Breast enlargement (implants)
Having a breast enlargement is a major decision. It can be expensive, the results aren't guaranteed, and there are risks to weigh up.
It involves inserting breast implants to increase the size of the breasts, change their shape, or make them more even.
But before you go ahead, be absolutely sure about why you want them. Take time to reflect on your decision. It may help to discuss it with your GP first.
How much does it cost?
In the UK, breast implant surgery costs between £3,500–£7,000, plus the cost of any consultations or follow-up care that may not be included in the price.
If there is a problem with the implant and it has to be removed, you'll usually need to pay for any replacement and further surgery yourself.
Where do I go?
If you're looking in England, check the Care Quality Commission (CQC) website for treatment centres that can perform the operation.
All independent clinics and hospitals that provide cosmetic surgery in England must be registered with the CQC. The CQC publishes inspection reports and performance ratings to help people choose care.
Also, research the surgeon who is going to fit your breast implants. All doctors must, as a minimum, be registered with the General Medical Council (GMC). Check the register to see the doctor's fitness to practise history.
You may also want to find out:
- how many operations they've performed where there have been complications
- what sort of follow-up you should expect if things go wrong
- their own patient satisfaction rates
What does it involve?
Breast implant surgery is carried out under general anaesthetic.
The operation involves:
- making a cut (incision) in the skin next to or below the breast
- positioning the implant – either between your breast tissue and chest muscle, or behind your chest muscle
- stitching the incision and covering it with a dressing
The operation takes between 60 and 90 minutes.
You may be able to go home the same day, but may need to stay in hospital overnight if the operation was scheduled late in the day.
Pain relief is provided if you experience any discomfort afterwards.
Choosing your implants
The type of implants most commonly used in the UK are silicone gel, but saline implants are also available.
Your surgeon should discuss with you what shape and type of implant is best for you, but below is a rough guide.
Silicone gel implants
These are filled with either soft or firm silicone gel. Implants filled with the firmer gel are called cohesive gel implants. Some have a polyurethane coating.
Pros: Generally less likely to wrinkle than saline implants. The soft type can give a natural feel. Polyurethane-coated ones are claimed to reduce the risk of capsular contracture and the implant rotating – see What could go wrong.
Cons: If a soft gel implant ruptures, silicone could spread into your breast and cause siliconomas. This is much less of an issue if cohesive implants are used, but this firmer gel may not feel as natural. Polyurethane-coated ones may cause a temporary skin reaction.
Saline solution implants
Pros: If the implant were to rupture, the saline solution would be safely absorbed or passed out of your body.
Cons: More likely to rupture or deflate earlier than silicone, as they tend to slowly deflate over time. More prone to wrinkling or folding. May feel less natural than soft silicone.
Where to place them
The implants can either be placed between the breast and the chest muscle or behind the muscle. You'll need to decide with your surgeon where is best for you, but here's a rough guide.
Between the breast and the muscle:
- most natural location
- less discomfort immediately after the operation
- chest muscle is not damaged
Under the muscle:
- extra tissue coverage
- less risk of rippling and capsular contracture – see What could go wrong
How long do breast implants last?
Breast implants will not last a lifetime. They are likely to need replacing at some point.
Some women may need further surgery after about 10 years, either because of problems with the implants or because their breasts have changed around the implants.
Recovery
It can take a few weeks to fully recover from breast implant surgery. You may need to take a week or two off work and shouldn't drive for at least one week.
Some surgeons recommend wearing a sports bra 24 hours a day for up to three months after breast surgery.
You'd need to avoid heavy lifting or strenuous exercise for at least a month, and keep your breast scars out of direct sunlight for about a year.
After a week or two: Stitches would be removed (unless you had dissolvable stitches).
Within six weeks: You'd usually be able to return to most of your normal activities.
After a few months: Your breasts would usually start to look and feel more natural. You may be able to stop wearing your sports bra.
Side effects to expect
It's fairly common after breast implant surgery to have:
- temporary pain, swelling and bruising
- a tight feeling in your chest for a few weeks
What could go wrong
Breast implants can occasionally result in problems, including:
- thick, obvious scarring
- the breast tissue feeling hard because scar tissue has shrunk around the implant (capsular contracture)
- a ruptured implant – this may cause small tender lumps (siliconomas) only detectable on breast scans, and the implant will need to be removed
- creases or folds in the implant
- the implant rotating within the breast, which may lead to an abnormal shape
- 'rippling' of the implant – this occurs when the implant is covered by only a thin layer of tissue, which sticks to the implant surface and is very difficult to treat
- nerve problems in the nipples – they may become more sensitive, less sensitive, or completely desensitised; this can be temporary or permanent
- not being able to breastfeed or producing slightly less breast milk than you would without implants – your baby won't be harmed if you breastfeed with implants
Also, any type of operation carries a small risk of:
- excessive bleeding
- infection – this is rare, but may mean the implant needs to be removed
- an allergic reaction to the anaesthetic
- a blood clot forming in the deep veins
You should also be aware of a possible link between breast implants and a rare type of immune system cell cancer called anaplastic large cell lymphoma (ALCL).
ALCL has been reported in a very small number of women who have had breast implants. So far, it has only been found in scar tissue that develops around breast implants.
The surgeon should explain how likely all these risks and complications are, and how they would be treated if they occurred.
Occasionally, people find the desired effect wasn't achieved and feel they need another operation.
Mammograms after implants
Mammograms for breast cancer screening are less accurate if you have implants, so it's important you tell the radiographer about them.
It's safe to have mammograms and they do not cause implants to rupture. They may reveal an implant that has ruptured.
What to do if you have problems
Cosmetic surgery can sometimes go wrong and the results may not be what you expected.
You should contact the clinic where the operation was carried out as soon as possible if you have severe pain or any unexpected symptoms, such as redness of your breast skin, a burning sensation or unusual swelling.
If you experience a problem with your breast implants, you can report this through the government's Yellow Card Scheme. By reporting any issues, you are helping to provide more information on the safety of the implants.
If you are not happy with the results or think the procedure wasn't carried out properly, you should take up the matter with your surgeon through the hospital or clinic where you were treated.
If you have concerns about your care, you should contact the CQC. If necessary, you can make a complaint about a doctor to the General Medical Council (GMC).
Breast implant registry
From 10 October 2016, everyone who has a breast enlargement operation in England will be able to have their breast implants recorded on a national registry.
This measure has been introduced following the 2010 PIP implant scandal, when many women were unable to find out whether they had been given the faulty implants.
This registry is designed to capture all breast implant surgery carried out both privately and by the NHS, so patients can be easily traced if implants ever need to be recalled and removed. Talk to your surgeon if you want data about your implants to be stored.
Find out more about the registry.