Breast Augmentation

What the procedure is

Breast augmentation is an operation to increase volume or improve symmetry, performed either by placing an implant or by transferring the patient's own fat.

Two implant fill types are common: cohesive silicone gel and saline, each with different characteristics in feel and in behaviour if rupture occurs. Implants also differ in shape, between round and anatomical, and in surface type.

Autologous fat transfer gives a more limited increase in volume than an implant. It suits those seeking a modest change or improved symmetry and requires sufficient fat elsewhere on the body.

Augmentation does not treat breast droop. Where there is clear ptosis, an implant alone may add volume without raising position, and the addition of a breast lift is then discussed.

Who is a suitable candidate

• Women whose breast development is complete.
• Women in good general health without uncontrolled medical conditions.
• Women who are not pregnant or breastfeeding.
• Women with realistic expectations, who understand that implants are not lifetime devices and that further surgery at some point is a real possibility.
• Women who have had the screening appropriate to their age and family history, including mammography where indicated.

How it is performed

Performed under general anaesthesia, usually taking about one to two hours.

The incision may be in the fold beneath the breast, at the areolar border, or in the armpit; each position has its own implications for scarring and access.

The implant is placed either above the pectoral muscle, or partly or wholly beneath it, which affects feel and appearance and also the reading of mammograms.

For fat transfer, fat is harvested from a donor site, processed, and injected into the breast in layers.

Recovery

• Discharge is usually the same day or after one night.
• A supportive bra is advised for several weeks.
• Tightness and discomfort in the first days are expected, particularly with sub-muscular placement.
• Return to desk work is often within a week; weightlifting and upper-body exercise after about four to six weeks.
• The final shape usually takes three months or more to settle as swelling resolves and the implant position stabilises.

Scars

The operation leaves a permanent scar at the chosen incision site.

An inframammary incision sits in a natural shadow; an areolar incision sits at a colour boundary.

Scars improve gradually over months, and their final appearance differs between individuals.

Risks and complications

Every operation carries risk. This is an educational list, not an exhaustive one; the risks specific to your case are discussed during consultation.

• Risks of anaesthesia.
• Capsular contracture — scar tissue tightening around the implant — among the more common complications that may require further surgery, and which can cause firmness, distortion or pain.
• Implant rupture or leakage, which may be silent and detected only on imaging.
• Altered sensation in the nipple or breast skin, temporarily or permanently.
• Asymmetry, or rippling and visible implant edges beneath the skin, particularly where the overlying tissue is thin.
• Haematoma or infection; infection around an implant may require its temporary removal.
• Change in implant position over time.
• An effect on the reading of mammograms; the radiology department must be told an implant is present so additional views can be used.
• An effect on breastfeeding is possible, with likelihood varying by incision site and technique.
• Very rare conditions have been associated with certain textured implant types; these remain under ongoing review by regulators and are discussed when choosing an implant.

Combining with other procedures

Augmentation is sometimes combined with a lift where there is ptosis — an augmentation-mastopexy — which carries longer scars than augmentation alone. It is also sometimes performed alongside abdominoplasty as part of post-pregnancy surgery.

Common questions