Breast Enlargement (Augmentation) Surgery

Information Video Guide

We have created a free information video guide on breast enlargement surgery, which lasts over an hour and discusses the process from choosing a surgeon, to the best implant for you, the operation itself and your recovery as well as the final results. This video guide can be watched here.

Before and After Photos

We generally advise that you have a good look at before and after photographs prior to a consultation and bring both photos you admire and ones you dislike to your initial consultation. See our before and after photos here.

Patient Testimonials

Not only can hearing about other peoples' experiences be very helpful in deciding whether or not to go ahead with the surgery, it can also alleviate any fears you may have and help you to be fully prepared for the operation and recovery period. We would advise that you listen to a number of testimonials as everybody has a very different experience and this will enable you to gain the broadest perspective. Read & Watch our patient reviews and testimonials here. If you are lucky enough to know someone who has recently undergone a breast enlargement procedure it can be very helpful to talk to them in person to hear why they decided to have the operation, how they chose their surgeon and their personal experience of the whole procedure including the surgery itself and their recovery afterwards.

Patient Reviews

There are a number of independent review sites which allow patients to review both the plastic surgery company as well as the surgeon itself. The most popular ones are Trustpilot and Realself. During the research process you are likely to think of certain questions specific to your surgery. Before an initial consultation it is wise to write down a list of these questions or topics you would like to discuss with your surgeon as it can be easy to forget these during your appointment. You can find a selection of our FAQs here.

We generally advise that you have a good look at before and after photographs prior to a consultation. Although it is not an exact guide to the final appearance of your breasts after surgery, it is a good rule of thumb that if you find someone who shares similar characteristics with you and you admire the appearance of their breasts after surgery, then a similar size and shape of breast implant might be appropriate. It can also be helpful to bring along these pictures, ones you both admire and dislike to your consultation. This helps your surgeon develop the best idea of what you want to achieve from your breast enlargement surgery.

You can research your breast enlargement surgeon by checking the General Medical Council which lists all qualified plastic surgery specialists in the United Kingdom. You should particularly check to see if your surgeon is listed on the surgery specialists register.

Other web resources which can be useful are the British Association of Aesthetic Plastic Surgeons which lists all fully registered plastic surgeons who specialise in cosmetic surgery procedures in the UK. Surgeons who register for BAAPS have usually, in most cases, been a consultant plastic surgeon in the UK and have to publish and record their yearly activity which is assessed.

It is also worth researching your plastic surgeon online prior to your consultation. There are a number of websites  that allow you to see reviews of your surgeon:

• Good Surgeon Guide
• Realself
• Trustpilot

Some surgeons perform breast enlargement surgery infrequently and we at Aurora Clinics would recommend that you choose a surgeon who performs at least ten of these surgeries per month at minimum. This is because it is crucial that your surgeon specialises in this type of surgery in order to produce the best results.

In most cases it is advisable to have consultations with at least two plastic surgeons to give you the best idea of the best approach for you and also gives you the opportunity to decide which surgeon makes you feel most comfortable.

The initial consultation is one of the most important aspects for anyone considering having a breast augmentation. In this consultation it is very important that you feel you have time to adequately explain to your surgeon your aims from surgery. Aims will vary from person to person and will depend very much on your type of physique, the clothes you would like to wear and the aesthetic outcome you would like following your operation. It is important that you develop a good rapport with your surgeon and that they understand fully what you hope to achieve from the operation and also your desired appearance. In some cases you may meet a non-medical specialist in the first instance, but at Aurora Clinics our philosophy is that your first appointment will be with the surgeon to discuss the best type of breast enlargement surgery for you; in particular:

• The best type of breast implants for you
• The best size and shape of implant for you
• The best placement for the implant (under or over the muscle)
• Whether you would need any other procedures, such as an uplift

You should also feel free to ask your surgeon:

• how many breast augmentation/enlargement procedures they perform per year.
• how many of these patients have required further surgery (e.g. – to adjust the size of their implants).
• how many patients have developed capsular contracture following surgery.
• how many patients have developed other problems following surgery, such as infection or bleeding.
• to show you before and after pictures of patients whom they have treated
• if it's possible to talk to any patients whom they have treated recently in order to get a first hand experience of what is involved
• what are the follow up arrangements and whether, if you do have any problems following your operation, your initial payment would cover this

It is key that you feel comfortable with your surgeon and feel that they have answered your questions adequately before proceeding with your breast enlargement surgery. It is very useful to bring along some pre-prepared questions to make sure that you have all of these answered. It is also a good idea to take a notebook and pen with you so you can also record the answers you are given. We would also encourage you to bring along pictures showing the type of bust that you would like following surgery and some of your own clothing in various styles to see how they might look with different implants.

Your sizing appointment will involve you seeing and trying breast implants of various sizes and shapes. It's important to realise that breast implants come in different heights and widths as well as shapes and that the same implant will have a very different appearance on different physiques. At Aurora Clinics we pride ourselves on our breast sizing appointments and spend at least an hour with you looking at various sizes and shapes. We would encourage you to come in with different tops and clothes you will wear to see how the implants will look in different outfits. Some surgeons will incorporate the sizing appointment with your initial consultation. We can also offer you a 3D Crisalix simulation of your breasts with different sizes and shapes of implants to give you an idea of how you may look following surgery. Click here for more information on what to bring to your sizing appointment.

We at Aurora Clinics would recommend you have at least two weeks to think after your initial consultation before you decide whether or not to go ahead with your breast enlargement surgery. Playing some of our previous patient testimonials might help you to make a decision.

The early breast implants had a very thin, smooth silicone shell with a fluid, gel-like silicone within them. Since then, with each generation of implants, the shell has become more robust and the silicone gel inside it has become more cohesive. Cohesivity is the stiffness of the silicone and over the years the silicone has moved from being a liquid gel to more of a firm gel with the consistency of a Turkish delight. The advantage of a firm gel is that it is much less likely to run and move to other areas of the body should the shell of your implant become compromised.

Over the years there have been significant improvements to breast implants and not only are the breast implants made of stronger, more robust materials and contain more solid, cohesive silicone, they have also developed many more shapes, sizes and profiles.

Teardrop shaped implants aim to mimic the breast shape, with a natural teardrop shape being flatter in the top portion and more rounded at the base of the implant. Some surgeons feel that teardrop shapes give a much more natural appearance to the bust as they aim to replicate the shape more accurately than the round implants.

A potential disadvantage of the teardrop implants is that they can rotate, causing distortion to the bust. Your surgeon would counsel you fully as to the risks of this prior to the surgery.

Round implants and shaped implants come in different heights. The height of an implant is how much it protrudes from your chest, known as the profile of your implant. Many of the more old-fashioned implants were very low profile and nowadays many implant manufacturers produce a variety of different profiles. These range from wider, less high implants which are generally used on people wishing to have a natural appearance who have a relatively wide chest base to more high-profile implants that are used predominantly on people with a narrower chest base who still wish to have a full breast appearance following their surgery.

Before considering breast enlargement you need to look at the potential risks and consequences that sometimes can occur with breast enlargement. The risks following breast enlargement surgery can be divided into two: the general risks of any operation and the risks associated particularly with breast enlargement surgery. General risk

• Deep vein thrombosis
• pulmonary embolism
• Reactions to the anaesthetic
• Allergies to some of the drugs used during the surgery

Other risks specific to breast enlargement surgery include; Capsular Contracture After you have had breast implants, your body begins to naturally surround the implant with a layer of scar tissue. This tissue is known as a ‘capsule’ because it encapsulates or surrounds the implant. Sometimes the capsule can tighten and squeeze the implant. This is then known as a capsular contracture. It can cause the breast to feel hard, look misshaped and can sometimes be painful. Capsular contracture is treatable and it may require additional surgery. Your surgeon will talk about this with you in more detail at your consultation. Capsular contracture is one of the most common reasons for having another operation, and is also a risk factor for implant rupture. As part of your initial clinical assessment your surgeon will take steps to reduce your chance of developing capsular contracture. The severity of capsular contracture is graded using the four-grade baker scale; Grade I capsular contracture is the least severe and Grade IV is the most severe. Implant rupture An implant rupture is a tear or hole in the breast implant shell. When this occurs in a silicone gel-filled implant, the gel may remain in the shell, leak into the tissue (or capsule) that forms around the implant or spread beyond the capsule. Breast implant ruptures can occur by a variety of causes such as extreme capsular contracture, excesive trauma to the chest or damage by surgical instruments. The symptoms of implant rupture that you may notice include; changes in the breast shape, decreased breast size, tenderness or pain and swelling. In some cases a ‘silent rupture’ may occur and the woman will experience no changes to the way the implant looks or feels. This type of rupture is diagnosed by magnetic resonance imaging (MRI), and this may be recommended as part of your post-surgery medical examinations. Implant rupture can be treated and a removal of the implant will be recommended. Your surgeon will diagnose if your implant has ruptured and determine if you should have it replaced or removed. At Aurora you are initially provided with 3 years cover for higher grades of capsular contracture and breast implant rupture that may require further treatments. This cover period can be extended with our unique Extended Aftercare Scheme for additional peace of mind, ask your co-ordinator for details on this. Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) BIA-ALCL is a Breast Implant Associated Anaplastic Large Cell Lymphoma, a rare T-cell lymphoma that can arise around breast implants. Currently the cause of BIA-ALCL is not clearly understood and research is ongoing. BIA-ALCL is rare and the true incidence is hard to estimate. To date, the estimated incidence rates in scientific literature range from 0.03% to 0.003% or 1 in 3,817 to 1 in 30,000. Current MHRA (The UK Regulator for Medical Devices) estimates that the rate is 1 in 24,000. BIA-ALCL has been associated with both saline and silicone implants, round and anatomical implants, all gel types, all types of implant texturing, and all projections and seizes, as well as breast implants that have been used for both reconstructive and cosmetic purposes. Presently, no specific risk factors have been identified by health bodies around the world that are studying this disease. However, factors such as breast implant texture, genetics and bacteria have been implicated and are presently undergoing further study. Breast implants have different surface textures, including smooth or textured. For cases reported to date, BIA-ALCL has been seen most often in patients with textured implants. Your plastic surgeon will be able to provide you with much more information at your consultation and please don’t hesitate to ask any questions you may have regarding BIA-ALCL or any other risk associated with breast implant surgery. When diagnosed early BIA-ALCL can be treated, often successfully by removing the breast implant and surrounding scar capsule, however additional treatment may be necessary depending on the individual and whether the disease has spread throughout the body. As with all cancers it is important to be diagnosed and treated as early as possible. We advise it is good health practice to self-examine breasts regularly and we would recommend that all patients with breast implants do this. Should anything such as swelling of the breast or other symptoms such as pains, lumps and unevenness between the breasts be detected an appointment to see your surgeon or GP should be made as soon as possible. Further information can be found on the following websites: Gov.uk Guidance https://baaps.org.uk/media/press_releases/1693/statement_from_praseag_on_breast_implants_and_guidance_for_patients Other breast augmentation surgery risks include change in breast or nipple sensation, implant displacement, breast asymmetry and ptosis. Find out more on our Breast Implant Safety page.

During the lead up to your breast enlargement surgery it is best to reduce or stop smoking and try to get as much rest as possible in the week prior to the operation. It is important to avoid medication such as aspirin and non-steroidal anti-inflammatory drugs such as Ibuprofen or Nurofen in the two weeks before the surgery. This is because these can increase the risk of bleeding by thinning your blood slightly. Other medications, such as St John's Wort, Vitamin E, Gingko Biloba and Arnica should be avoided in the two weeks prior to the surgery, although Arnica can be very useful in helping to resolve any bruising you may experience after the operation.

• Do not eat anything for six hours prior to your operation. The reason for this is that you need to have an empty stomach before any general anaesthetic to prevent the risk of vomiting or inhaling the stomach contents.
• Don't chew any chewing gum for six hours before surgery as this can increase the acid secretion in your stomach in a very similar fashion to food.
• Drinking water is fine up until two hours before your surgery, then nothing until after your operation.
• Avoid applying any body lotion on the day of the surgery as this can interfere with the sticky heart lead tracing and cautery pads which will be applied during your procedure.
• Remove all jewellery that it is possible to remove before surgery, although with items such as belly-button piercing we can tape the area down to avoid any interference with the surgical apparatus.
• We would advise that you remove nail varnish before your surgery as you will have a machine attached to one fingernail to measure your blood oxygen saturation.
• We would also recommend that you avoid excessive makeup on the day of surgery.

You will be given detailed instructions at your consultation which will provide more information on these matters. Before your operation, your surgeon will come in to see you and will discuss his plans for your surgery and answer any last minute queries you may have regarding your breast enlargement procedure. Your surgeon will then, if they have not already, take photographs of your bust from different angles and will also draw on you, outlining in most cases the margins of the pocket they plan to use for the breast implant and also the incision. This gives your surgeon the best idea of where to place the implant to give the most natural appearance. You will then be asked to sign a consent form which gives your permission for the breast enlargement procedure to be completed. There will be some waiting prior to the operation and you will be given a pre-med to settle your nerves. It would be a good idea to bring your phone, book, magazines or tablet to entertain yourself whilst waiting.

Unless you prefer not you will be given a pre-medication which makes you slightly sleepy and relaxed. You will then be taken down to the operating theatre and gently put to sleep by a general anaesthetic; a small injection in the back of your hand. In many cases a numbing cream will be used on the back of your hand so that you do not feel any pain from the injection.

Most breast enlargement procedures last between one and one and a half hours and when you wake up from your surgery you will be in no pain because local anaesthetic will have been placed in your breast area to numb the region.

Immediately following your surgery you will wake up with a specially designed surgical bra in place. Some patients report feeling a tightness in their breast tissue, but no significant pain. This may develop into mild to moderate discomfort depending on your physique and pain threshold. If you have had your implants placed behind the muscle, you may experience slightly more pain in the first few weeks following surgery. You may also find that one breast may be slightly more swollen or firm than the other and this is nothing to worry about initially. You will be given something to drink and eat and be encouraged to mobilise yourself as soon as possible. You will then be able to return home the same day as we know that patients feel happier convalescing in a familiar environment. It is important to rest after your breast enlargement procedure and not drive during the week following the operation to allow your breasts to heal in the best possible way.

The most commonly used approach in the UK is via an incision placed in the fold underneath the breast. Other incisions, such as through the armpit, underneath the bottom of the areola (the darker area surrounding the nipple) and through the tummy button are less commonly performed types of breast enlargement incision in the UK.

Therefore if you are having a straightforward breast enlargement you will likely have a scar approximately in your inframammary fold. If you are having an uplift procedure as well then the scarring may be more extensive but this will be discussed during your consultation.

At Aurora Clinics we now offer the revolutionary short scar breast enlargement using the Keller Funnel which means a scar as short as 4cm, less trauma and it reduces the chance of infection and capsular contracture.

On the day after your surgery you will be discharged with painkillers and an appointment date for one week following your operation. Should you have any concerns before this one week appointment you should contact us immediately. During the first week it is important to gently walk about and mobilise your legs to minimise the risk of any blood clots in your calves. We advise you to avoid driving during the first week and also any strenuous activity which could raise your blood pressure thereby increasing your risk of bleeding. Most people take one week off work following surgery until their first post-operative appointment. Some people with manual jobs which involve lifting take two weeks off following the surgery. It is unusual to require longer than this off work. It is important to have some support at home, particularly if you have young children. If you do have young children who require lifting then you will need help with that and with taking them to and from school. It is not essential to have someone with you 24 hours a day at home, but it is key that you have someone to support you during this period. As you will be unable to drive for a week and therefore not be able to perform the school run it is wise to make childcare arrangements for the period immediately after your surgery. Most people need at least a week off childcare after their surgery. After two weeks you will be able to resume light exercise and, if you are working out, we recommend that you concentrate on the lower body and gentle aerobic exercise rather than high-grade upper-body physical exercise involving the pectoralis major muscle. If you need to you can book in for a two week follow up appointment with one of the nurses to check that all is well but most patients find this is not necessary. After 6 weeks you will have your post-surgical appointment with your surgeon. At this stage they should be able to advise that you are clear to return back to your normal activities.

It is very normal to experience emotional side effects following this surgery. It is normal to feel very euphoric on the day following surgery and 2-3 days later feel very tired. This is due to a combination of the adrenaline surge you will likely experience before your surgery and as a result of the anaesthetic medication. Generally patients will continue to feel a little bit tired over the week immediately following surgery, but they rapidly recover and are feeling relatively normal by 1-2 weeks after surgery.

Your first follow-up appointment will be one week after your surgery when you will come into the clinic and the nursing staff will remove the brown tape over your incision and trim the ends of any residual soluble stitches. The brown tape will then be re-applied and you will be able to wear a comfortable support bra,  we do not recommend an underwired bra at this stage as the wires can press against the scars causing discomfort. All patients will have a follow up appointment six weeks after their breast enlargement surgery. Most patients do not have any residual discomfort by this point. Photographs will be taken at this appointment. If you need to see your surgeon or someone from our nursing team sooner than this then please contact your local clinic or patient adviser. All follow up appointments are included in the initial cost of surgery. After your six weeks follow up it is unlikely that you would return to Aurora Clinics until your first annual follow up with our team. These yearly follow up appointments will consist of your surgeon checking the incision and the firmness of the breasts to ensure that no capsular contracture has taken place. If there are any concerns at one of your annual follow up appointments your surgeon can arrange either an ultrasound scan or MRI scan of your breasts to assess them internally. These yearly check ups are also free of charge. Most of our patients do come back for their yearly follow up appointments, although if you have any concerns in the interim there is the 24 hour helpline for you to call to make an immediate appointment. We recommend that all patients attend their annual breast enlargement surgery follow up appointments without fail, especially at the 15 year mark when a full assessment of your breasts will be made.

Guidance for patients regarding Allergen Natrelle implants with a textured surface called Biocell and textured implants: The Private Clinic follows the latest UK regulatory advice from the Medicines and Healthcare Products Regulatory Authority (MHRA) and the British Association of Aesthetic Plastic Surgeons (BAAPS). Based on this advice and other relevant agencies, we regularly review the types of breast implants we offer to patients.

The British Association of Aesthetic Plastic Surgeons advises that concerned patients need not take any action at this stage. They should continue their routine follow up with their healthcare professional and discuss any questions they have about their breast implants. There is no need to remove or exchange any current implants based on the most up-to-date scientific data available. Indeed, unnecessary surgery may cause additional harm in a small number of patients.

We advise any patients with new symptoms such as swelling or pain to contact their implant surgeon for specific advice, otherwise they should make a routine appointment with their GP when available to discuss their concerns.

We encourage women to continue to self-examine their breasts as a matter of good health. Should you notice any changes, feel any discomfort, or have any other concerns then please contact us and we will arrange for you to see your surgeon or consult your General Practitioner (GP).

The majority of patients in the UK with breast implants will have textured surface implants in their breasts. According to all the latest scientific data there is no indication for any woman to consider removing or replacing their implants. Patients should continue with any planned follow-up they have arranged.

Further information can be found on the following websites: Gov.uk Guidance

https://baaps.org.uk/about/news/1675/a_statement_by_the_british_association_of_aesthetic_plastic_surgeons_baaps_on_the_withdrawal_of_allergan_natrelle_textured_implants

https://baaps.org.uk/media/press_releases/1693/statement_from_praseag_on_breast_implants_and_guidance_for_patients - April-4'2019

What to expect at your consultation? At your consultation, your plastic surgeon will discuss all the risks and complications mentioned above. You will also receive a Breast Enlargement Patient Guide which outlines all of the information that you need to know before going ahead with breast augmentation surgery. Your consultation is a great time to discuss any questions or concerns that you may have, your surgeon will also be able to go through the different implant sizes, shapes and implant brands available and assess which is suitable for you and your shape and discuss what are your desired goals.

last update April 2019

The Private Clinic follows the latest UK regulatory advice from the Medicines and Healthcare Products Regulatory Authority (MHRA) and the British Association of Aesthetic Plastic Surgeons (BAAPS). Based on this and other relevant agencies, we regularly review the types of breast implants we offer to patients.

The British Association of Aesthetic Plastic Surgeons advises that concerned patients need not take any action at this stage. They should continue their routine follow up with their healthcare professional and discuss any questions they have about their breast implants. There is no need to remove or exchange any current implants based on the most up-to-date scientific data available. Indeed, unnecessary surgery may cause additional harm in a small number of patients.

We advise any patients with new symptoms such as swelling or pain to contact their implant surgeon for specific advice, otherwise they should make a routine appointment with their GP when available to discuss their concerns.

We would encourage women to continue to self-examine their breasts as a matter of good health. Should you notice any changes, feel any discomfort, or have any other concerns then please contact The Private Clinic and we will arrange for you to see your surgeon or consult your General Practitioner (GP).

The majority of patients in the UK with breast implants will have textured surface implants in their breasts. According to all the latest scientific data these remain safe devices and there is no indication for any woman to consider removing or replacing their implants. Patients should continue with any planned follow-up they have arranged.

Further information can be found on the following websites:

• Gov.uk Guidance - https://www.gov.uk/guidance/breast-implants-and-anaplastic-large-cell-lymphoma-alcl
• BAAPS Statement https://baaps.org.uk/about/news/1675/a_statement_by_the_british_association_of_aesthetic_plastic_surgeons_baaps_on_the_withdrawal_of_allergan_natrelle_textured_implants
• https://baaps.org.uk/media/press_releases/1693/statement_from_praseag_on_breast_implants_and_guidance_for_patients - April-4'2019