Breast augmentation, Sheffield
Breast augmentation (breast enlargement or a ‘boob job’) involves inserting breast implants to increase breast size. Breasts can also be enlarged with fat injections (lipofilling). Breast augmentation is the most frequently performed cosmetic surgery procedure in the UK. Mr Morritt regularly undertakes breast enlargement surgery at the Claremont Private Hospital and BMI Thornbury Hospitals in Sheffield.
Review from one of Mr Morritt’s breast augmentation patient’s
Breast enlargement – typical patients
Breast enlargement is most frequently performed to:
- Increase the size of small breasts
- Restore lost breast volume following pregnancy, weight loss or ageing
- Improve breast symmetry (in cases of breast asymmetry)
- Lift the breasts in women with minor drooping who do not want the scars associated with a breast uplift (mastopexy)
- Improve self-confidence
Breast augmentation – procedure
‘Boob jobs’ are usually performed under general anaesthesia and involve an overnight stay in hospital. The breast implant is placed under the breast tissue either directly below the breast (subglandular; also known as ‘overs’) or under the chest muscle (submuscular; also known as ‘unders’).read more
The incision (scar)
Mr Morritt inserts breast implants through a small scar in the crease under the breasts (inframammary) incision. Scars in this area tend to heal very well and this incision allows an excellent view inside the breast during surgery so that a good breast shape can be created.
Under v over the muscle
Over the muscle (Subglandular or prepectoral)
- Preferred option for patients who already have moderate/large breasts
- Less painful and less risk of bleeding following surgery compared with submuscular
- The breasts move more naturally than when implants are placed under the muscle
- The cleavage gap is often narrower than when implants are placed under the muscle
- Can fill loose breast skin better than when implants are placed under muscle
Under the muscle (Submuscular or ‘Dual plane’)
- Preferred in thin patients with small breasts eg. those who have visible ribs
- Greater cover over the implant particularly in the cleavage
- Reduces chance of seeing the implant edge or feeling the implant
- Lower capsule formation rate compared with subglandular
- More uncomfortable than subglandular in healing phase following surgery
- Slightly greater risk of bleeding following surgery
- The breasts can change shape when the chest muscle contracts (animation)
Drains following breast augmentation surgery
It is sometimes necessary to have drains with breast augmentation surgery. These are tubes that go through the skin into the breast where the implant is located and draw away fluid and blood from the surgery. Drains are usually removed the day following surgery before the patient goes home.
Mr Morritt generally uses Mentor ® silicone breast implants for breast augmentation. These are high quality implants with good safety records and come with a 10yr replacement warranty in the event of rupture. Mr Morritt has never used PIP breast implants but is regularly asked to remove them.
To learn more about Mentor (R) breast implants – click hereread more
Modern breast implants comprise a silicone shell filled with either silicone jelly or saline (salt water). In contrast to the breast implants used years ago which were filled with runny silicone that could leak if the implant shell broke, modern breast implants are filled with thick silicone called cohesive gel which is similar in consistency to a jelly baby and does not leak to the same degree in the event of implant shell rupture.
Breast implants are either round or shaped (teardrop) and are manufactured in a wide range of sizes which means that different looks can be achieved in different patients and Mr Morritt will discuss the available options with you during your consultation. The most commonly requested breast implant sizes are in the range 250-450cc. Silicone gel filled implants tend to feel more natural and are more durable than implants filled with saline so are used more frequently for breast enlargement.
Fat transfer (lipofilling) breast enlargement
It is possible to increase the size of the breasts without inserting breast implants by using a technique called fat transfer (lipofilling). This involves using liposuction to harvest fat from the abdomen or thighs. The harvested fat is then prepared and injected into the patient’s breasts to increase their size. Only limited amounts of fat can be injected into the breast during a single operation meaning that this is not a useful technique for patients who wish to increase their breast size significantly in a single operation. Fat transfer can however be repeated a number of times if patients desire. Mr Morritt has found this to be a particularly useful technique in patients with breast asymmetry where the smaller breast can be increased in size without the need for an implant. Other good candidates for fat transfer breast enlargement surgery are those who have lost a small amount of breast volume after weight loss or childbirth and want to restore this volume without implants.
Hybrid breast augmentation – implants & fat transfer
Mr Morritt also sometimes combines breast implants with fat transfer. Examples of this combined approach are where patients want to narrow the gap between breasts (more cleavage), to improve the thickness of soft tissue cover over the implants, or to reduce/avoid double bubble deformities that can happen in some patients where the distance from the nipple to the breast skin fold is short.
Before and after photos of patients who have had breast augmentation by Mr Morritt
Case 1. Round 325cc subglandular (in front of muscle) mod plus profile implants
Case 2: Round 425cc high profile implants Dual Plane (partially under muscle)
Breast augmentation – after surgeryread more
Patients are asked to wear a support garment or sports bra 24/7 for 6 weeks following the surgery except when showering. It is useful to have two bras that can be worn in rotation. It is important that the bra is comfortable and provides support without being overly tight. Patients should not wear an underwired bra for approximately 6-8 weeks following surgery as the skin under the breast can be numb for some weeks following surgery and can be damaged by pressure from the wiring.
The wounds will be covered with dressings. You will be seen 1 week after the surgery to check that the wounds are healing well. Mr Morritt uses hidden, self dissolving stitches so there is no need for any stitches to be removed. The dressings are showerproof so you can have short showers following surgery. Please be aware that the wounds are relatively fragile in the first week following surgery and care must be taken when washing/drying the breasts. Patients are advised to avoid submerging their breasts in a bath until at least 2 weeks after surgery.
Recovery after breast augmentation surgery
Most patient’s scars are healed within 2 weeks of breast augmentation surgery but internal wound healing takes a few more months. Patients are advised to avoid strenuous exercise for at least 6 weeks following surgery.read more
0-7 days following surgery
Mr Morritt recommends taking it very easy in the first week during surgery as this is the most frequent time to encounter problems such as bleeding or fluid accumulation (seroma) following surgery if patients overdo things. Patients with young children should therefore organize for help and support with childcare and housework during this period. It is normal for the breasts to seem slightly high and also firm at this stage.
7-14 days following surgery
Patient’s should only have low levels of pain at this stage following breast enlargement and will be able to gradually increase their activities e.g. walking as their energy levels allow.
3-6 weeks following surgery
Most patient’s should be able to return to work approximately 2 weeks following surgery. Mr Morritt advises that patient’s should not undertake any heavy lifting before 6 weeks following surgery. Those in active jobs may therefore need to take more time off work or to modify their activities at work until they have fully healed.
6 weeks onwards
Patients can undertake all exercises without restriction. The breasts should have softened and look more natural but will continue improve over the next 5 – 6 months. For those who have their breast implants inserted under the chest muscles Mr Morritt advises waiting until 3 months after surgery before undertaking strenuous chest muscle exercises such as bench pressing, press ups, pole dancing etc.
Breast augmentation – risks
Breast augmentation is a commonly performed procedure and for the vast majority of patients the surgery goes very well without problems. Mr Morritt has incorporated a number of safety modifications into his practice to reduce the risks for patients having breast enlargement surgery. As with all surgical operations there are potential risks that patients should be aware of before proceeding with breast enlargement.read more
- scars following breast augmentation tend to heal well but will vary between patients and some patients (6.3%) may get poor scars (red, thick, raised, painful)
- the scars fade with time and can take up to 18 months to fully settle
- The scars are never invisible but sometimes heal so well that they are difficult to see
- The scars tend to be located in the crease under the breast but for some patients the scars will be located on the skin of the breast
- Very rarely, patients may get stretch marks on the breast after breast enlargement surgery
- results in a collection of blood in the breast that will make the breast appear swollen and may cause pain.
- This blood has to be removed in the operating theatre
- Rare – affects approximately 2-3% of patients
- More frequent when implants are placed under the chest muscle
- Infections are rare following this surgery (0.5%)
- Shallow infections (of the skin) can be treated with a course of antibiotics but deeper infections (of the impact itself) are more difficult to treat and sometimes it is necessary to remove the implant. If the implant is removed for infection then it is normal practice to wait 2-3 months for the infection to settle before inserting more implants.
Asymmetry of breasts or nipples
- almost all women have different sized/shaped breasts
- Breast augmentation can sometimes make differences between breasts and nipples more noticeable or less noticeable
- There will always be small differences in breast size, shape and nipple position following breast enlargement surgery
Wound breakdown after breast augmentation
- this is very rare but requires removal of the breast implant if the implant gets exposed to the air
Significant capsule formation (capsular contracture)
- this causes the breast to harden, change shape (become rounder) and can become painful
- usually further surgery is necessary to correct this problem (capsulectomy)
- Significant capsular contracture (Baker 3 or 4) affects approx 20.4% of patients 13yrs after surgery
Visible/palpable implant/Rippling following breast enlargement
- This is more common in thin patients or patients with only a small amount of breast tissue
- Breast implants naturally ripple and this rippling can sometimes be seen as rippling of the breast skin
Permanence of result
- Breast appearance changes with ageing, pregnancy, breast feeding and weight change.
- The appearances created with breast enlargement surgery do not last forever
Need for more surgery in the future
- Patients having breast enlargement surgery are warned that they will need to have surgery on their breasts at some point in the future.
- This may be to replace implants that have ruptured or for capsular contracture.
- Some patients develop breast drooping and decide to have breast uplift surgery
- Other patients decide to increase or decrease the size of their implants
- Some patients decide to have their breast implants removed.
Long term effect of breast implants on surrounding tissues
- breast implants can cause permanent thinning of the breast skin and of the breast tissue
- breast implants can cause permanent indentation of the rib cage
- breast implants increase the weight of the breast and this can cause breast drooping with time
Lifespan of breast implants
- breast implants last different amounts of time in different people but at some stage will rupture
- breast implants last on average between 10 and 20 years
- Ruptured implants need to be removed or replaced which requires further surgery
- It is not always possible to remove all the silicone from the body (breast/chest tissue/lymph nodes) in the event that a breast implant ruptures. Sometimes the silicone cannot be seen with the naked eye during surgery to remove the implant and may only become apparent when a lady goes for a mammogram.
Nipple sensitivity alterations after breast enlargement
- reduced nipple sensitivity occurs frequently following surgery
- may affect one or both sides
- generally improves with time
- may be permanent in 10% of patients
- Rarely, the nipples may become hypersensitive
Breast animation for subpectoral breast implants (under the muscle)
- When breast implants are placed under the chest muscle it is normal for the breast to change shape to some degree when the muscle contracts
- Rarely this phenomenon can happen spontaneously when the patient is not actively contracting the muscle
BIA – ALCL (Breast implant associated – anaplastic large cell lymphoma)
- a very rare type of cancer which has been identified in some patients who have had breast implants
- Worldwide, approximately 800 cases have been reported (includes 20 disease-related deaths)
- The lifetime risk for BIA-ALCL ranges from 1:1,000 to 1:30,000 for those with textured implants (for Mentor implants the incidence is 1:24,000)
Breast implant sickness or illness
- Some patients with silicone breast implants can develop fatigue and general ache/pains
- In these patients usually no cause can be found to explain their symptoms after extensive investigations
- Removing the implants can sometimes improve the symptoms
- Extensive scientific studies have failed to prove the existence of this condition and it is not currently recognised by the World Health Organisation
- Many doctors think that these patients are actually suffering from fibromyalgia and it is simply a coincidence that the patients have breast implants
Breastfeeding after a ‘boob job’
- approximately 80% of women can breastfeed after breast augmentation
Unhappiness with size or shape of breasts after breast augmentation
- Mr Morritt cannot promise that inserting breast implants will create a specific breast shape as the effects of breast implants vary between individual patients. In fact, two friends with identical size breast implants may get very different breast size and shape after a ‘boob job’
- Mr Morritt cannot give an exact indication of expected bra size following breast augmentation as bra sizes vary between different manufacturers. An approximate prediction is given about expected cup size.
- the breast skin can develop stretch marks after breast augmentation surgery. This is more common when people with small, tight breasts have larger than average sized breast implants
Breast implant scares
- Patients having breast implants are made aware that medical knowledge grows with time. In the case of breast implants this means that in the future some breast implants will almost certainly be found to have an increased complication rate etc and may be recalled or removed from the market
- association with autoimmune and connective tissue diseases
- early scientific reports in 1980’s suggested a link between silicone implants and connective tissue diseases e.g. scleroderma, rheumatoid arthritis, SLE etc
- all studies have concluded that there is no association between silicone breast implants and any connective tissue disease
- tissue fluid accumulation immediately after surgery can happen and if significant may require drainage with a needle.
- It usually settles within a few weeks of surgery.
- Rarely, patients may suffer from long term fluid accumulation (chronic seroma) around breast implants and in this situation the implants usually need to be removed (0-1% of patients).
General risks of breast enlargement surgery
- chest infection, DVT, PE, Death, COVID-19
Frequently asked questions – Breast augmentation (Boob job)
Mr Morritt answers FAQs on the Claremont Private Hospital, Sheffield website – click here to read more.
Will I experience any pain after the procedure?read more
Patients differ in how much pain they experience following breast augmentation surgery. Some patients may be free of pain within 3-4 days following surgery whereas others may have discomfort for 2-3 weeks. Most patients find that the pain following breast augmentation surgery can usually be well controlled with tablet medication. Severe pain following breast augmentation is less common. Younger patients sometimes experience more pain following surgery than older patients and submuscular breast implant placement can also be more painful than when the breast implant is placed over the muscle (subglandular).
How long will I need off work? What is the recovery time?read more
People heal at different rates following breast enlargement. Furthermore, physical activity requirements do vary between different jobs. While some patients may feel ready to return to work one week following breast augmentation surgery, others may not feel ready to return until two weeks after the surgery. Those with particularly strenuous jobs will need to take a bit longer off work or to restrict their duties to light activities during the first six weeks following surgery. Usually all patients are fully healed and are able to return to normal activities including exercising at six weeks following surgery. We advise that patients avoid driving until they are completely pain free and can perform an emergency stop confidently so that they are covered by their insurance policies.
Can I come back and see you anytime if I’m worried about anything?read more
Yes. We aim to provide excellent aftercare following breast enlargement surgery. You will be given a follow-up appointment before you leave the hospital following the surgery (this is usually 7 days following surgery). You will then have a number of further follow-up appointments to check that you are progressing well following the breast augmentation surgery. There is an opportunity to answer any questions and address any concerns that you may have at these appointments. Patients are usually seen 6 weeks and 6 months following breast enlargement surgery but are seen more frequently if necessary. You will also be provided with contact details so that you can contact the team at any time following the breast enlargement surgery for advice or review if you have any concerns.
Breast augmentation on the NHSread more
When I first started surgical training in 2000 it was common to see patients having breast augmentation or ‘boob jobs’ on the NHS for purely cosmetic reasons. Patients with common conditions such as hypomastia (small breasts) or postpartum breast changes (breast shrinkage after pregnancy) were entitled to have breast enlargement on the NHS. Fast forward 20 years and it is now very rare for patients to have breast augmentation on the NHS (I undertake approximately 2 breast augmentation cases per year on the NHS at the Royal Hallamshire Hospital, Sheffield). Breast enlargement for cosmetic reasons on the NHS requires funding approval (IFR) by the Clinical Commisioning Group (CCG) and the criteria are strict. This application must be made by your GP.
In South Yorkshire the criteria (click here for whole policy document) for getting breast augmentation for cosmetic reasons on the NHS are as follows:
- complete absence of breast tissue either unilaterally or bilaterally or,
- has suffered trauma to the breast during or after development
- BMI within the range 18.5 – 27
- completed puberty as surgery is not routinely commissioned for individuals who are below 19 years of age
Replacement of breast implants on the NHS is generally only available if the breast implants were originally inserted on the NHS.