Breast Enlargement

Pre-operatively, you will be seen by the pre-assessment team who will advise you if any changes to your medications are required before surgery. “Practice” sleeping on your back – If you’re a side/stomach sleeper, train yourself pre-surgery to avoid accidental strain post-op. Use a pregnancy pillow for support.

After surgery, there are lots of ways to invest in your recovery to optimise your surgery outcome. We have written an article with our advice in the Information Hub section which covers the strategies that we would recommend to you. You can read this here.

Unfortunately, we cannot guarantee specific postoperative cup sizes. During your consultation, cup sizes will be discussed but these are often inaccurate as they vary between bra manufacturers, and also many patients have never been formally measured. Cup size is often used during the consultation as a guide to how much change is desired, although no guarantee is given to achieve this exact amount, again because cups sizes are so variable.

Mr McLean has had experience with a wide range of implants. Some of the implant brands that he uses are Motiva (including Ergonomix implants), Nagor, Mentor and Polytech (including B-Lite implants). The choice and suitability of different implant types will be discussed at your consultation.

Certainly there has been a lot of media attention surrounding the use of silicone in breast implants, particularly following  the PIP implant scandal. Minute quantities of silicone can diffuse, or ‘bleed’, through the silicone casing of the implant and at present there is no evidence to suggest that silicone from breast implants causes disease, however, the long-term effects of silicone continue to be studied.

Breast implants do not increase the chances of getting breast cancer and women with breast implants who develop breast cancer have the same prognosis (overall outcome from the cancer) as women without implants. However, breast implants can potentially interfere with routine mammography by ‘hiding’ areas of breast tissue, making it difficult to interpret the results. When attending for mammography, inform the team that you have a breast implant and they can adapt their imaging to overcome this problem. Normally for patients undergoing cosmetic breast surgery we would recommend a mammogram for if you are aged over 40 or for those who have other risk factors, such as a family history of breast cancer.

A further consideration is a rare type of lymphoma associated with breast implants. This is known as Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), which is a type of cancer involving cells of the immune system. ALCL has generally been found within the capsule surrounding the implant. It is thought to occur at a rate of 1 in 18,000 cases of breast augmentation with textured implants per year, and hence is rare. It is also treatable with surgery alone in the majority of cases.

Another, much rarer type of cancer, BIA-SCC, a squamous cell carcinoma, has also been reported. It occurs in the capsules surrounding breast implants. To date there have been around 20 cases reported world-wide, and they occur in both smooth and textured implants, and present 11-40 years after the implant surgery. Patients may present with swelling, pain, redness or hardness. Furthermore, we may also discover new problems in the future.

The insertion of a breast implant does not routinely interrupt the ducts that connect the breast tissue to the nipple and breast feeding should therefore be unaffected. The present state of knowledge also shows that silicone does not affect breast milk and that it is quite safe to breast feed. If the nerve supply to the breast and nipple has been damaged, this may affect the ability of the milk to be produced although this is extremely rare.

After any breast augmentation, your body naturally forms a thin layer of scar tissue around the implant called a capsule. In most cases, this capsule remains soft and flexible – you won’t even notice it’s there. However, in some women (about 10% within the first five years), this scar tissue can thicken and tighten around the implant, causing the breast to feel firm, appear misshapen, or even become painful. This is called capsular contracture, and whilst it can develop at any time – even years after surgery – it can usually be corrected with a minor procedure to release the scar tissue and replace the implant if needed.

Why does it happen?

While the exact cause isn’t fully understood, research suggests that low-grade bacterial exposure(often from the skin or nipple ducts) may trigger an inflammatory response, leading to excessive scar tissue formation. Even tiny amounts of bacteria can form a “biofilm” on the implant’s surface, which may contribute to tightening over time.

 How do we reduce the risk?

Placing the implant under the muscle, rather than under the breast tissue alone, seems to reduce the chances of capsular contracture. However, this is likely to be due to the muscle coverage making a mild capsule less obvious, rather than a true reduction in capsular contracture. Polyurethane texturing also reduces the ability of the tissue to tighten around the implant.

Mr McLean uses advanced surgical strategies to minimise the chances of capsular contracture, including:

• Nipple shields– sterile coverings prevent bacteria from the nipple ducts from contacting the implant.
• No-touch implant delivery– this avoids skin contact with the implant.
• Antibacterial wash– the implant is rinsed with an antiseptic to further reduce infection risk.

While no method can completely eliminate the risk, these steps significantly improve long-term results. During your consultation, Mr McLean will discuss which techniques are best suited for your anatomy and goals.

Breast augmentation is a safe and commonly performed procedure, but like all surgeries, it carries some risks. The overall complication rate for routine breast augmentation is less than 10% and most of these are minor problems. While serious complications are rare, it is important to be fully informed before making your decision. Below are some possible risks and how they are managed.

• Scar – the incision will commonly be hidden in or beneath the crease under your breast (inframammary fold).
• Haematoma (bleeding)– a collection of blood around the implant may cause swelling and pain. Small haematomas resolve on their own, but large ones may need a second operation to remove the blood clot and stop bleeding.
• Seroma (fluid accumulation)– a small amount of fluid may collect around the implant post-surgery. Most resolve naturally, but symptomatic cases may require needle aspiration.
• Infection– some minor wound infections may require antibiotic treatment. Implant infection is rare but possible, in severe cases, temporary implant removal may be required.
• Capsular contracture– your body naturally forms a thin scar capsule around the implant. In some cases, this capsule tightens, making the breast feel firm or altering its shape. If severe, surgery may be needed to release the scar tissue or replace the implant.
• Changes in nipple sensation– temporary numbness or heightened sensitivity is common. For most women, sensation returns to normal, but in rare cases, changes may be permanent.
• Implant rupture– modern silicone implants are highly durable, but if rupture occurs, silicone can leak within the capsule (intra-capsular rupture) or outside the capsule (extra-capsular rupture). If this occurs, you may need revision surgery.
• Implant visibility or rippling– thinner breast tissue may make implants slightly palpable or visible, especially at the edges.
• Implant malposition or extrusion– rarely, an implant may shift or, in extreme cases, push through the skin (especially in smokers or with oversized implants).
• Breast asymmetry– minor natural asymmetry may persist post-surgery. Significant differences can be improved but not always fully corrected.
• BIA-ALCL (Breast Implant-Associated Lymphoma)– an extremely rare condition (1 in 18,000) linked to certain textured implants. The most commonly involved implants have been removed from the market. There is also a very rare risk of BIA-SCC (Breast Implant-Associated Squamous Cell Carcinoma) – this has been seen in around 20 cases worldwide, so is exceptionally rare.
• Long-term considerations– implants may need replacement due to aging, rupture, or changes in breast shape over time.

Mr McLean leads efforts to reduce complications and improve the safety of surgery by ‘stacking marginal gains’. This has resulted in excellent patient outcomes following surgery. Some implant brands that we use also come with a lifetime guarantee for the cost of your implant should you require replacement in the future.

Breast implants are not lifetime devices, whilst they do not have a “shelf life” – they may require changing in the future if they become symptomatic. On the whole, about 50% of patients will require some form of revision implant procedure over the course of 10 years. However, this is just a guide and some implants last much longer than others.

An implant may become visible with time as the overlying breast tissue becomes thinner with age and often the breast prostheses can be felt at the edges where there is less tissue coverage. With advancing age, the breast also tends to ptose or droop. This is usually corrected by a mastopexy (breast uplift) operation and not breast implants.

Whilst they can last twenty years or more, revision surgery, removal or replacement may be indicated at any time. The management of any of the complications described above may also involve removal. This will have a financial implication for you if revision surgery is required.

It is important that the implants are held in place firmly for the first few weeks after the surgery and a well-fitted surgical bra helps. At Enova Surgery, we have included a resource to assist you in selecting your postoperative bra. Please bring one of the bras to theatre with you so that it can be put on at the end of the operation whilst you are still asleep.

These bras need to be worn for six weeks following the surgery, both during the night for sleeping and during the day. You should then be fitted for your new regular underwear.

The Department of Health give advice on protecting patients who are considering cosmetic surgery.

Specific advice regarding breast augmentation and implants can be obtained from:

• Read more about Breast Englargement
• Breast Englargement Patient Leaflet
• Visit the The British Association of Aesthetic Plastic Surgeons website