screening your breasts. Mobile breast screening units usually don’t have the facilities needed, so you’ll probably have to go to a screening clinic in a hospital.
There are two main types of implant available in the UK: those filled with silicone gel and those filled with saline (salt water). Your surgeon will discuss the best option with you.
All implants have an outer layer of silicone. This can then be filled with either silicone gel or with saline. Other filling materials have been withdrawn from use in the UK. Your surgeon can explain the pros and cons of each type of implant and help you decide which is the best option for 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.
The softer silicone gel has a more natural feel than other implants but can show wrinkling on the skin in very slim people. The more solid gel has the advantage of keeping its shape if the implant shell ruptures. Choosing the more solid gel implants may mean you’re left with a slightly larger scar.
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.
Breast implants are made to be tough, but they can sometimes rupture. This means they get a hole or split in the shell, letting the contents leak out. If it happens to you, your symptoms may depend on the type of implant you have.
- Silicone gel-filled implant. If a silicone gel-filled implant ruptures, the silicone gel is likely to stay within its shell or within the scar tissue around it. You or your doctor may not even notice it has happened. Or you may notice your breast looks smaller and its shape has changed. You may have hard lumps over the implant or over your chest. And you may feel pain and tenderness or other sensations such as tingling, numbness or burning in your breast.
- Saline implant. If these rupture (or deflate) it may become 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.
Having a ruptured breast implant isn’t necessarily harmful, and doesn’t always cause a medical problem. But if you notice any of the signs mentioned here or you’re at all concerned, talk to your doctor. If you have a ruptured breast implant, your surgeon will discuss what’s best for you. This will probably include removing the implant and exchanging it for a new one.
If you decide to have breast enlargement it’s really important that you choose a surgeon with the right skills and experience. There’s no single qualification for cosmetic surgery and no central register of surgeons trained in cosmetic surgery. So you’ll need to do your homework and ask lots of questions. Don’t be guided by price, and be very wary of advertising claims. Don’t rush into a decision – remember this is major surgery. Make sure all your questions are answered to your satisfaction and you fully understand all aspects of the care you’ll receive.
Ask your GP
It’s best to discuss any sort of surgery with your GP first. They 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.
Your surgeon’s qualifications
Your surgeon must be registered with the General Medical Council (GMC). You can check this on the GMC website. Look there to see if the surgeon is on the GMC specialist register in the area of practice relevant to the procedure you’re having. General surgeons with a specialist interest in the breast, as well as plastic surgeons, carry out breast enlargement surgery.
If you’re choosing to have your surgery in England check that the hospital is registered with the independent regulator – the Care Quality Commission (CQC). You can ask the hospital to show you their registration certificate or search the CQC website. Think about how far you’re prepared to travel for your surgery and follow up appointments, and arrange a visit to the hospital. Don’t be afraid to ask questions.
Ask your surgeon
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 their qualifications and experience. For instance, you can ask how often their patients get complications after surgery. And ask about what insurance they have, and what it covers.
Your surgeon will also be able to tell you whether they belong to a relevant professional association. These include:
- the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)
- the British Association of Aesthetic Plastic Surgeons (BAAPS)
- the Association of Breast Surgery (ABS).
Doctors don’t generally recommend routine replacement of breast implants after a particular time. However, breast implants don’t come with a lifetime guarantee and it’s likely that they’ll need replacing eventually. Your surgeon can’t tell you exactly when that will be but most implants last at least 10 years.
So if you’re thinking about having a breast enlargement operation, take this into account. You should be prepared for going through further surgery and expense at some point in the future.
On 10 October 2016 a new Breast and Cosmetic Implant Registry was started in England. Its main aim is to allow doctors to find and contact patients if there’s a future recall of a failed implant. It’s a safety measure.
Setting up a registry was recommended after there were problems finding women who had received faulty PIP (Poly Implant Prothèse) implants in 2010.
All women who have breast enlargement operations will be asked for permission to keep their details on this national registry. These details will include your name, your NHS number, your postcode and your date of birth. The registry will also keep details of your surgeon, the procedure you have and the implant itself.
This information will only be kept if you agree. Your personal details will be held in confidence and will only be used if there’s a recall of your particular implant in future. If you don’t agree to having your details in the registry this won’t affect your surgery or the care you receive. It will just mean that it will be difficult (or even impossible) for doctors to let you know about future recalls of your implant.
Your surgeon will be able to answer any questions you have. They’ll give you a form to sign if you agree to be on the registry.
- Information for women considering breast implants. Medicines & Healthcare products Regulatory Agency. www.mhra.gov.uk, 2011
- Your guide to breast augmentation. British Association of Plastic Reconstructive and Aesthetic Surgeons. www.bapras.org.uk, 2014
- Breast augmentation. British Association of Aesthetic Plastic Surgeons. www.baaps.org.uk, accessed 17 November 2016
- Submuscular breast augmentation. Medscape. emedicine.medscape.com, updated 13 November 2015
- Subglandular breast augmentation. Medscape. emedicine.medscape.com, updated 3 March 2016
- Principles of plastic surgery. OSH Operative surgery (online). Oxford Medicine Online. oxfordmedicine.com, published October 2011
- Breast construction using implants. Cancer Research UK. www.cancerresearchuk.org, updated 31 July 2014
- Cosmetic surgery. Royal College of Surgeons. www.rcseng.ac.uk, accessed 22 November 2016
- Choosing a surgeon and hospital. Royal College of Surgeons. www.rcseng.ac.uk, accessed 22 November 2016
- Breast enlargement (implants). Royal College of Surgeons. www.rcseng.ac.uk, accessed 22 November 2016
- Breast cancer screening. NHS Choices. www.nhs.uk, last reviewed 14 July 2015
- Breast implants and breast screening. NHS Cancer Screening Programmes. www.gov.uk, 2010
- Risks of breast implants. US Food and Drug Administration. www.fda.gov, published 25 September 2013
- Breast and cosmetic implant registry. NHS Digital. content.digital.nhs.uk, accessed 22 November 2016
- Information for patients about the Breast and Cosmetic Implant Registry. NHS Digital. content.digital.nhs.uk, approval date September 2016
- The NHS guide to cosmetic procedures. NHS Choices. www.nhs.uk, last reviewed 19 May 2016
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Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, November 2016
Expert reviewer, Mr Robert Hardy, Consultant Surgeon
Next review due November 2019
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