By Consultant Plastic Reconstructive Surgeon, Martin Jones

Breast augmentation is the surgical procedure of inserting implants underneath breast tissue to increase the bust size. The procedure was first introduced in America in the early 1960s, since then its popularity has continued to sharply rise. It is now the most common aesthetic surgical procedure conducted in the UK. According to BAAPS (British Association of Aesthetic Plastic Surgeons) just under 8000 women had the procedure in 2016.

Over the years, subtle improvements have been made to the shell of implants as well as to their contents. All current implants have a shell that is made of silicone that is either textured, allowing it to stick to the breast tissue or it can be smooth. In the large majority, the filling is high-grade medical silicone. This can be soft in consistency or firm depending on what type of implant is selected. Saline or salty water is rarely used as the filler, as this is less life-like and has the disadvantage of rippling over time. Modern implants have a lifespan of around 10 to 15 years, although if they are still in good condition at that time, there is no necessity to change them. No implant will last forever, so it is likely that further surgery and expense will be encountered at some point in the future.

There are three broad scenarios where breast implants are used surgically. They may be used in a cosmetic operation to increase bust size equally on both sides of the chest. This may be seen in women who develop little or no breast tissue in their teenage years. We also see women whose breast tissue has reduced over time as a result of pregnancy. In this situation, an implant can restore volume and shape especially to the upper part of the breast. It can also be combined with an up-lift procedure or mastopexy to help correct droop or ptosis of the breast. If there is breast asymmetry, it may be appropriate to use different sizes to balance out the breasts, allowing clothes to fit properly. Lastly, implants can be used to help reconstruct a breast when it has to be removed in the treatment of breast cancer to help restore balance. It is important to remember that a cosmetic breast augmentation is not necessary for your health but may enhance your well-being.

It's very important to choose the right surgeon, you should pick a Consultant Plastic Surgeon who is on the GMC register. It is also ideal if they belong to either BAAPS or BAPRAS (British Association of Plastic and Reconstructive Aesthetic Surgeons). At The McIndoe Centre, all surgeons are GMC registered and belong to BAAPS and BAPRAS. Additionally, they all follow the Professional Standards for Cosmetic Surgery set by The Royal College of Surgeons- it may be wise to familiarise yourself with these to reassure yourself that all the surgeons here stick to concrete standards of good practice.

You should only consider surgery if you trust and understand the surgeon. Likewise, the surgeon must be able to understand your expectations and consider whether it is safe and ethical to deliver these expectations. In addition, it's important to feel comfortable and happy in the hospital where the procedure is to be performed. At The McIndoe Centre, the process is tailor-made to you. From the beginning to the end of your journey, you will always be seen by the surgeon who is performing your surgery. During the first consultation, your desires will be taken into account followed by a physical examination and thorough explanation of your options.

To make an informed and independent decision, it's important to discuss all the facts at this meeting, including the pros and cons of the surgery as well as the risk of possible complications. In addition, the type, shape and size of implants as well as where they are placed- just under the breast tissue or under the pectoralis chest muscle can have a significant effect on the outcome. No two women are the same so the art is in selecting the most appropriate procedure and implant to your requirements.

It is likely that a second appointment will take place before the operation so that any further questions can be answered. At this point the GP is often informed of the plan.

The operation is usually about an hour to 90 minutes long under a general anaesthetic. Most patients will stay overnight and go home the following morning. It's usual to take a week to 10 days off from work and a similar time off driving. You can expect there to be swelling for 4 to 6 weeks afterwards with the final result usually visible at four months. We mostly use dissolvable sutures and small dressings afterwards allowing a sports bra to be worn for the six weeks for support. It's also best to avoid heavy gym workouts and foreign travel for about six weeks afterwards. It's usual to come back several times post-operatively to see the operating surgeon to make sure both you and they are happy with the outcome.