Breast Augmentation Surgery
What Is Breast Enlargement?
Also referred to as a “boob job”, breast implants or breast augmentation, a breast enlargement is a surgical procedure by which the size of a woman’s breasts is increased, usually by insertion of implants. Around 30,000 breast enlargement procedures are carried out privately each year in the UK alone, making it the most common cosmetic procedure.
What Should You Consider Before Getting A Boob Job?
There are two main purposes for undergoing a breast enlargement procedure; reconstruction following a mastectomy (usually following breast cancer) or a cosmetic procedure to enhance the shape and size of a patient’s breasts. The latter is by far the most common and is in fact the most common cosmetic procedure performed in the UK.
The decision to have a breast enlargement should not be taken lightly, as it is a highly invasive procedure with significant risks and recovery time.
Furthermore a great deal of aftercare is needed, and implants do need to be replaced. A patient wishing to undergo a breast enlargement should therefore be fully aware of all the potential risks and complications and should speak thoroughly to their GP or private cosmetic surgeon beforehand.
Things to consider before opting for a breast enlargement include:
- The financial cost
- The potential risks
- The aftercare / upkeep needed
- Researching the clinics and surgeons available
Types Of Breast Enlargement
- Implants Artificial implants are inserted into your breasts to enlarge your bust. There are two types of implants:
Breast Augmentation Fat Transfer
Breast augmentation fat transfer is a procedure during which unwanted fat is removed from one area of the body (such as the thighs or stomach) and inserted into the breasts to increase their size.
What Happens During A Breast Enlargement?
Breast enlargement surgery is normally performed under general anaesthetic and lasts 60-90 minutes. During the procedure an initial incision is made next to your breasts, the exact positioning of this incision depends on the procedure being done and should be discussed with you by your surgeon prior to your procedure.
The implant will then be inserted through the incision and positioned between your breast tissue and your chest muscle, or even behind your chest muscle. The incision will then be closed and dressed. You are usually able to return home the same day or next day following your procedure where you should rest before resuming your normal activities within 4-6 weeks.
During a breast augmentation fat transfer, the area used for collection (usually your stomach or thighs) will be injected with a “tumescence” solution which reduces pain and bleeding. The area then undergoes liposuction and the collected fat is purified before being injected through a cannula into the natural small hollows within the upper portion of your breasts, resulting in their enlargement. As this procedure is performed under local anaesthetic you should be able to return home straight away, and will need minimum recovery, resuming normal activities within 1-2 weeks.
Watch Mr David Floyd, Consultant Plastic Surgeon at the Royal Free Hospital, explain what happens during a breast enlargement procedure:
"Breast augmentation is an operation that happens under general anesthetic. Usually patients will come into a hospital in the morning of surgery having had nothing to eat or drink the night before. They will meet the anesthetist who will discuss the anesthetic with them, they will have already had their preoperative assessment by the plastic surgeon nurse, usually, and then they’ll meet their breast surgeon who will come in and deal with the consent form, draw some lines on them potentially, and have a brief discussion about exactly what you expect to get out of the surgery and what type of implants might be used.
The patient is then taken to the operating theater, put to sleep, and on the operating table to begin with we prepare the patient by cleaning the skin, then draping them so we creating a sterile field, and then we mark where we are going to make the incisions, and with a scalpel we make a cut through the skin, usually in the crease beneath the breast, but there are other areas we can use also.
Through that small hole which is usually 4.5 centimeters long, a pocket is dissected either under the breast itself or under the pectoris muscle that we can put the implant in. The pocket is adjusted to get it to the right size, the bleeding is stopped, we carry a washout, and then implant is prepared and inserted into the pocket, spread out, and orientated in the right direction.
There’s quite an art to getting the implant in the right place so it sits with respect to the nipple in the right place so when the patient is all healed up the breast shape looks good, the volume is behind the nipple not too high, not too low, and the fold beneath the breast sits in the right place where the scar is. There’s a bit of adjustment on the table, and we’ll sometimes sit the patient up during the operation so that we can see the effect of gravity to make sure that both sides are the same, everything is matched.
Some surgeons will then use a drain, which will be a tube that comes out through the armpit, it will drain off any extra fluid that builds up overnight, and then the wound is sutured up. The patient then goes back to the ward with some tapes and strapping on, and is looked after overnight before being discharged home the next day."
Mr David Floyd, Consultant Plastic Surgeon at the Royal Free Hospital
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Recovering From A Breast Enlargement
Recovery depends on the procedure undertaken and any complications that arise during the procedure. Following a straightforward implant insertion you should be able to return home the same or next day, and should minimise the use of your arms and chest, as this may cause irritation or bleeding. You will be able to resume your normal activities within 4-6 weeks. In the longer term, most breast implants have a natural life expectancy of 10-15 years, after which they will need to be replaced in another implant procedure.
Following a breast augmentation fat transfer you should be able to return home immediately and will be able to resume normal activities within 1-2 weeks.
Watch Mr David Floyd, Consultant Plastic Surgeon at the Royal Free Hospital, describe a typical recovery from a breast surgery procedure:
"Usually the patient will go home the day after surgery. In my practice we’ll take the drains out the next day and the patient will be discharged home. I expect the patient to be quite slowed down that week, I usually recommend a full week off, a week to ten days and that will be spending most of the time at home lying on the sofa, watching TV, reading magazines but not really running around too much.
What I want is the breast to sit gently, supported by the tapes and the dressings so that the implant settles in, you get no additional bruising or swelling and it allows everything to heal up nicely. We then usually see the patient at one week which is to check the wounds and make sure they’re okay and they have no issues. Some patients get bruising and swelling in the breast that occasionally required intervention to deal with it, and we like to see patients at a week to make sure that hasn’t happened.
At one week I then put patients into a sports bra which they wear day and night for six weeks, no physical sport, no vigorous activity, and they take it gently for those six weeks. But you can usually return to work, start driving a car at a week or two weeks. I then see patients at the six week time point when we stop wearing the support bra; they can then go into normal underwear, return to the gym, back to normal activities. I then review patients at three months and six months and if all is well I usually discharge them at that point.
Things can happen right through that whole timeframe, so there are a range of issues that you can encounter that we like to see patients to ensure all is well. Because actually you have to remember, a patient hasn’t done this before so it’s all new to them, whereas I do it every week, so they don’t know what’s normal and what’s not normal. I think it’s important that you’re there for patients so you can actually reassure them, don’t worry that’s fine, that’s how it’s meant to look, this is normal for now, or when there are things going wrong you pick it up quickly and you can deal with it."
Mr David Floyd, Consultant Plastic Surgeon at the Royal Free Hospital
How Much Does A Breast Enlargement Cost?
Breast enlargement prices vary depending on the exact procedure and clinic used.
Breast implant procedures typically cost around £3,845-£5,000, whereas breast augmentation fat transfer costs from £3,000-£8,000.
Most clinics offer finance packages to make the procedure more affordable, with most even offering interest free credit.
Potential Complications of Breast Enlargement
As with any invasive surgical procedure, breast enlargement surgery comes with some general risks, such as:
- An adverse reaction to the general anaesthetic
- Post-operative infection
- Blood clots
- Excessive bleeding
There are also a number of risks specific to breast enlargement, such as:
- Scarring: All implant surgery will result in scarring from the surgical incision, but in most cases this is relatively mild and will fade over time
- Rupture: the implant may split open, leaking out its contents. If this occurs it is recommended that the implant be removed or replaced
- Capsular contracture: An unavoidable side-effect of breast implant surgery, capsular contracture occurs when your body creates a capsule of fibrous scar tissue around the implant which over time begins to shrink. This may result in pain and discomfort or the breast feeling hard
- Creasing and folds: Especially common with saline implants and with women with small breasts before surgery, you may find that your breasts appear creased or folded
- Siliconomas: If a silicone implant ruptures, the silicone can spread into the your breast tissue causing small painful lumps called siliconomas
- Breastfeeding issues: Although uncommon, some women have difficulty breastfeeding and you may produce less milk following an enlargement procedure
- Cancer: There is evidence to suggest that having breast implants increases your risk of some cancers, in addition to altering mammogram results
- Altered nipple sensation: Some patients experience reduced or increased nipple sensitivity following breast enlargement
In the longer term, implants are at risk of rupture. If silicone implants rupture they may spread outside of the scar tissue within your breast and lead to small, painful lumps called siliconomas. If a saline implant ruptures, the fluid will just be reabsorbed by your body and the breast will return to its natural size. Saline implants also have a higher risk of wrinkling or folding leading to breast distortion.
Breast augmentation fat transfer is generally less invasive and thus avoids the complications and risks of general anaesthetic. However, it does incur the standard risks of liposuction including scarring, bruising and saggy skin.