Breast Augmentation Q&A

Ask the Consultant

We asked three of our leading cosmetic consultants about breast augmentation surgery.

Find out what the experts have to say about this popular procedure below.

Mr David Crawford
Patients need to carefully consider the following:

  1. Ask yourself - Do I need the surgery? What difference will it make for me?
  2. Make sure you find a good and reputable surgeon. Your consultant should be a member of both BAAPS (British Association of Aesthetic Plastic Surgeons) and / or BAPRAS (British Association of Plastic, Reconstructive & Aesthetic Surgeons) and have a good local reputation.
  3. Make sure you go to a good hospital.

Mr Raj Ragoowansi
This is an elective procedure and therefore it is important that you make an informed decision after adequate advice and forethought.

  1. If you are about to embark on a pregnancy/ weight loss regime and/or have other health issues it is better to postpone the breast augment procedure.
  2. Clarify your concerns/aspirations with regards to your breasts: Is it a lack of volume? Is it droop? Is it a combination of both? Is it a generalised loss of shape due to weight loss, pregnancy, breastfeeding?
  3. Ensure you have been given adequate, evidence-based advice and options to consider with regards to the following:
    • Implant shell and gel composition
    • Implant shape, size and projection
    • Placement of scar (in the breast crease or around the nipple-areolar complex) and pocket (sub-glandular, sub-muscular or a combination of both)
    • Post-operative recovery and restriction of certain activities

Mr Alan Park

  1. Experience of Surgeon - Always research the reputation of the consultant, their qualifications, how many breast augmentations completed and the consultant's complication rates.
  2. Which Hospital - It is important to select a hospital that you feel relaxed in that has good cleanliness figures, low infection rates and a good reputation.
  3. Expectations following surgery - Why are you having surgery? Will the surgery meet your expectations? This should all be discussed in advance with your chosen consultant to ensure you are choosing surgery for the right reasons and will be happy with the results.

Mr David Crawford
Silicone and saline have the same shells but the filler is different.

Silicone is gel whereas saline is salt water. With salt water you cannot have shaped implants. 

95% patients choose silicone gel as it feels better to touch, wrinkles less and it lasts better over a period of time.

Mr Raj Ragoowansi
In modern contemporary UK/European aesthetic practice, silicone implants are the preferred choice. 

Saline and silicone implants both have an outer silicone shell - they differ in their material 'fill' and consistency.

Saline implants are filled with salt water and silicone implants are filled with silicone gel. 

Saline implants are rarely used in the aesthetic arena except for the purpose of reconstruction after cancer and when the breast tissue envelope needs to be expanded in cases of congenital asymmetry (where one breast is grossly different to the other) and/or tuberous breast deformity (birth defect breast shape/size).

Saline implants feel stiff and also have a tendency to ripple and 'swish' with activity and have shorter durability than silicone implants.

Mr Alan Park
Both types of implants contain a silicone envelope but silicone implants are filled with silicone and the saline type with saline. 

Normally patients opt for the silicone versions as they have a softer, natural feel and usually last longer.

Saline implants have more of a water texture which feels less natural and can be prone to leakage.

Mr David Crawford
Every patient is different and individual. 

There is a balance between the breast size a patient desires and the size which may look natural and achievable with an implant. 

Patients should try the sizers which will help them decide on the shape and form they desire and will be guided by their surgeon on any possible pitfalls or downfalls of their choice.

Mr Raj Ragoowansi
My patients find this the most exciting and engaging part of their clinical pathway!

Have realistic goals and expectations. Take photos of women who you find have attractive/aesthetic busts to the surgeon. 

During the consult, be explicit about your preferred type of clothing, activity and lifestyle. 

Although it is difficult to guarantee the final cup size, go with an idea of your ideal bust cup size and projection. 

Also, ask the surgeon to show you their gallery of pre and post-operative clinical pictures - this exercise not only displays their expertise and understanding of this aesthetic procedure but also gives you an idea of their philosophy in terms of size, shape, contour and symmetry.

I take detailed measurements of the breasts and also ask you to try various sizes and shapes of implants within the privacy of the clinic and with a nurse chaperone. 

Elaborate imaging for complex cases such as revisions, congenital asymmetry, post-cancer reconstruction is also carried out with Vectra 3D analysis.

Mr Alan Park
When considering which size and projection is correct for you it is important to know what type of look you are hoping to achieve i.e. natural vs a more pronounced look.

You should also consider your body shape, proportions and the amount of native breast tissue. 

Clothing is an important factor to consider as if you have a small frame but go for large implants you may find that you struggle to find clothing that fits you well.

As with everything, the larger something is, the heavier it is and this is also true with implants.

The larger your implants the more weight you will be carrying around which can cause ailments such as back ache, the implants can also start to droop if they are too heavy and you may be able to see/feel the implant.

Mr David Crawford
The operation takes approximately one hour and you would usually expect to have a one night stay in hospital.

Mr Raj Ragoowansi
Ensure that the surgeon operates at a Health Care Commission approved private hospital or clinic.

The procedure takes 90 minutes with home the same day if the implants are placed above the muscle and an overnight stay if they are placed under the muscle.

I use thin, light drains for implants placed under the muscle and as they need to stay in for 12-16 hours, I generally keep the patient overnight and discharge them after drain removal the following morning.

Mr Alan Park
The operation generally takes around 60 to 90 minutes. 

You will normally arrive at the hospital on the morning of your operation where you will be shown to your room to relax before your procedure.

Following surgery you will be required to stay overnight but this is just a precautionary measure to monitor your surgery and you will normally be discharged the following morning.

Mr David Crawford

  1. Some discomfort and a feeling of unnatural tightness of the breast
  2. How the breasts look and feel immediately is not how they will be
  3. It takes time for the breasts to settle and for the patients mind to get used to the body change.

Mr Raj Ragoowansi
A well-fitting, un-wired bra advocated for 6 weeks providing comfort and support.

For implants placed above muscle, minimal swelling and discomfort for 3-5 days for which I prescribe simple painkillers and a supportive, soft bra.

For implants placed below muscle and partially under muscle, there is moderate swelling, tightness and pain on chest movement for 5-7 days. 

With adherence to my post-operative exercise protocol, these symptoms usually settle within 10 days.

Mr Alan Park
Following surgery you will experience swelling and tightness around your breasts along with mild pain that can be controlled by analgesics.

Mr David Crawford
In a light job most patients are back at work and driving at one week and back at the gym in 4-6 weeks.

Showering is OK immediately after surgery.

Mr Raj Ragoowansi
Restrict chest activity/exertion for 4-6 weeks.

For implants placed above muscle, recovery time is 2-3 weeks.

Driving allowed at day 7 and most household/work activity (apart from lifting, carrying) allowed at 10 days.

5-7 days off work is generally recommended
For implants placed below muscle or partially under muscle, recovery time is 4-6 weeks. 

Driving allowed at day 10 and most household/work activity (apart from lifting, carrying) allowed at day 14.

For both groups, walking as comfort allows, gentle jogging at 2 weeks. No lifting/gym/weights for 6 weeks. No swimming or contact sports for 2 months.

Mr Alan Park
Generally it takes about six months for everything to settle and your implants to move into their final position.

Normally people are able to drive after one week, return to work within one to two weeks and return to full activity after two weeks.

Mr David Crawford

  1. Hardening of the implants (capsule formation) due to the body's reaction to the implant in 5-10% of patients. Most are mild and one breast just feels firmer than the other.
  2. Lifespan of the implant is around ten years.
  3. 7% of patients may have reduced nipple sensitivity.

Mr Raj Ragoowansi
The benefits of every procedure are balanced with risks and responsibilities. 

With adequate preparation and meticulous post-op care the incidence of risk after breast augmentation is minimal.

Scars are initially pink but settle with time and massage. 

In patients with darker skin tones, scar pigmentation can be minimised with early massage, scar care, topical silicone.

Nipples may be numb/hyper-sensitive for a few weeks but do settle with time and massage. 

If chest wall skin is thin, implants can appear to 'ripple', in order to prevent this - I plan a moderate-sized augment with cohesive gel implants.

Implants have a lifetime guarantee but lose their turgor at 10-12 years and may need to be exchanged at that stage.

When you come to the age of screening, this is possible with implants in situ and does not mask the parenchymal (breast tissue) view. 

You merely need to inform the radiographer that you have implants so that they can image the breasts with special views (Eckland views).

These procedures last for approximately 10-12 years (as I am unable to influence ageing and gravity) after which you may request an uplift/implant exchange.

Every implant forms a thin capsule around it - this rarely (in patients who smoke or who have other disorders) thickens and needs to be released through the same skin scar within 3-4 years of the initial surgery.

Mr Alan Park
Capsular contracture is the main long-term complication, which is scar tissue that causes hardening of the implant. This occurs in around 4-5% of all cases. The down-side of this complication is that you may need to have the implants replaced in the future. Patients who become pregnant or loose a significant amount of weight may find that the implants become visible through their skin.

Mr David Crawford
The key benefits I see are:

  1. Improved self-confidence
  2. Patients able to fit into their clothing without having to use padding.

Mr Raj Ragoowansi
Benefits are not confined to size enhancement alone - most of my patients feel more youthful and energised.

Benefits specific to your bust:
Improvement in unevenness, asymmetry. Better definition of cleavage.

General benefits: Enhances self-esteem and body image. 

Patients walk with confidence, posture becomes straighter and leaner. Better fit in clothes, underwear and swim wear.

Mr Alan Park
Most patients undergo breast augmentation procedures to improve their self-esteem and feel better about themselves. 

Apart from the obvious benefits to the look and size of your breasts there are psychological benefits relating to low self-esteem and improvements in confidence and social skills.

Mr David Crawford
Patients should ensure that the consultant they go with is a member of BAAPS (British Association of Aesthetic Plastic Surgeons).

All BAAPS Members are on the Specialist Register of Plastic Surgeons maintained by the General Medical Council and are required to return an annual safety audit of their work as a condition of membership.

The consultant must have a good reputation; have plenty of experience and practice at a good hospital. 

Patients need to ask themselves the following questions:

  1. Do you feel comfortable with the consultant?
  2. Do you feel comfortable with the operation?
  3. Do you feel comfortable in the hospital?

Mr Raj Ragoowansi
Caring, compassionate, certified BAAPS registered. Adequate time allowed during the consultation to listen and understand patient's concerns and aspirations. 

The surgeon sends the patient a detailed consultation letter. 

Adequate time given to patient to reflect, consider opportunity given for 2nd/3rd consultation to re-discuss procedure, ask questions and generally to build a rapport with the surgeon.

Reasonable, contemporary options of implant type shaped together with surgical approach thoroughly discussed and understood by the patient.

Mr Alan Park
It is very important to research your consultant to ensure that they have the right professional memberships and are signed up to a code of conduct.

When researching you should be looking for consultants who are on the specialist register for plastic surgery and are members of BAAPS and BAPRAS. 

BAPPS performs a compulsory annual audit of the consultants outcomes for you to select a consultant you are confident in.

When you go for your initial consultation you should have a level of rapport and trust with your consultant so that you are confident that your expectations and health needs are their priority. 

Don't get talked into something you feel uncomfortable about, the right consultant for you should be able to provide advice and guidance to help you make the right decision on whether surgery and what implant/look is right for you.

Mr David Crawford
That 20 years after starting, I still enjoy my job as much as I did at the start. I particularly enjoy the patient contact and the artistry of the surgery.

Mr Raj Ragoowansi
Voted in as one of 'Top 3' Consultant Plastic Surgeons for Breast and Body Contouring in the Tatler Guide 2014. Restoring breast shape and volume in patients who have undergone breast cancer surgery. 

Satisfying to observe self-confidence in young patients who undergo breast rebalancing for uneven development during adolescence (congenital asymmetry)

One such patient then went on to marry and invited me to her wedding! 

Asked to speak at several national, international conferences on breast aesthetics.

Mr Alan Park
I am a Consultant Plastic and Reconstruction Surgeon at University Hospitals Coventry and Warwickshire and have been on the specialist register since 2000. 

Within my role at UHCW I am the head of the Plastic Surgery department and have been chairman of the West Midlands Cosmetic Fellowship, which trains the cosmetic surgeons of the future.

I organise an annual international conference in Coventry, have presented at numerous international meetings and written papers for peer reviewed journals dedicated to plastic surgery.

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