Breast Enlargement Fact Sheet

This factsheet is for women who are considering having an operation to enlarge their breasts.

A breast enlargement (also known as breast augmentation) operation usually involves placing an artificial implant either under your breast tissue, or under your chest muscle behind your breast.

The reasons why you may choose to enlarge your breasts include:

* feeling that your breasts are too small
* loss of breast volume after pregnancy (although enlargement will not lift them)1
* a difference in size between your two breasts
* reduced breast size after losing weight

Breast enlargement surgery may also be offered if you are having surgery for breast cancer or other conditions that may affect the size and shape of your breasts.

Your breast implant will be made of an outer layer of firm, elastic silicone, but may be filled with silicone gel or salt water (saline). Your surgeon will discuss the various options with you.

Breast implants leak in around 10 percent of women and this usually starts six or more months after surgery. The breast implant often has to be removed.

The contents of the implant can either leak slowly through the coating, or suddenly if the implant breaks open. This can lead to pain and an abnormally hard feel to the implant in the breast.

The body naturally forms a fibrous capsule around the implant, which helps to contain the contents of the implant. The newer designs of breast implants have features to reduce the likelihood of the implant leaking or breaking.

There have been concerns that leaking breast implants may be linked to serious health problems such as cancer but there is no conclusive evidence to support this.

Having breast implants does not usually interfere with breastfeeding, and there is no evidence that silicone is found in breast milk. But, it is important to tell your surgeon before your operation that you plan to breastfeed because this can affect the decision about where to make the cuts for your operation.

Breast implants interfere with mammography, a low-dose X-ray of the breast tissue used to detect cancer. You should let the radiographer or nurse know that you have implants as special X-ray views can be taken to minimise this interference.

Breast implants generally last for at least 10 years. Eventually some of the advantages of the enlargement surgery will be lost and you may need further surgery.

It is important to discuss with your surgeon what you are hoping to gain from the operation and the result you can realistically expect.

Your surgeon will discuss how to prepare for your operation. For example, you may be asked to stop smoking before surgery. Smoking increases the risk of chest infection, deep vein thrombosis (DVT) and slows the healing of wounds.

Before surgery you will talk to your surgeon about the operation and you will be asked 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. He or she may also draw on your breasts to mark the operation site.

Your surgeon may want you to have a mammogram taken. He or she may also suggest that you have a photograph taken of your breasts before the operation so that the results of surgery can be compared with your original appearance.

If you are having a general anaesthetic, 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

Breast enlargement usually takes between one and two hours and is done under general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain. Usually it requires an overnight stay in hospital, but occasionally may be done as a day-case, which means you can have the operation and go home the same day.

Your surgeon will make some cuts, the exact position of which 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, or pocket, for the implant. The pocket will probably be beneath your breast or under your chest muscle.

The cut will be closed with stitches. If these are not dissolvable, they will be removed about a week after surgery. Bandages or dressings will be applied over the operation area.

You will be given painkillers to help relieve any discomfort as the anaesthetic wears off.

Before you go home your nurse will give you advice about caring for your breasts, hygiene and bathing. He or she will also give you advice about wearing a special supportive bra in the days after the operation.

Once home, you can take more painkillers if you need to, as advised by your nurse or surgeon.

There are some important things to remember while recovering from a breast enlargement:

* don't shower for four to seven days after the operation
* don't lift heavy objects
* don't do any strenuous activity for the first two to three weeks after the operation as advised by your surgeon - if the implant is placed under the muscle, activity may be restricted for longer

It's important not to rush into the decision to have any cosmetic operation. And it's sensible to discuss the options with your GP, who may be able to recommend reputable surgeons or give advice about how to choose which hospitals to be treated in.

Breast enlargement is a commonly performed and generally safe operation. For most women who want the operation, the benefits in terms of improved appearance outweigh the risks. However, if you are deciding whether or not to have this procedure you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but usually temporary effects of a successful procedure. An example is feeling sick after the general anaesthetic.

Anyone having a breast enlargement can also expect:

* pain, swelling, tenderness and bruising for at least a few days
* a burning sensation in the nipples for a few weeks, but this should go away as you heal

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anaesthetic.

Specific complications of breast enlargement include those listed below.

* There may be a difference in size between the two breasts, possibly caused by natural differences that are highlighted by the surgery.
* You may get an infection in the breast. If this happens, the implant may need to be temporarily removed to allow the infection to be completely treated.
* Abnormal scar tissue can form around the pocket in which the implant sits. This may squeeze the implant and cause firm, painful breasts. This is known as capsular contracture. If the breast goes hard, further surgery may be required.
* There is usually a temporary difference in skin and nipple sensation following breast enlargement but this can be permanent.
* Fluid can build up around the implant. This is called a seroma and may require further surgery to remove.