Breast augmentation is one of the most commonly performed plastic surgery operations. It is one where excellent results are achieved by careful attention to detail and meticulous pre-operative planning. In addition to simply enlarging the breasts, this procedure may also help improve mild drooping after pregnancy or weight loss. It can also be used to balance differences in size between the two breasts, whether this is due to a congenital difference, or following previous surgery (e.g. lumpectomy or mastectomy).
BREAST AUGMENTATION/ BREAST ENLARGEMENT/ BREAST IMPLANTS/ “BOOB JOB”
Type of anaesthetic
Length of surgery
Nights in hospital
In fold under breast (inframammary)
1-2 weeks off work
4 weeks gentle exercise
6 weeks strenuous exercise
2 weeks (dressing clinic)
Annual check-up for life
When I perform a breast enlargement procedure, my aim is to produce natural-appearing breasts that look good clothed and unclothed, and that are in proportion with the patient’s build. I always meet with my patients at least twice prior to surgery, as I see the planning of the procedure as a collaborative process in which we get to know one another and formulate a very clear plan as to the desired (and achievable) results.
The enlargement procedure involves placement of a breast implant in a pocket either behind the breast tissue, or behind the pectoralis muscle. I use both round and anatomical (‘tear drop’) implants. The choice of pocket and implant depends on your build, your existing breast tissue, your levels of physical activity, and your desired result (in terms of breast size and shape), and will discussed with you at the time of your consultation. Generally, I prefer to use the “dual plane” technique, which places the implant partially under the muscle. I feel this offers the best solution for a natural, durable result. In almost all cases, the implants are inserted via a scar that lies in the crease where the breast meets the chest wall. These scars usually fade well over time and are very acceptable to patients.
Expectations and Complications
The popularity of breast augmentation is testimony to the high satisfaction rates with the procedure. This satisfaction is greatest when the patient’s expectations prior to surgery are realistic and achievable. This is why I place such an emphasis on the pre-operative consultation process. Implants alone may be insufficient to correct moderate-to-severe drooping of the breast, or to correct the shape of the breast: in this case an augmentation mastopexy (implants combined with an uplift) may be necessary.
While silicone gel breast implants are generally considered to be very safe, with dated reports of links to arthritis and connective tissue disease now discredited, they are not without risks. It is impossible not to mention the PIP scandal, in which thousands of women were implanted with sub-standard implants. During the course of my fellowship training, I met and operated on many of these patients, as well as conducting extensive research into the outcomes of their surgery. This experience underlined to me the importance of selecting the highest-quality implants, with a proven track record, and I take my responsibility in this regard very seriously. Following surgery, my patients are given precise details of the implants they have received, as well as the assurance that I, and the hospital, maintain a permanent database of every implant used.
More recently, concerns have arisen around two distinct entities, and it is important to distinguish between the two. The first issue is that of breast-implant associated anaplastic large cell lymphoma (BIA-ALCL), a rare form of blood cancer, seen in women with breast implants in place. The great majority of cases have been reported in women with textured breast implants (texturing refers to a deliberate roughening of the outer surface of the implant, which is done to reduce the risk of capsular contracture formation). Since 2017, I have used only smooth-walled breast implants, which do not seem to have the same association with ALCL. Our understanding of this condition is evolving all the time, and you will be provided with the most current information at the time of your consultation.
The second concern, which has received more attention of late, is the concept of breast implant illness. Auto-immune diseases (such Sjögren’s syndrome, chronic fatigue and rheumatoid arthritis) have also been investigated in relation to breast implants. These symptoms have been called ASIA syndrome or breast implant illness (BII). There is no conclusive evidence of a causal link and more research is needed to assess any potential link between Auto Immune/Inflammatory Syndrome Induced by Adjuvants (ASIA syndrome) and breast implants; one of several names for this potential Breast Implant illness. There is no question that there is a small subset of women with whom breast implants do not agree, and some of whom report improvement in symptoms following removal of their implants. Unfortunately, there is no pre-operative test that we can do, in order to determine whether or not someone will be affected by such symptoms. This will also be discussed with you at the time of your consultation.
Potential complications of which it is important you are aware are the risk of capsular contracture, and the potential effects of implants on breast cancer detection. The body will form a scar around any foreign body, and in some cases, this scar may become hard and tight, forming a capsular contracture, which can be uncomfortable and unsightly, and may necessitate further surgery. Traditionally, the rate of significant capsular contracture is usually quoted as being approximately 6%, however, this rate may be lower with the most modern implants.
The presence of breast implants may impact the effectiveness of mammography, the x-ray test commonly used for breast cancer screening. It is important that you let the radiographer know that you have implants if you are having this test done, in order that they can take images from specific angles, taking into account the presence of the implants. Silicone breast implants do not increase a woman’s risk of developing breast cancer, however one recent study did show that women with implants may pick up on lumps at a later stage. For this reason, it is essential that self-examination is performed regularly, and that patients do not attribute any changes in their breast to their implants, but instead check with their surgeon or GP.
It is important for any woman contemplating breast implant surgery to consider the possibility that she may require further surgery in the future. The USA’s regulatory body (the FDA) estimates that 20% of women who have cosmetic breast surgery and 50% of women who undergo reconstructive surgery using implants, will require further surgery within 10 years of their original procedure. The potential cost and inconvenience of this surgery should be considered prior to undergoing the initial surgery.