A breast augmentation is a surgical procedure that enlarges the breasts by the insertion of a silicone implant underneath either the breast or chest muscle.
Women undergo breast augmentation to enlarge the size of their breasts because they feel they are too small, have dropped or become empty - for instance after pregnancy, advancing age or weight loss. Implants can also be used to correct asymmetry or for reconstruction after breast cancer. Excessive sagging of the breast may require an uplift (mastopexy) by removing excess skin, which can be performed at the same time as a breast enlargement - if so, the procedure is called an augmentation mastopexy.
An alternative to the use of breast implants is fat grafting, in which fat is taken from one area of the body by liposuction and transferred to the breasts to provide a permanent, implant-free breast enlargement. However the amount of enlargement that can be achieved in one go is much less than can be achieved with a breast implant. Fat grafting can be repeated several times for larger size increases, and can be combined with breast implants - for instance to avoid a wide cleavage gap or to create very natural-looking results.
When using breast implants for cosmetic cases I exclusively use silicone implants. These have been used for breast augmentation for more than 30 years and have reliable long-term data.
Implant size, shape and projection are decided in the clinic through a four-step process: firstly, we run through an accurate history of your current and desired breast size, to estimate the approximate volume increase you need; next I take measurements of your breasts and chest wall, to assess what will actually fit your body; then using a 3D simulation we fine-tune the exact size and shape you most prefer; and finally, you wear external sizers over your breasts in a bra, to simulate the weight change you can expect and to see how your new breasts would look in your usual clothes. Most patients are very happy with their implant selection after running through this process.
I use a small incision either under the breast or around the nipple, depending on whether you would like a nipple reduction or small nipple lift at the same time. Most of my patients request a very natural look, which often entails placing the implant beneath the muscle using the "dual plane" technique.
I am fastidious about antimicrobial precautions - not just to avoid infection, but to reduce the chance of capsule formation many years later. Precautions include covering your nipples during surgery, washing the implant cavity with antibacterial solution, opening the implants immediately before they are needed, using fresh gloves to handle them and inserting them through a sterile funnel.
The sutures used to close the wound are placed under the skin and dissolve - you will never see them, so you don't need to worry about your one week postoperative check.
Before embarking on cosmetic surgery always do your research and find a reliable surgeon with a good local reputation. Developing a rapport with your surgeon is essential. A consultation usually takes at least half an hour and it should be with the surgeon rather than a nurse or patient coordinator. I like to meet twice before surgery so you can ask all the questions you've thought of between meetings. If necessary I would prefer to meet more than twice before surgery than for you to have unanswered questions going into the operation.
After the surgery you will be asked to wear a post-surgical bra to support and protect your breasts, and will be given postoperative exercises to start on the day of surgery. In this way, many patients report not needing paracetamol after a few days. You should be able to return to work after one or two weeks depending on the nature of your job.
Anaesthetic: General Anaesthetic
Hospital stay: 1 night
Surgery time: 1.5-2 hrs
Time off work: 1-2 weeks
Reasonably mobile: from Day 1
Washing: Shower after Day 2, bath after 2 weeks
Driving: 1-2 weeks
Exercise: 4-6 weeks
Bras & garments: Surgical bra for 4-6 weeks, non-underwired bra for 2 months.
Full recovery: 4-6 weeks
Smoking: we advise all patients to stop smoking for 2 weeks before and after any surgery
Analgesia (pain relief) - Ibuprofen and paracetamol
Surgical skin tapes should be left in place for the first week and replaced thereafter
The hospital or surgeon should be contacted if you develop a temperature, bleeding or rapid swelling
Wounds will be checked at 1 week, and I usually then see you at 1, 3 and 6 months.
Swelling reduces after a few weeks