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Published by Bupa's health information team, July 2009.
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 your breast tissue, or under your chest muscle behind your breast.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.
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 also 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 affect 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 may be suitable for you. Manufacturers of breast implants say that they last for at least 10 years, but they may last for longer than this with no problems.
You may still be able to breastfeed with breast implants, and there is no evidence that silicone is found in breast milk. It's important to tell your surgeon before the procedure if you plan to breastfeed because this can affect the type of operation you have.
Breast implants can interfere with mammography. If you're going for breast screening you should tell your radiographer or nurse that you have breast implants.
Where breast implants are placed
Getting advice about breast enlargement
It's important not to rush into the decision to have any cosmetic operation. Discuss your options with your GP, who may be able to recommend a reputable surgeon or advise you about how to choose which hospital to be treated in.
It's important to 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 give you advice on how to prepare for your operation. For example, if you smoke you may be asked to quit because smoking increases your risk of getting chest and wound infections, and can slow the healing of your wounds, which can leave you with worse scarring.
Breast enlargements are usually done under a general anaesthetic. This means you will be asleep during the procedure. You will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
The operation may be carried out as a day case or you may need to stay in hospital overnight. You may be asked to bring in a soft, supportive bra without underwiring, such as a sports bra, to wear after your operation.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine. Your surgeon or another healthcare professional will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
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. With your permission, 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 theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs (deep vein thrombosis).
About the operation
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 reduces the risk of a complication called capsular contracture. But it makes it harder to place larger implants and may mean more pain afterwards. Your surgeon will decide which method is best for you.
The surgeon will close the cut with stitches (which may be dissolvable), and wrap your breasts in a supportive dressing or support bra.
Fine plastic tubes may be left in each breast for a few days afterwards. These allow excess blood and fluids to drain into a bag.
How breast enlargement surgery 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. If you go home the same day as your operation, 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 48 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 doctor/surgeon's advice.
You will go home wearing your support bra, which you should wear day and night. This helps to prevent the weight of the breasts pulling on the wound and slowing the healing process.
The stitches are taken out after seven to 14 days. If you have had dissolvable stitches, the amount of time they will take to disappear depends on the type you have. They usually disappear in around two to three weeks, but it can sometimes take longer.
Recovering from breast enlargement surgery
If you need them, continue taking painkillers as advised by your surgeon.
At your follow-up appointment, your surgeon will advise you about returning to your usual activities. You may need one to four weeks off work, depending on what you do, and you should not do any heavy lifting or exercise for three or four weeks afterwards. If the implant is placed under your chest muscle, you may need to reduce your activity for longer.
What are the risks?
Breast enlargement is a commonly performed and generally safe operation. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this 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 continue to fade for 12 or more months after your surgery.
This is when problems occur during or after the operation. Most women are not affected. 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, most commonly around seven to 10 days after the operation. If this happens, the implant may need to be removed to allow the infection to be properly treated.
- Abnormal scar tissue can form around the implant. This can squeeze the implant and cause a firm, painful swelling called capsular contracture. You might need another operation to treat this.
- Your breast skin and nipple may feel more or less sensitive after breast enlargement, which usually improves over months. Sometimes this can be permanent.
- Sometimes scars can become red, thick and painful and may need more surgery.
- Implants can sometimes cause ripples and creases on the skin on your breast.
- Implants can leak. This may be a slow seeping or a sudden split. If this happens, your implant may need to be taken out.
The exact risks will differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
Breast enlargement Q&As
See our answers to common questions about breast enlargement, including:
- British Association of Aesthetic Plastic Surgeons
020 7405 2234
- Breast enlargement. British Association of Plastic Reconstructive and Aesthetic Surgeons. www.bapras.org.uk, accessed 23 February 2009
- Breast augmentation. The British Association of Aesthetic Plastic Surgeons. www.baaps.org.uk, accessed 23 February 2009
- Smoking and anaesthesia. British Association of Day Surgery. www.daysurgeryuk.org, accessed 18 February 2009
- Breast implant. Department of Health. www.dh.gov.uk, accessed 23 February 2009
- Venous thromboembolism: Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. National Institute for Health and Clinical Excellence (NICE), www.nice.org.uk, 2007
- Breast augmentation, submuscular. eMedicine. www.emedicine.medscape.com, accessed 23 February 2009
- Information for women considering breast implants. Medicines and Healthcare products Regulatory Agency. www.mhra.gov.uk, accessed 23 February 2009
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: July 2009