Stephen McCulley, Reconstructive and Aesthetic Surgeon. MBChb, FCS(SA)Plast, FRCS(plast)

Breast augmentation overview—what it is, types of surgery and which method is right for you

What is breast augmentation?

Breast augmentation is a surgical procedure designed to increase the size of the breasts. It can be achieved via saline or silicone implants or via a fat transfer procedure.

Women generally choose to have breast augmentation surgery for one of three reasons:

  1. To change the size of the breasts
  2. To change the shape of the breasts
  3. To make the size of the breasts more even

If you’re unhappy with the shape of your breasts because they have lost volume, you may be a good candidate for a breast lift procedure, with or without implants.

Am I a suitable candidate for breast augmentation?

Women who are not happy with the size, shape or symmetry of their breasts may choose to have breast augmentation surgery.

Your surgeon will discuss whether you’re a suitable candidate for breast augmentation surgery. They will make sure you:

  • are a healthy and consistent weight, with a BMI between 5 and 28
  • aren’t pregnant or breastfeeding
  • have fully developed breasts
  • are in good overall physical health
  • don’t smoke, or are able to stop for at least six weeks before surgery
  • have realistic expectations about the outcome of your surgery
  • understand what’s involved in the surgery, including the risks

You can find out more about how to make the decision whether breast augmentation is right for you here.

Once you know whether you’re a suitable candidate for the surgery, you’ll then have to:

How much does breast augmentation surgery cost?

In the UK, you can expect to pay around £3,500 to £7,000 for breast augmentation surgery.

The surgeon’s experience and reputation will be reflected in the price, and so you’re likely to encounter a higher level of risk by choosing a surgeon at the cheaper end of the scale. Also the cost of implants varies considerably and, not surprisingly, the cheaper surgeons are likely to use the cheaper implants.

Stephen McCulley charges from £5,300 for a breast augmentation procedure.

It’s unlikely you’ll be able to have your breast augmentation paid for by the NHS. The NHS only funds cosmetic surgery in extreme cases—for example, if a patient’s breasts were severely asymmetrical.

What are the risks of breast augmentation surgery?

Like any major surgery, breast augmentation surgery has a number of associated risks:

During surgery

  • Anaesthesia-related risks, such as an allergic reaction to the anaesthetic
  • Excessive bleeding

After surgery

  • Less or no sensation in the nipple due to nerve damage
  • Obvious scarring—some scarring is to be expected but scars can be particularly pronounced in some patients
  • A blood clot in the breast—extremely rare but if it was to happen it would be within 24 hours of surgery
  • Difficulties breastfeeding or not being able to breastfeed at all
  • Infection in the wound
  • Implant-related problems

It’s normal to be in pain for at least a few days after breast augmentation surgery. Find out more about what you can expect after your operation with our advice on breast augmentation pain and swelling.

A good surgeon will fully explain all the potential risks so you have a full understanding of the risks you face during and after surgery and what you can do to limit them.

What are the different types of breast augmentation?

There are two different types of breast augmentation surgery:

  • Breast augmentation with implants
  • Breast augmentation with fat transfer

Breast augmentation with implants

During this operation, your surgeon will:

  • make an incision, usually below the breast along the fold
  • insert the implant, either under or over the chest muscle
  • close the incision with stitches

The procedure usually takes around an hour to an hour and a half. Breast augmentation can be combined with a breast lift during the same procedure, but this will be a longer operation. You can read more about combining cosmetic procedures below.

Breast augmentation with fat transfer

During this procedure, which typically takes around three hours, your surgeon will:

  • use liposuction techniques to remove fat cells from your stomach, thighs and/or the buttocks
  • ‘clean’ the fat cells to separate the fat from the blood
  • inject the fat cells into the breasts using a very small needle

Breast augmentation with implants or fat transfer are generally safe procedures, provided you choose an experienced, reputable and qualified surgeon. However, there are possible side effects and risks you should be aware of.

You can find out more about the risks of breast augmentation with fat injections here and the risks of breast enlargement with implants here.

You can find out everything you need to know about breast augmentation with fat injection transfers here.

Which type of breast augmentation should you choose?

If you choose to have implants rather than a fat transfer, you’ll have to choose whether to have:

  • under-the-muscle augmentation
  • over-the-muscle augmentation

We’ve provided an overview of these two procedures below but make sure you discuss with your surgeon which is most suitable for you.

What is under-the-muscle breast augmentation?

The breast implants sit under the pectoral muscles (your chest muscles). Your surgeon will create a ‘pocket’ under the chest muscle and place the implant inside it. This procedure is also known as sub-muscular placement.

Am I a good candidate for under-the-muscle breast implants?

Good candidates for under-the-muscle breast implants tend to be thin, as the muscle provides extra ‘padding’ to reduce the chances of seeing the edge of the implant through the skin.

What are the benefits of under-the-muscle breast implants?

  • Reduced risk of capsular contraction and rippling
  • More breast tissue is visible during mammograms
  • Results tend to look more natural
  • Implants are supported by the pectoral muscles, so there is less pressure on the breast tissue and skin

What are the downsides of having breast implants under the muscle?

  • Recovery tends to be more painful than over-the-muscle implants
  • Increased chance of needing drains after surgery to drain excess fluid from the wound
  • Not suitable for large implants
  • Difficult to achieve significant cleavage as the implants can’t be positioned as closely together as over-the-muscle breast implants
  • Flexing the chest muscles may distort the implants

What is over-the-muscle breast augmentation?

Also known as sub-glandular placement, in this procedure your surgeon will place the implants under the breast tissue but over the chest muscle.

Am I a good candidate for over-the-muscle breast implants?

Good candidates for over-the-muscle breast implants have a medium or large frame and want round, lifted breasts for maximum cleavage.

What are the benefits of over-the-muscle breast implants?

  • Slightly less invasive surgery as the muscle remains intact
  • Quicker recovery from surgery
  • Suitable for larger implants as breast tissue can stretch more than muscle
  • Implants are placed closer together so patients can achieve more significant cleavage

What are the downsides of having breast implants over the muscle?

  • Slight increase in risk of capsular contracture as the breast tissue may contract and harden when stretched
  • Rippling can occur in patients who have less breast tissue or very large implants, as there’s not enough tissue to cover the implants. Rippling looks like folds or lines under the skin.
  • Increased risk of implants ‘bottoming out’—where implants fall below the bottom fold of the breasts.

What happens during breast augmentation surgery?

After speaking to your surgeon you’ll have a good idea of what to expect during and after the operation. You can find out more about how to prepare for your breast augmentation here.

Below is an overview of what will happen during your breast augmentation surgery.

The surgeon will make an incision in each breast to create a ‘pocket’ for the breast implants to sit in. They’ll then insert the silicone or saline breast implants through this incision and into the pocket.

This incision can be:

  • an inframammary incision—made along the fold where the breast tissue meets the chest
  • a periareolar incision—made around the outer edge of the areola (the darker tissue that surrounds the nipple)
  • a transaxillary (armpit) incision
  • a transumbilical incision—made through the belly button

Not many surgeons offer the transumbilical method as it can only be done with saline implants and it’s very difficult to create consistent results. This is because the surgeon has to rely on using a tiny camera to perform the operation.

Once the implants are in place, the surgeon will then close the cuts with stitches or surgical tape and surgical glue, before covering them with a dressing. If you have stitches, these will usually be removed after a week—unless dissolvable ones are used. Mr McCulley uses deep self-dissolving sutures and glue dressing.

Your surgeon will give you full aftercare information before you have the surgery.

You can find out more about what happens during surgery with our guide How to prepare for your breast augmentation surgery.

Is it possible to have breast augmentation with a breast lift or tummy tuck?

It’s possible to combine procedures and have a breast lift done at the same time as breast augmentation. If you’d like larger, less droopy breasts, you’re the ideal candidate for this procedure.

Combining these procedures is unlikely to lengthen your recovery as your surgeon will be operating on the same area. Our guide Top 8 questions you need to ask before having breast uplift surgery will give you all the information you need about the breast uplift procedure.

Tummy tucks are also commonly performed at the same time as breast augmentation. However, having these two procedures done in one procedure will need a longer recovery.

The key benefits of having two procedures done at once is that you only need to have one pre-op, one hospital stay and one general anaesthetic. If you’re planning to have more than one procedure, you may also save money by having the procedures done together.

Some women choose to have breast lift and/or augmentation and a tummy tuck as part of a ‘mummy makeover’ after they’ve had children.

Resources

To find out more about the breast enlargement surgery Stephen McCulley provides, please contact us on or take a look at our procedures page on breast augmentation.

What to expect from having a second breast augmentation

Breast augmentation aftercare FAQs

Breast augmentation pain and swelling: what’s normal and how to reduce it

How to prepare for your breast augmentation surgery

How to reduce scars after breast surgery

How to massage scar tissue after breast surgery

Your guide to breast augmentation and the associated risks