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A breast enlargement, also known as a breast augmentation or an augmentation mammoplasty, is one of the most commonly performed cosmetic procedures in the world. Patients often refer to it as a “boob job”. It is important that you have a good understanding of the surgery before you have treatment. This breast enlargement overview will give you an introduction to the procedure.
What can a breast enlargement achieve?
A breast enlargement aims to enhance the size and shape of your breasts by giving them a fuller and more contoured look. Your surgeon may either use a breast implant for the enlargement, or they may use liposuction to remove fat from one part of the body, then transfer that fat to the breasts. If a surgeon uses fat to enlarge the breasts, it is called a breast enlargement by fat transfer or, “lipofilling”.
You may choose to have a breast enlargement if you want to:
- Restore volume to your breasts after ageing, weight loss or pregnancy
- Create a more contoured breast shape
- Balance an asymmetry of the breasts
- Boost your self-esteem.
Although a breast enlargement can improve the shape of the breasts, it cannot correct severe sagging (breast ptosis). A breast uplift, also called a mastopexy, is a more suitable procedure for patients with severe sagging. Your surgeon may however, choose to combine your enlargement with an uplift in order to achieve a more aesthetically pleasing result.
Who are the ideal candidates for a breast enlargement?
Breast enlargement surgery may be an option for women looking to enhance the size and shape of their breasts. The ideal breast enlargement candidates include those who are:
- Over 18 years old
- Are not pregnant or breastfeeding
- Realistic with their expectations
- Physically healthy
- Emotionally prepared for surgery
- Unhappy with the current look of their breasts
- Non-smokers or those who have not smoked or used nicotine products for at least 6 weeks before surgery.
Why have a breast enlargement?
Women may want to have a breast enlargement for the following reasons:
A breast enlargement gives breasts a fuller and more contoured appearance. Women may choose to have this done to enhance the shape and size of their breasts. A breast enlargement can:
- Restore breast volume that may have been lost with ageing
- Enhance the shape and size of the breasts after pregnancy
- Balance a difference in breast size after weight loss
- Correct asymmetry between the breasts
- Boost self-esteem
It is important to be aware that although a breast enlargement can enhance breast shape and size, it cannot correct severely drooping breasts. For drooping breasts (also called breast ptosis), a breast uplift would be a better option. Your surgeon may choose to combine a breast enlargement with a breast uplift in order to achieve the best results.
Breast enlargement surgery may also be an option for women who have been affected by breast cancer.
Treatment for breast cancer may involve removal of one or both the breasts (a procedure called a mastectomy). A mastectomy may also be performed as a preventative measure for women who are at high-risk of developing breast cancer in the future. Women who have had this surgery done, may want a breast enlargement to restore the breast shape.
If you are thinking about having a breast enlargement, you can increase your suitability for surgery by optimising your health. Regular exercise, a healthy diet, stopping smoking and reducing your alcohol intake are all ways you can increase your chances of having surgery!
How is a breast enlargement procedure performed?
A breast enlargement procedure often lasts between 60 to 90 minutes. Before your surgery, you must follow the guidance given for eating, drinking and taking medications the night before.
The procedure involves the following steps:
1. Consent form
You will meet your surgeon and anaesthetist to sign the consent form. This will happen either on the day of surgery, or during your pre-operative assessment a week before. After you have consented, your surgeon will draw marks on the treatment area and discuss the exact goals of the surgery.
Your anaesthetist will administer your anaesthetic. They may use either a general anaesthetic, or a local anaesthetic with IV (intravenous) sedation. You and your surgeon will discuss which anaesthetic to use during your first consultation.
Your surgeon will clean and drape your skin before making the incisions in the areas discussed. They will place the incisions in less visible areas in order to create a more aesthetically pleasing result.
There are three areas where an incision can be made during your breast enlargement procedure:
- Transaxillary – in the armpit.
- Periareolar – around the areola.
- Inframammary – below the breast, in the inframammary fold.
4. Insertion of breast implant
Your surgeon will then insert the breast implant into your breast. They can place the implant over the chest muscle (pectoralis major), under the chest muscle or as a combination of both.
Subglandular/Submammary implant (over the chest muscle)
Breast implants placed over the chest muscle can create a more defined breast shape as the implant is closer to the skin’s surface. As the procedure is less invasive, you may feel less pain in the first few days after surgery. Placing the implant over the muscle leads to less movement of the implant when the chest muscle moves or flexes.
Subpectoral implants (under the chest muscle)
Breast implants placed under the chest muscle are less likely to be felt or seen. This is because the muscle provides excellent soft tissue padding. As these implants are not directly below the breast tissue, they are also less likely to interfere with mammograms. This placement is however, more invasive and would therefore lead to a longer recovery period.
Dual plane implants (combination)
A dual plane implant (also called a dual plane or bi-planar augmentation) combines both subglandular and subpectoral techniques. The top part of the implant sits under the muscle. This reduces the risk of implant visibility and ripples. The bottom part sits directly in contact with the breast tissue. This helps create a more curvaceous underboob.
Your surgeon will work with you to choose which technique will work best for you.
5. Closing of incisions
Your surgeon will then close the incision and apply a dressing over it. You may have drains put in below the skin to reduce swelling and bruising. The drains are usually removed before you are discharged home.
6. Return to the ward
Finally, you are taken back to the ward to recover from the anaesthetic. You should be able to go home the same day or the following day.
Once your surgery is over, the results will be visible straight away. It may however, take up to 8 weeks for the swelling and bruising to subside; after which, you will be able to see the full cosmetic result of your breast enlargement procedure.
What are the different breast implants available for a breast enlargement procedure?
All breast implant types have a thin outer layer made up of silicone. The outer layer of breast implants can have either a smooth or textured surface. The implants can contain saline, silicone gel or highly-cohesive silicone gel.
Saline implants consist of an outer silicone shell filled with sterile salt water (saline). The surgeon will insert the empty silicone shell into the breast, then inflate it with salt water through a small valve. Insertion of saline implants leaves a smaller scar than surgery with silicone implants. This is because silicone implants are pre-filled before surgery.
Saline implants are often one of the least popular breast implant types. This is because they are more prone to rupture, deflation and loss of volume over time. Due to their consistency, they may also look and feel less natural than silicone based implants.
Silicone gel implants consist of an outer silicone shell filled with a soft, silicone gel. Insertion of silicone gel implants require your surgeon to make a larger incision. This is because, unlike saline implants, they are pre-filled before surgery.
Silicone gel implants have a firmer consistency than saline implants, making them loss prone to wrinkling and allowing them to feel and look more natural.
Highly-Cohesive Silicone Gel
Highly-cohesive gel implants consist of an outer silicone shell containing a much firmer silicone gel. This firm consistency allows the implants to achieve the most natural look and feel. They are the least likely implant type to rupture, and even when they do – the contents do not spill out as they do with the other types of implant.
Avrupamed surgeons only use the highest-quality implant brands that are rigorously tested for both quality and safety. The size of your breast implant is measured by volume cubic centimetres (cc). Once you have picked your desired cup size, your surgeon will work with you to identify the perfect implant size. It is however, important to keep in mind that breast implant volumes do not necessarily equal a certain bra cup size. You can use ‘ The Rice Test’ to get an idea of how you would look with different sizes of breast implants.
Breast implant shapes
Breast implants can have a “round” or a “teardrop” shape. Both shapes can help create a full, natural looking breast, but the shape of implant that is best for you will depend on what you would like to achieve from your breast enlargement. Your surgeon will work with you to find an implant shape that will help achieve the best aesthetic results from your surgery.
Round implants add volume to both the upper and lower parts of the breast. This allows them to give the breasts a “fuller” look, making them a good choice for patients who want to add more volume to the breast.
Teardrop (anatomical) implants
Teardrop implants add more volume to the lower part of the breast than the upper part. This gives a more discreet look that is more in keeping with the natural shape of breasts. This is typically a better option for patients looking to achieve a more natural breast enlargement.
What should I expect during my breast enlargement consultation?
Your breast enlargement consultation will usually last between 15 minutes to 1 hour. Your surgeon will discuss the following:
- Why you want to have a breast enlargement
- Your expectations and desired outcomes from surgery
- Any current or past medical conditions or allergies you may have
- Past or current surgical procedures
- Current medications, vitamins or herbal supplements you are taking
- Any personal or family history of breast cancer
- The results of any mammograms or biopsies you have had
- Any alcohol, tobacco and drug use
After your surgeon has covered your medical history and medications, they will examine and measure your breasts. This will include them taking measurements of your breast size, shape, skin quality and the placement of the nipples and areolas. They will then take photographs of your breasts and discuss your options for treatment.
When recommending a course of treatment, your surgeon will consider:
- Your current breast size and shape
- The breast size and shape you want
- The quality and quantity of your breast tissue and skin
- Your past and present medical conditions.
In order to make sure you are informed, your surgeon will also talk through any risks or potential complications from the surgery. It is very important for you to be familiar with these before you give consent for your surgery.
Questions to ask during your breast enlargement consultation
There are some important questions you should ask your surgeon during your breast enlargement consultation:
- Do you think what I want to achieve from surgery is realistic?
- How can I get the best results?
- Where will my scars be located?
- Can I see pictures of similar operations you have done?
Your consultation time is your chance to be as honest and candid as possible with your surgeon. It is important to be honest about what you would like to achieve, so that you may explore whether this is possible or not. At Avrupamed, our surgeons want to help you achieve the best results possible.
Risks & complications
What are the main breast enlargement risks and complications?
Although a breast enlargement is an elective surgery, it does come with some risks and complications that you should be aware of. The breast enlargement risks and complications are as follows:
Bleeding & bruising
It is normal to have some mild bleeding and bruising after your surgery. In some cases however, the bleeding may be more severe. If this occurs, it usually happens shortly after surgery, but can occur a few weeks later. The breast will become very swollen and tight, and you may need to have further surgery to correct it. You may need to spend an extra night in hospital, but things should settle down in time. If treated promptly, it is unlikely to adversely affect the results of your surgery.
As a breast enlargement requires your surgeon to make incisions on the skin, scarring is unavoidable. In most cases however, the scars are mild and will fade over time.
Infection is a risk that comes with any surgery. If you develop a mild infection, such as a wound infection, your surgeon will give you antibiotics to treat it. It is however, important to flag up any signs of an infection, which can include:
- A temperature over 38°C
- Redness at the incision line that begins to spread away from the incision
- Yellow pus-like or foul smelling fluid coming from the incision site or drains
- Increasing pain or discomfort that is not relieved by your pain medicine.
If you notice any of these symptoms, you must notify your surgeon.
Numbness or altered sensations
One of the most common breast enlargement risks is the feeling of altered sensations in the breasts. Typically, patients feel either an increased or reduced sensitivity (numbness) around the scar, nipple or areola.
Both numbness and oversensitivity gradually settle down over time; but it can take several months before the skin sensation returns to normal. In some rare cases, the numbness or altered sensation can persist and may become permanent.
During surgery, the blood supply to some areas of the nipple, skin, fat, or breast tissue may be lost. If this occurs, the area affected may die. This is called ‘necrosis’ and is a very rare complication of surgery. It is however, more likely to occur in smokers. If necrosis does occur, you will need further surgery to remove the dead tissue. This is one of the rarest breast enlargement risks.
When your surgeon places any kind of implant (wether saline or silicone) in the body, the body’s natural response is to form a capsule of fibrous scar tissue around it. This scar tissue has a tendency to contract. In some cases, the contraction can lead to tightening and hardening of the capsule. As the capsule tightens, the implant and breast become abnormally firm, and sometimes hard and uncomfortable. Usually, this causes the implant to rise up, giving it a high and round appearance. The rest of the natural breast tissue hangs below the implant.
Capsular contracture is the most common long-term complication of a breast enlargement. It occurs less commonly with saline implants than with silicone implants. In most cases, your surgeon will recommend the surgical removal of the implant and fibrous capsule, with or without replacement of the implant. This procedure is called a capsulectomy and it aims to restore breast symmetry and relieve discomfort.
A seroma is a pocket of fluid that commonly develops 7 to 10 days after surgery, usually around the incision line. The affected area of the breast may feel swollen or you may feel like there is fluid under the skin. The development of a seroma can increase your recovery time. Most seromas resolve on their own, but in some cases, a surgeon may need to drain the fluid.
Creasing and folds
After a breast enlargement, the implant may cause the outer surface of the skin to crease and fold. The risk of developing creasing and folds is very low. It does however, occur more commonly in thin patients with small breasts who choose to have saline implants.
A rupture occurs when an implant splits open, leaking out its contents. If this occurs, the implant should be removed, and can be replaced if the patient wants it to be. It can be caused by damage to the implant, or as a result of mishandling of the implant before and during surgery. This is why it is crucial to choose an experienced surgeon that knows how to handle the implant appropriately.
Ruptures are more likely to occur with saline implants. They may be harder to detect in silicone implants, as the contents do not leak out as readily. If a silicone rupture goes undetected, it is called a ‘silent rupture’. The FDA (Food & Drug Administration) recommend patients with silicone implants to have regular MRI checks after their surgery to screen for silent ruptures.
Over time, both natural breasts and breasts with implants begin to droop down. Larger sized implants will lead to a greater extent of drooping. The gravity effect can reduce the firmness of the breasts. It occurs due to a mix of: loss of elasticity, the effect of gravity and breast tissue volume loss (especially after pregnancy and breastfeeding). This can be corrected with a breast uplift.
During your surgery, your surgeon will create an ‘implant pocket’ in which they will place the implant. This pocket can sometimes loosen, causing the breasts to move too far outwards towards the armpits. This leads to a reduction or loss in cleavage.
Lateralisation can occur when women with a small amount of natural breast tissue get very large implants put in. It is also more likely to occur when a surgeon places the implants above the muscle. If it does occur, you surgeon can correct it with further surgery.
Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a cancer of the lymph glands. Symptoms can include swelling of the breast, a mass, or fluid build-up around the implant. This is however, an extremely rare condition. Treatment involves surgical removal of the breast capsule and implant, and in some cases, chemotherapy. If you and your surgeon detect and treat BIA-ALCL early enough, treatment is curative.
The placement of a breast implant can cause it to interfere with the natural fold at the bottom of the breast (the inframammary fold). A “double bubble” occurs when an implant drops down below this fold. Implants placed below the chest muscle (subpectoral implants), are at greater risk of developing this.
During your surgery, your surgeon will create an ‘implant pocket’ in which they will place the implant. This pocket can sometimes weaken. This reduces the tissue support at the bottom of the breasts, which then causes the implant to drop down, pulling the breast tissue down with it. This results in misshapen breasts where there is a fullness at the bottom of the breast, and a nipple that appears unnaturally high. Further surgery can restore the breasts to their former position.
There is always a risk that you may be unhappy with the results of your breast enlargement. For example, you may be unhappy with the size, shape or symmetry of your breasts. We therefore advise you to choose your surgeon carefully, making sure he or she fully understands your expectations.
Your surgeon will discuss all the breast enlargement risks and complications with you during your consultation. It is important to choose a highly experienced surgeon. This reduces the chance of any breast enlargement risks and complications occurring.
Preparing for your treatment
How can I prepare for a breast enlargement?
It is important for you to prepare well for your surgery. We recommend the following tips for your breast enlargement preparation:
You will not be able to drive immediately after your surgery. You may have to wait 5 days to 2 weeks before you are able to drive. For this reason, it is essential that you arrange for a family member or a friend to take you home after your surgery. Medbelle can help you with your travel arrangements as well!
As you may still have anaesthetic and painkillers running through your system, you will need adult supervision for the first 24 hours after surgery.
Sleeping & resting
You may find it more comfortable to sleep propped up after surgery. You should therefore make sure that you have plenty of extra pillows. Rest and sleep on your back continuously in an inclined position (25-to-45-degree angle) for the initial postoperative days.
Although you should get plenty of rest after your operation, it is important that you do not spend all your time in bed. You should frequently get up and walk around. This helps reduce the risk of developing a blood clot, which is one of the risks of having surgery.
Household items & chores
It is really handy to put cupboard items like mugs, crockery and food cupboard items on the kitchen counter. This will prevent you from putting strain on your stitches by reaching for things. This will help the healing process.
You must also clean the house and do things like the laundry or taking the bins out before your operation. It is good to get jobs like that out of the way.
You will not be able to lift heavy shopping for a while, so do a big food shop before the day of your surgery. You could also cook some meals for the freezer, so you will not have to worry about cooking either.
Children & pets
Ask family and friends to help look after young children and pets for the first week or so until your stitches are removed.
After your breast enlargement, eat high-protein, low-sodium foods, including fresh fruits and vegetables. Drink lots of water and caffeine-free beverages. Avoid food and drink containing high amounts of salts and sugars during your recovery time.
Pick items that open in the front in the first few days. Wear slip-on shoes so you don’t have to bend. Your care agent will tell you if you need to bring a supportive bra on the day of your operation.
Our Avrupamed surgeons promote the following advice to help reduce the risk of complications:
- Smoking, alcohol, a high BMI and any form of drug use, wether medicinal or recreational, can increase your risk of developing complications during and after surgery.
- In order to reduce the risk, our surgeons strongly advise patients to stop smoking and using all nicotine products at least 6 weeks before treatment. Smoking strongly increases the risk of infection and delays the healing process.
- It is also worth noting that several homeopathic medications available over the counter and taken for general wellbeing can negatively affect the outcome of cosmetic surgery.
- Such medications include: but are not limited to those containing ginger, ginkgo, garlic, cod liver oil, St John’s Wort, Aspirin and several preparations of multivitamins.
- We therefore advise that all homeopathic medication is stopped 2 weeks before cosmetic surgery to reduce the risk of postoperative bleeding, excessive bruising and haematoma.
Your breast enlargement preparation is also essential to making sure you are fit enough for surgery.
What can I expect after a breast enlargement?
During your consultation, your surgeon will give you specific instructions on the breast enlargement aftercare process.
After your breast enlargement, you will usually be able to return home the same day or the day after. Before you leave the hospital, a post-operative appointment will be arranged within two weeks time. During this appointment, your surgeon will examine your breasts, remove any non-dissolvable stitches and address any surgical complications.
As part of your breast enlargement aftercare process, your surgeon will give you specific timeframes and advice regarding things such as time off work, sports & exercise, driving etc. These time frames can differ greatly from surgeon to surgeon. It is therefore important to follow the specific advice that your surgeon gives you, as it is specific to your recovery.
Time off work
The time you need to take off work after a breast enlargement procedure depends on the type of work you do. If your job includes a lot of physical activity, for example waitressing, you may have to take at least one full week off. If however, it does not involve a lot of activity, such as an office job, you may only need to take 4 to 5 days off work. In any case, you should avoid even light duties for at least 1 to 2 weeks.
Return to sports & exercise
Although you will need to rest after your surgery, it is important that you do not stay in bed all day. You should take occasional light walks to prevent the risk of developing blood clots in your legs.
Although it is recommended for you to be mobile, the following advice for sports & exercise is:
Week 1 – 3
No exercise at all. Even minor aerobic activities may lead to increased swelling and longer recovery times.
Week 3 – 6
You may begin to resume sports that do not involve vigorous movement, for example cycling.
After week 6
6 weeks after your surgery, you should be able to resume all types of exercise again.
You will not be able to drive immediately after your surgery. You will therefore need to arrange for a family member or friend to take you home after your breast enlargement.
After your treatment, you will have to wear a post-operative bra for around 2 to 5 weeks. The amount of time you will have to wear this recovery bra for depends on your surgeon’s advice. The bra you during your recovery by reducing swelling, bruising and helping achieve the best result possible.
There are a number of different techniques that your surgeon may recommend to aid the healing of your scars after your nipple correction. These include:
- Scar massage – you can gently massage your scar after it has full healed and the scab has completely disappeared by itself.
- Silicone creams/gels/sheets – silicone based products may help reduce the appearance of your scars. Your surgeon may recommend using these products for 6 to 12 months. Make sure to use them only after the glue or tape from surgery has been taken off and your incision has fully healed.
- Avoid exposing your scars to the sun or sunbeds. You should use a high-factor sunscreen to protect the healing skin and avoid colour differences.
Your surgeon will advise you specifically on how to take care of your scars.
Although you will see an immediate difference in your breasts after surgery, it may take 2 to 9 months before you are able to appreciate the full cosmetic results of your breast enlargement.
It is important to keep in mind that the exact recovery time will vary from patient to patient. These timings are different for each patient and each surgeon gives different advice. Therefore, it is important to follow the post operative advice your surgeon gives you.
It is important to research your breast enlargement well before going ahead with the procedure. Common breast enlargement FAQs include the following:
How much time do I have to take off work after a breast enlargement?
This depends on what type of work you do. If your job includes a lot of physical activity you may have to take at least one full week off. If it does not involve a lot of activity you may only need to take 4 to 5 days off work. In any case, you should avoid even light duties for at least 1 to 2 weeks.
Will a breast enlargement effect my ability to breastfeed?
Some women have difficulty breastfeeding following a breast enlargement. This is however, uncommon, and most patients will still be able to breastfeed on the assumption that they were able to breastfeed before their surgery.
Incisions made under the breast or in the armpit may prevent damage to milk ducts, glands, or nerves. Implants placed under the chest muscle are also less likely to damage milk ducts and nerves.
How long after breastfeeding must I wait to have a breast enlargement?
If you are currently breastfeeding, your surgeon may require you to stop nursing at least 3 to 6 months before surgery. This allows the breasts to settle before your procedure.
How long after pregnancy must I wait to have a breast enlargement?
If you’ve recently had a baby, your surgeon may require you to wait 3 to 6 months before you are able to have a breast enlargement.
What do breast implants feel like?
Breast implants are designed to mimic the feel of natural breasts. Silicone gel implants, especially highly-cohesive silicone gel, have a more natural feel than saline implants.
Do I need a GP referral for a breast enlargement?
Most cosmetic surgeons will be happy to see you for an initial consultation without a referral from your GP. If you plan to go ahead with surgery however, your surgeon may contact your GP for details regarding your medical history.
Is a breast enlargement available on the NHS?
Cosmetic procedures such as a breast enlargement, are usually not available on the NHS. If however, you have had a lumpectomy or mastectomy for breast cancer treatment, you may be eligible for a breast reconstruction on the NHS.
What is the effect of drugs and alcohol on a breast enlargement?
Smoking, drinking large amounts of alcohol and/or taking recreational drugs, increases the risk of complications during and after surgery. Our Avrupamed BAAPS / BAPRAS surgeons strongly recommend that you stop smoking and using all nicotine products at least six weeks before your operation.
Will I need additional surgeries after my breast enlargement?
Further surgery may be required for a number of reasons. In most cases, it is needed following the development of a complication such as capsular contracture or implant rupture. Some patients also choose to have further surgery to change the size, shape or type of implant.
Who is not a suitable candidate for a breast enlargement?
A breast enlargement may not suitable for women who:
- Have an active infection
- Have active cancer or pre-cancer, and have not received adequate treatment
- Are pregnant or nursing
A breast enlargement may interfere with the treatment of the infection or cancer. It may also compromise the safety of the baby during pregnancy.
What effect will weight gain or loss have after my breast enlargement?
Major weight loss or weight gain may affect the look of your breasts. Drastic weight gain will result in a less noticeable size-effect of the implants; whilst drastic weight loss will make their effect more prominent. The effect of weight loss or gain will however, vary between individuals.
If you have any other questions that are not been listed under these breast enlargement FAQs, give us a call!