Breast Enlargement

A surgical operation in which implants, usually silicone, are placed in a pocket behind the breast.
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Breast Enlargement
Breast Augmentation

20+ Years

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What is a breast enlargement (augmentation)?

Breast enlargement is an operation to make the breasts larger. It usually involves placing a silicone implant behind the breast or behind the breast and pectoral muscle. Most people will have a general anaesthetic (asleep).

Recovery varies from person to person but most people would take one to two weeks off office type work.

As with all surgery you should ensure you understand how implants will change your breasts and the potential risks.

Please see the FAQ section below for more details and information such as types of implant, over or under the muscle, size of implant, recovery, risks or complications, alternatives.

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Before & Afters

Summary – Breast Enlargement

A surgical operation in which implants, usually silicone, are placed in a pocket behind the breast.

Decisions – things to consider

Various decisions need to be made concerning implants. The type, the size or width, the shape, textured or smooth, silicone or saline and under or over the muscle. (A very popular choice would be round, textured, silicone implants of about 280ml size placed under the breast, unless you are very slim in which case under the muscle may give a more natural appearance.)

What's is involved in the Surgery?

The operation is carried out under general anaesthetic (asleep). Usually a day case (home same day) or stay one night in hospital. A 5cm (2 inch) incision is usually made in the fold under the breast. The operation typically takes 60 to 90 minutes.

Drains are not normally necessary. Stitches are dissolving, under the skin and do not need to be removed.

How long do most people need to recover?

Most people return to office work 7-14 days

Regular walking is recommended from day 1

Light physical work 3-4 weeks

High impact aerobics 6 weeks

What are the potential risks?

Complications within the breast may occur and you should make sure you understand them before deciding on surgery. Some of the most significant are infection, changed feeling in the breast and loss of feeling, asymmetry (the two sides are different), feeling or seeing the implant, ruptured implants, capsular contracture (going hard).

What result can I expect following surgery and in the future?

The majority of people are pleased with their larger breasts typically 2-3 cup sizes.

Breast enlargement with silicone implants is best considered non permanent. Most people can anticipate 10-15 years before their implants may need to be removed.  However implants can stay in for longer if they are not causing any problems.

Other things you may wish to think about

For some people with sagging breasts (ptosis), an uplift (mastopexy) may be a better option. There are additional scars with this procedure.

Mastopexy with implants: An uplift can be combined with breast implants although the complication rate is higher.

Frequently Asked Questions

A breast enlargement is a surgical operation in which an implant is placed behind the breast to increase the breast size or to improve the breast shape. The procedure is sometimes called a breast augmentation, an augmentation mammoplasty, a breast enhancement or colloquially a ‘boob job’.
There are two main groups of people who usually have breast enlargements. The first is women who have always wanted larger breasts and the second is women whose breasts have lost volume and shape either with age orfrequently following pregnancy and breast feeding. Breast implants are also helpful in treating people who have significant asymmetry. They are also used to reconstruct a breast after surgery.
You are admitted into hospital on the day of your operation. The time you come in varies on when your operation is scheduled. The operation is carried out under a general anaesthetic (asleep). The operation usually takes between one to one and a half hours. The stitches are absorbable (‘dissolving’) and are placed under the skin, so that you can not see them. A dressing is placed over the wounds at the end of the operation. Drain tubes are almost never necessary. You will be prescribed regular painkillers while you are in hospital and to take home. You are advised to wear a supportive (not wired) sports type bra for 4 weeks following surgery. You are offered a dressing check one week after surgery and you have a follow up consultation with your surgeon 4 weeks after the operation. If you are worried at any time after you have gone home you can phone the ward, phone the cosmetic nurse advisor or the consultant’s secretary for advice. If necessary you can return to the ward at any time for a check (please phone first).
An incision is made in the skin and a pocket developed under the breast tissue. An implant is then placed in the pocket. An alternative is to make the pocket under the pectoral muscle (see below). The skin is closed and the wound dressed.
The most usual place for the scar is under the breast either in or just above the natural fold under the breast. It is usually about 2 inches (5cm) long. Implants can be placed leaving a scar round the edge of the nipple and in the armpit but these are less frequently used.

The majority of implants are placed under the breast and on top of the pectoral muscle. If you are very slim and have little tissue thickness above the nipple there may be benefit in placing the implant under the pectoral muscle. This gives an extra layer of covering over the top of the implant and tends to make the implant less visible. As a guide you should measure the pinch thickness between the collarbone and the nipple. If this is less than 2cm then it would not normally be advisable to place the implant under the muscle. A further benefit of placing the implant under the muscle is that it makes it easier to do a mammogram. The main disadvantages of placing the implants under the muscle include it being a more painful operation with a slightly longer recovery. The implants will move when the muscle contracts which some people do not like.

Dual plane: some people refer to submuscular placement of the implants as ‘dual plane’ because the implant is under the muscle in its upper part and under the breast in the lower, so it is in 2 planes. However, this is a long standing approach which is usually called submuscular. When the term dual plane was introduced it described a new idea where the pocket and implant was placed under the muscle as a normal sub muscular implant. The plane between the breast and the muscle was then opened up so the breast could be lifted on the muscle. As this was a new concept it would seem reasonable to give its own name ie dual plane. (If dual plane confuses you do not worry it is not recommended for most patients).

Almost certainly not. In the past plastic drain tubes were placed from around the implant passing through the skin to a drainage bottle. This was to collect any excess blood or tissue fluid. For the majority of people this is unnecessary and it is most unusual for Mr Hurren to use drains for breast enlargement operations.
Everyone is different so the choice must be made for each person. In practice, round, textured, silicone implants of between 260ml and 340ml give a very pleasing result for the majority of patients. However, there are a number of alternatives and options you may wish to consider. Implants may be round or shaped (anatomical or tear drop). They may be silicone or saline. Implants may be smooth or textured on the surface and they can be of differing volumes.
The size of implants you choose will be influenced by many things. These include your build and breast shape and how large you wish your breasts to be. Furthermore you will be advised what can be achieved surgically or what is advisable. An experiment which may help you to consider what size you would like is to place water in a freezer bag (dry rice in a stocking foot is an alternative) and seal it carefully then place it in a supportive sports type bra. You can try this with different tops. The most frequently-used volume in breast augmentation is 280ml to 320ml. This will increase most people’s cup size by 2 to 3 sizes (i.e. A cup to C or D cup). Implants of less than 200ml would be very unusual and more than about 400ml is unusual. The largest standard implants are about 800ml. Larger implants are more likely to give you an ‘implanted’ appearance, more likely to cause the breast to droop over time and are more likely to lead to complications. Larger implants are likely to result in you needing further surgery in the future.
All implants are made with an outer shell of silicone elastomer. Implants vary in what is contained within the implant (the filling). Most implants used in the UK are filled with silicone gel. The main alternative is saline which is salty water. Saline filled implants tend to feel less natural. Saline implants are more likely to rupture and when they do they deflate very rapidly.
Most implants used in the UK are textured. Originally implants had a smooth surface. In the UK it is considered that textured implants have a lower rate of capsular contracture and so almost all surgeons recommend textured implants.
Round implants give a good result for most people. Round implants are often softer, can rotate without affecting the breast shape and give high satisfaction to most people who have them. Shaped implants may help to achieve a certain appearance for the breast. They can rotate leading to asymmetry and are more expensive.
The majority of people who have a breast enlargement procedure are pleased with the results. It is reasonable to expect your cup size to increase by two to three sizes (e.g. an A cup to a C or D) depending on the size of the implants. Many people feel more confident and feel able to dress more freely. If you are unlucky enough to experience complications, this may affect the end result and how you feel about the surgery. People who are unrealistic about what they are expecting from surgery may feel dissatisfied. Breast enlargement does not change you or how other people feel about you. You should not have a breast enlargement for someone else or because you think it will affect how they feel about you.
The scars are usually about 5cm long and lie in the fold under the breast or on the breast just above the fold. In most people these scars settle down very nicely as a thin pale line. As with any scar they can stay red or become lumpy (hypertrophic or keloid). It is most unusual for people to complain about the scar. Scars can also be placed at the edge of the areola (brown area surrounding the nipple) or in the armpit (axilla).

Most people go home the day after surgery, although a few go home on the day of surgery. Most people take 10-14 days off office-type work and return to driving a car at the same time. Some people find they need less than a week but this is unusual. By 4 to 6 weeks the majority of people are getting back to normal and returning to their normal activities. Individuals vary and if there have been complications, recovery may be delayed. The following reflects most patients experience:

Go home: usually next day (some can go home on day of operation).

Shower and bath: day after operation (dressings are waterproof).

Driving car: not for at least 48 hours. Most people wait 7-10 days.

Office work: varies, allow 10 days some people need less than a week.

Pick things up: as you feel comfortable, avoid straining to lift for at least 2 weeks.

Wear wired or ‘pretty’ bras: after you have had your follow up outpatient appointment (4 weeks).

Exercise gym: walking is good from day one. Rest for 2 weeks. Lighter lower body (eg power walking) 2-4 weeks. Build back to normal 4-6 weeks.

Swimming: 4-6 weeks.

Sex: as you feel able and comfortable. Squeezing or direct pressure on the breasts should be avoided for 6 weeks.

Flying in an aeroplane: usually not for 2 weeks.

Back to normal: most people feel back to normal after about 4-6 weeks.

The majority of Implants do not have a set life span and do not have a specified time when they need to be changed. Implants can last your life time although this can not be guaranteed. You must understand that implants may need to be removed or changed.

The safety of breast implants is an important question although different people will have different views on what is safe and what is a level of risk they are prepared to take. There are a number of potential issues with breast implants and silicone which I will cover.

Breast cancer and silicone implants

There is no good evidence that breast implants increase the risk of the usual common types of breast cancer. Breast implants may make screening mammograms more difficult. Usually, women between the ages of about 50 and 70 are offered screening mammograms in England every 3 years. Implants may make it more difficult to get all of the breast into the machine so some parts of the breast will not be seen on the mammogram. This means that a cancer in that part of the breast would not be found. If the cancer formed a lump you would still be able to feel it as the implant is behind the breast so a cancer of the breast would be in front of the implant. There are some rare cancers, such as ALCL, that have been associated with breast implants. (see below).

Certain rare cancers (e.g. ALCL) and silicone implants

Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA–ALCL often abbreviated to ALCL including in this information).ALCL is a rare cancerous condition of the white blood cells. It is a Non-Hodgkin’s lymphoma. Women with or considering breast implants need to be aware of ALCL. Although there had been earlier reports in 2011 the British and American regulatory authorities issued warnings about a possible link between a rare form of lymphoma and breast implants. It is currently thought that breast implants are responsible for causing ALCL. ALCL is usually diagnosed when fluid builds up around the implant causing the breast to swell up. ALCL can also form a lump in the breast. If detected early the best treatment is currently considered to be surgical removal of the implant with the surrounding capsule tissue by a complete capsulectomy. For most patients surgery will cure ALCL. However, some patients have been treated with chemotherapy and or radiotherapy. There have been deaths from ALCL. ALCL appears to be mainly a local problem around the breast and chest rather than a cancer that spreads (metastasises) to other parts of the body in the blood stream. The risk of ALCL is thought to be about 1 in 24,000 at 10 years. That is to say that if 24,000 women had breast implants after 10years it would be expected that one would develop ALCL. Data from Australia and the Netherlands has shown higher rates of ALCL. Higher rates of ALCL are probably caused by more textured implants and less textured or smooth implants have lower rates of ALCL.ALCL is an evolving subject with new evidence being published regularly. You should ensure that you have the latest evidence before making decisions in relation to ALCL.

In 2022 another even rarer cancer called Breast Implant Associated Squamous Cell Carcinoma(BIA-SCC)was reported as possibly being caused by breast implants .It is unclear if this rare form of cancer was caused by breast implants and this will be monitored and studied in the future. The risk of developing BIA SCC is lower than the risk for ALCL and much lower than for the usual types of breast cancer.

Breast implant illness or BII
Breast implant illness is usually abbreviated to BII. Breast implant illness is a group of symptoms that people attribute to their breast implants and silicone. It is a self-identified illness. That means that people diagnose themselves rather being given the diagnosis by a
doctor. Usually this is based on information they have found on the internet. There is no medical test for BII. Many of the symptoms relate to the hormonal, immunological and neurological systems. The commonest
symptoms are aching joints and muscles, fatigue and difficulties with concentration (brain fog). There are numerous other symptoms. Studying BII is complicated because many of these symptoms are common in people without implants.

When people with BII have their breast implants removed about half of them feel that their symptoms improve.

BII remains under investigation and more information will become available in the future.

Systemic harms from silicone breast implants.

Systemic harms refers to illnesses affecting the body. There has been concern for many years that silicone might be responsible for causing illnesses. In particular if silicone may cause diseases of the immune system such as autoimmune disease. Autoimmune disease is where the body’s immune system attacks the body itself rather than bacteria against which it is designed to protect you. There has been a long running debate as to whether silicone can cause autoimmune diseases like rheumatoid arthritis. Unfortunately autoimmune diseases are quite common in women with about 20% of women, that is one in five, suffering an autoimmune condition during their lifetime. It is not possible to prove whether silicone increases this risk or it does not. If silicone implants do cause this type of illness it is likely to be in small numbers compared with the number of people who develop these conditions without having implants.

As with all surgery there are potential risks. There are the risks of having a general anaesthetic and the risks that exist for any operation. There are also risks that need particular consideration with breast enlargement:

Bleeding and haematoma

Bleeding may occur after any operation. A build up of blood around the implant after the operation is called a haematoma. The great majority of patients do not have a haematoma. If you do have a haematoma it is usually advisable to re-operate to remove the haematoma. Although this usually means an extra night in hospital it does not normally delay recovery by a significant amount. You are not left without an implant.

Infection

Infection is a rare complication of breast augmentation. If an implant becomes infected it usually needs to be removed. Once the infection has settled an implant can again be placed behind the breast. This should normally be six months after the infection has fully settled.

Seroma

Fluid build up around an implant called a seroma is an unusual problem. The fluid is usually absorbed by the body.

Implant extrusion (‘rejection’)

If implants appear to be rejected it is usually due to infection (see above). Large implants or where the skin is thin may cause the skin to break down giving the impression of the body rejecting the implant. This is usually only a problem with very large implants. (True rejection is where the body’s immune system attacks something in the body such as a kidney transplant. This process does not occur with implants).

Asymmetry

Many women’s breasts are naturally asymmetrical. The chest wall may be a different shape on each side or the breasts themselves may have a different shape, position or volume. Sometimes the difference may be disguised by breast augmentation. Sometimes asymmetry may be more obvious after surgery.

Wrinkles, folds, knuckles irregularities

Breast implants are made in two parts, the outer shell and the inner filling. Sometimes the implant may lie such that folds or wrinkles form in the outer shell. These may then be felt through the skin or occasionally be visible. If a fold occurs near the edge of the implant then a prominence may be felt or seen. These are more likely if you are very thin or have very little breast tissue. The great majority of people do not have these problems.

Capsular contracture (‘implants going hard’)

Following breast enlargement with implants the body forms a layer of scar tissue around the implant. This has some advantages because if the outer shell of the implant breaks this capsule usually keeps the silicone with in the capsule and so it does not leak out. However, in some people the capsule starts to tighten and this makes the implants become round and feel hard. This is called a capsular contracture (‘implants going hard’). At worst they can become like ‘tennis balls’ and even be painful. Most capsular contractures form in the first year although less than 5% percent of patients are dissatisfied and seek further surgery at this stage. Capsular contractures may occur at any time following surgery. Capsule formation is reduced by using textured implants and may be reduced by placing the implant partly under the pectoral muscle (under the muscle). The presence of a capsular contracture does not necessarily require treatment. The main treatment for breast implant capsules involve surgery. A capsulotomy involves removing the implant and surgically dividing the capsule to release it.The implant can be replaced during the same operation. There tends to be a high rate of recurrence of the capsule following this procedure. A capsulectomy is more involved in that the capsule is removed with the implant rather than just split. The recurrence rate for capsules following capsulectomy is lower than for capsulotomy. If capsules recur further capsulectomies can be carried out but recurrence is common. It is important to appreciate that the cost of capsule surgery is similar or greater than for the original breast augment. For someone with a strong tendency to make capsules the choice may lie between living with capsules or having the implants removed. Closed capsulotomy is no longer recommended. This involved squeezing the breast until the capsule splits. Recurrence was common.

Rupture, gel bleed & silicone granuloma

Implants are very strong. You can stand on them and they do not break. However they are man made and over time the silicone gel that is with in the silicone elastomer shell may leak out. This is called ‘gel bleed’. For the most part the capsule around the implant keeps the silicone gel where it should be. However if significant amounts of gel leak out into the tissues you may develop a lump called a silicone granuloma. These usually require removal along with the implant although another implant can usually be put in at the same operation.

Loss of nipple sensation

Frequently the nipples are over sensitive following breast enlargement. This usually settles within 4-8 weeks. Sensation may also be reduced and the nipples may be numb. Numbness is usually temporary although recovery can take a number of weeks. Uncommonly the nipples can be permanently numb.

Tenderness and pain

Tender and painful breasts particularly before a menstrual period is experienced by many women. If you already experience breast tenderness or pain then implants may make it worse and this is something you must consider. Some women who have not had breast pain in the past find that they do have areas of tenderness or (rarely) pain following breast augmentation.

Deep vein thrombosis (DVT):

A breast augmentation is usually an operation carried out under general anaesthetic so there is a risk of a thrombosis (clot) in the deep veins of the legs (a DVT). A serious complication of a DVT occurs when a thrombus breaks off and travels to the lungs to cause what is called a pulmonary embolus (PE). A large pulmonary embolus can be life threatening. During your operation and time in hospital we will take measures to protect you from DVT formation, although these cannot guarantee complete protection. Once you go home the best prevention of DVTs and PEs is regular walking.

The combined oral contraceptive pill (the pill) increases the risk of DVT with surgery. If you are on one of these pills you should discuss this with your surgeon. If you stop the pill four to six weeks before your surgery then your risk returns to normal. If you stop the pill and you are having sexual intercourse then you must use alternative contraception otherwise you may become pregnant.

 

 

Mammograms after breast enlargement

In England women between the ages of 50 and 70 years (this may change to 47 to 73 years in the near future) are offered a screening mammogram every 3 years. This is to try and detect cancers at an early stage. Breast implants make it more difficult to do mammograms. In some women mammograms may become almost impossible. Usually you have to have your mammograms at the breast center rather than on a mobile van and extra views may need to be taken. There is a small risk of damage to the breast implants. If your implants are placed behind the pectoral muscle then mammography is easier than if they are behind the breast.

Pregnancy and breast feeding

There is no convincing evidence that breast implants cause any harm to unborn babies. Breast milk is the best for feeding small babies and there is no evidence that silicone implants cause any harm to breast feeding babies.

A good well fitting Bra and external prosthesis

A good bra will make the most of your natural breasts. Bras with additional filling will give the appearance of larger breasts. This approach does not involve surgery and is much cheaper.

Mechanical External Breast Suction Devices

Devices have been developed that are worn over the breasts and apply suction to the breasts. Modest levels of enlargement are possible with considerable time and effort.

Macrolane (no longer available in the UK)

Macrolane is a hyaluronic acid filler material that can be injected behind the breast to increase the size. The amount that can be injected is significantly smaller than a breast implant so it is best for people who have very small breasts or need a small increase in volume to the upper pole. It is very similar to the hyaluronic acid which is a normal part of your body. It tends to absorb over time so further treatments will be necessary to maintain the effect. Most people seek a top up after a year. One particular advantage is that it can be carried out under local anaesthetic.

Mastopexy or breast uplift

Mastopexy is an operation in which excess skin is removed from the breast so as to lift the breast. For some women with droopy breasts this is a better option than implants. Combining a mastopexy with implants is an operation with a significant complication rate. It may be better to have the uplift first and the implants 6 months later.

Fat injection, fat grafting or lipofilling

Fat injection is being more and more widely used. It involves taking fat from one part of the body and grafting it into the breast. This can fill out a defect in the breast or be used to increase the volume of the breast. It is a lengthy process and currently not widely recommended for routine breast enlargement.

Before & Afters

These photographs are all of patients who have undergone breast enlargement surgery with Jeremy Hurren. They have all given their written consent for the photographs to appear on Jeremy Hurren’s Website. It is important to appreciate that photographs of the results of cosmetic surgery should not be considered a ‘catalogue’ from which you can choose the appearance that you would like. Many factors determine the appearance following surgery and most of these can not be changed, such as the shape of your chest, the amount of breast tissue you have, the degree of breast droop and the elasticity (stretchiness) of your skin. However they may be helpful in discussions with your surgeon about your expectations and what may or may not be possible for you.

Please note: Mr Hurren will not discuss the details of the implants and surgery these patients have had except with patients who have seen him in clinic and are planning to undergo surgery themselves.

Sarah

Breast enlargement with 275 ml implant

Sophy

Breast enlargement with 300 ml implant

Rosie

Breast enlargement with 280 ml implant

Raya

Breast enlargement with 200 ml implant

Allison

Breast enlargement with 400 ml implant

Chloe

Breast enlargement with 320 ml implant

Ayla

Breast enlargement with 300 ml implant

Elicia

Breast enlargement with 320 ml implant

Tracey

Breast enlargement with 280 ml implant

Rhiannon

Breast enlargement with 240 ml implant

Mia

Breast enlargement with 410 ml implant

Cara

Breast enlargement with 340 ml implant

Amelia

Breast enlargement with 300 ml implant

Emma

Breast enlargement with 450 ml implant

Mel

Breast enlargement with 300 ml implant

Faith

Breast enlargement with 310 ml implant

Gina

Breast enlargement with 250 ml implant

Natalie

Breast enlargement with 320 ml implant
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See What Our Patients Say About Us

Read what our past and present customers have to say about their experience with Jeremy Hurren.

Thank you very much for doing such a good professional job with my reconstruction operation, also thank you for being so kind and supportive at this emotional time

Thank you for your professional skill and your personal care. You have achieved me regaining my confidence in myself and the way I look. I cannot thank you enough.

I just wanted to say thank you for all the kindness, help and consideration you have shown to me. You have always been a first class surgeon, consultant and someone I have the upmost respect and admiration for.

A big thank you for the way you treated me in your hospital, going above and beyond what you had to do and in such a kind and lovely way. I have never come away from an appointment feeling so looked after.

Thank you so much, now I look and feel great! The time you took at the first consultation explaining the nature of my problem was much appreciated.

I want to thank you for everything you have done for me. For the operation and all the aftercare you have given me. Your family must be so proud of you. You do an excellent job.

Thank you for the care you have given me over the last three years. You are a credit to your profession.

Just a quick note to say thank you for all your hard work and dedication you have put into my operation.

Just a note to once again thank you for having made a brilliant job of my “new breasts” they are lovely, although you only operated last week I already feel a completely different person.

I feel I have been given a new lease of life and I am really happy with all the different procedures you have performed.

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General Medical Council (GMC) register: Specialist Plastic Surgeon Number: 3243048 NHS Consultant. Plastic Surgeon. Surgical Cancer Specialist