What is implant breast augmentation?
Implant breast augmentation is a surgical procedure to increase the size and/or improve the shape of the breasts. It can also balance any differences in size between the breasts.
What does the surgery involve?
Surgical placement of breast implants includes a number of incision and placement options.
The breast implants can be inserted through an incision made in the crease underneath the breast (most common), around the lower edge of the nipple or in the armpit. They are placed either in front or behind the chest muscles, or a combination of the two.
Breast implants alone cannot lift low or significantly sagging breasts, which can occur after weight loss or pregnancy. If there is too much sag (ptosis), please see mastopexy leaflet.
The procedure is most commonly performed under a general anaesthetic (you will be fully unconscious during the procedure).
You will feel stiff and sore for a few days. Expect the most discomfort to be within the first 72 hours. Usually, only simple pain killers are required.
The procedure takes about an hour to perform. You are likely to stay in hospital for one night, although on occasions, you may be able to go home the same day as your surgery.
What types of implants are there?
Breast implants are available in a variety of types, with different shapes and sizes. Some are round and some are more of a teardrop shape. Most implants are made of an outer casing of silicone or polyurethane and filled with a silicone gel.
Selection of the correct size and shape of implant will be done with you at your first appointment. It is important that you take your time in deciding what shape and size of implant you would like. Your surgeon will help guide you with this decision.
How long do breast implants last?
Implants are designed to last for a lifetime and do not need replacing after a fixed period of time. However, they may still need to be changed at a later date if there is a problem.
Most breast implants used carry a lifetime guarantee from the manufacturer. Should the implants require replacement in future years, this guarantee covers the cost of the implants but does not include the cost of the surgery.
What are the risks and side effects of surgery?
Having cosmetic surgery can be a very positive experience. Complications are infrequent and usually minor. However no surgery is without risk and you should be aware of any possible problems.
The greatest risk with implants is that the breast may feel harder than normal. The body always forms scar tissue around any foreign object and breast implants are no exception. Following breast augmentation, the body makes a capsule of scar tissue around the implant. Sometimes this tissue can shrink and contract (capsular contracture). If this happens it can make the breasts feel abnormally hard and look more rounded. About five to ten percent of people will develop some degree of hardening. Further surgery can be done to correct this problem.
Infection of implants is rare, as is bleeding around the implant. On the rare occasion where infection occurs, the breast implant may have to be removed to allow this to settle. The implant can be replaced once the infection has settled.
Rarely tear drop shaped implants can rotate or shift position after surgery.
Sensation changes to the breast and nipple, such as numbness, reduced sensation or tender oversensitivity can occur. This is usually temporary, but occasionally, these changes can remain to some degree.
Rarely red, raised and lumpy scars can occur which may take some months to improve.
Implant rippling or wrinkling can occur. It can be more of a problem in very slim people or those who have very little breast tissue. However, the chances are reduced if the implant is placed behind the chest muscles. In addition to this an overfilled implant can reduce wrinkling in slim people.
Very rarely the implants can weaken over time and rupture. You therefore need to consider whether you are prepared for possible future surgery and the expense that goes with that.
There are general risks associated with all operations. Very occasionally a blood clot can form in the leg (deep vein thrombosis or DVT) which would require medical treatment. Part of these clots can also break off and move up to the lungs, causing acute shortness of breath and pain in the chest. This is known as a pulmonary embolus (P.E). Developing a chest infection is uncommon but more likely to happen to people who smoke.
There is no evidence linking silicone or saline filled implants to any form of disease. Breast augmentation does not increase the risks of breast cancer. You will still be able to examine your breasts with the implants in place. Mammography is still possible after breast enlargement but special views are required and you should tell the radiology staff that you have had surgery.
Some people worry that a breast augmentation will affect their ability to breast-feed. This is unlikely. If breast-feeding is important to you, be sure to discuss this with your surgeon.
All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss these with your surgeon. Decisions about cosmetic surgery should never be rushed.
How do I prepare for surgery?
You will be asked to purchase at least two supportive bras before your surgery. Sports bras that open at the front are easier to put on and take off after your operation.
If you smoke, you should consider giving up at least six weeks before your operation. The longer you can give up beforehand, the better. Smoking reduces the amount of oxygen in the blood and increases the risk of healing problems after your operation.
Following your consultation, if you decide to proceed with an operation, a range of dates will be offered to you. You may be invited to attend the hospital for a pre-operative assessment with a nurse. Depending on your age and general health, routine blood tests and a heart tracing (ECG) may be taken. You will be given the opportunity to ask any questions you may have or raise any concerns.
You will be admitted to the hospital on the day of your operation. If you are having a general anaesthetic, you will be asked not to eat anything six hours before surgery. Black tea/coffee or non-fizzy drinks (nothing containing milk) can be taken up to two hours before surgery. Chewing gum should also be avoided six hours before your operation.
It is important to inform your surgeon, anaesthetist and nurse of any medicines (self or GP prescribed) or recreational drugs you take. Medicines containing aspirin should be avoided for two weeks before the operation since they increase the risk of bleeding during surgery. If there are any other medications that may affect surgery then this will be discussed with you at your first appointment.
You will not be able to drive yourself home from hospital and ideally, you should have someone to stay with you for a few days to lend a hand.
What happens after the operation?
Expect to feel drowsy after the operation – you will wake up and doze off for the remainder of the day. You may feel quite heavy and sore around your chest. Pain killing drugs will be given to minimise this.
You may have small thin tubes, called drains, placed in your incisions to drain away any blood or body fluid. If required, these drains are usually removed the day after surgery.
Initially your breasts may seem larger than you expected. This is normal and it will take some months for the post operative swelling to reduce and for your implants to settle into position
Before you leave the hospital, you will be given a follow up appointment to see either the surgeon and/or nurse. This is in order to change any dressings and/or remove any stitches. You will also be given full details of your implants. These include the manufacturer, style, catalogue and batch/ lot number. You should keep this information in a safe place.
What is the estimated time for recovery, absence from work and return to usual activities?
Recovery times vary from one person to another so use the times given below as a guide only. If you have any concerns during this period, do contact the hospital team for some advice.
When you get home, you should take things easy for the first week or so. You should however, get up and walk around every hour or so to prevent complications. Aggressive arm movements must be avoided, as should any strenuous exercise, for six weeks after your operation. A good rule is if it hurts; don’t do it. You should wear your support / sports bra (not an under wired one) day and night for four to six weeks.
Breast augmentation post surgery timeline
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Days 1 to 4
Sleep upright in bed supported by pillows to help reduce swelling.
Wear support bra.
Take things easy when you get home.
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5 - 14 days
Gradually increase your activity but nothing too strenuous.
Driving may be commenced only when comfortable.
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2 weeks
Bruising and swelling continue to go down.
Can return to work a week or two after surgery.
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4 weeks
Gentle exercise can start after four weeks but avoid strenuous exercise for a further two weeks.
Appearance of breasts continues to improve.
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6 - 9 months
Scars will begin to soften and fade.
Can start to judge the result.