Breast enlargement (augmentation)

Are you considering breast enlargement or augmentation? Do you feel that your breasts are too small in proportion to your body? Have they lost volume and firmness following childbirth? The surgeons at Bristol Plastic Surgery are frequently asked to help and are happy to offer the very highest standards of care, state-of-the-art operating facilities, the very best quality implants and the most responsible advice.

Femininity is most certainly not dependent upon breast size but for some, a little more definition and a nicely shaped figure can do much for one’s confidence. Be certain that you seek breast enlargement for your own happiness and not for any other reason.

We have the highest aesthetic standards and aim for a pleasing, safe and complication free outcome from our breast augmentation surgery. A consultation with an empathetic surgeon will provide important personal counselling. Please use the following information in conjunction with that advice.

Prices start from £6,200

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    Your consultation is your opportunity to meet your surgeon and to explain what you wish from breast enlargement surgery. Your surgeon will also want to know quite a bit about your general health, your sporting and other physical activities and of course any relevant personal or family history relating to your breasts. You should report any tendency to poor scar formation. Examination of the shape and slope of your torso will determine if there are limitations as to the size, shape and symmetry of the outcome.


    We will only offer implants that are of the highest quality from reputable manufacturers. All implants are essentially silicone implants as this material has stood the test of time. A type and shape of implant best suited to you will be proposed at your consultation.

    Fat transfer which uses your own fat to boost your breast volume is still under development but is proving promising. It requires several stages and is only suitable for a modest increase in size. Your surgeon can discuss whether this might be a suitable option.

    Important information

    November 2018

    “The published literature indicates that breast implants are thought to be safe, in general, but can have rare, serious side effects. I endeavour to provide patients with well balanced, up to date information to ensure those deciding to undergo breast implant surgery feel confident in their choice.

    Breast implants are amongst the most used and studied implantable medical devices in the world. Data from the Netherlands and the USA estimates that 1 in 30 women have breast implant/s in place in those countries.

    The important question is “Do women with breast implants develop more diseases than women without breast implants?”

    Since the introduction of breast implants in the 1970s, side effects potentially associated with them have been studied extensively. The medical literature to date indicates that the commonest problems associated with breast implants are capsular contracture, implant displacement and implant rupture. I receive monthly updates on the most recent publications.

    We now know that there is a rare form of lymphatic cancer known as Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), which may rarely occur around a breast implant. The risk of this happening in the United Kingdom is currently estimated to be 1:24,000. The disease usually presents with rapid enlargement of one breast due to fluid accumulating over a period of weeks around the implant. It is diagnosed by studying the cells in that fluid. BIA-ALCL is treatable by surgery, and if necessary oncology, especially when diagnosed early. BIA-ALCL seems to be related in some way, that we do not understand at present, to the surface texture of the implant. It has been found in Australia that the more textured the implant the greater the risk BIA-ALCL, however we are not seeing that linkage in the UK at this time. Research continues into this linkage. I have used the same textured Allergan implants since the early 1990s until I became aware of the Australian evidence. I have not seen a case of BIA-ALCL or autoimmune diseases to my knowledge and many patients return to see me for follow up while they have the implants in place.

    Auto-immune diseases have been studied extensively in relation to breast implants. There is no conclusive evidence of a causal link with breast implants or with texturing of their surface but it is agreed that more research is needed to assess any potential link with autoimmune diseases. This collection of symptoms is known by several names, such as Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA Syndrome) and Breast Implant illness (BII).

    I ask patients, who have undergone implant surgery with me, to return for 2-yearly follow up, for which there is no charge. It is also very important that you give consent for your details to be recorded on the UK National Breast Implant Register. Many countries also have these registers and collect anonymised information about patients with breast implants. This data allows international comparisons of outcomes, within the international legal privacy framework. The International Collaboration of Breast Registry Activities (ICOBRA) is the organization, currently comprising 20 countries, coordinating this work.

    To summarise;
    It has been concluded by Plastic and Breast Surgeons worldwide that:

    • We believe breast implants to be safe in general but they can sometimes have serious, side effects.
    • Women presenting with side effects must be taken seriously, supported and investigated.
    • BIA-ALCL is rare and, usually, eminently treatable
      Therefore, I advise:
    • When you have questions, particularly if you are concerned about symptoms that may be related to your implants, please come to talk to me.
    • I will do my utmost to ensure you are completely informed about breast implant surgery so that you can make well informed choices.

    Preparation for surgery

    Do please read and heed the recommendations in the ‘general advice’ section. Remember to tell your surgeon if you are on the contraceptive pill well in advance of the operation date. It is premature to go out and buy bras to the size you have an ambition to be. It is better to wait until after the breast enlargement and ensure that you have a good fit.


    Under general anaesthesia an incision is made in the groove where the lower part of your breast arises from the ribcage. Here it will be less conspicuous and will be just long enough to allow the creation of a pocket or cavity into which the implant can be carefully inserted. If your tissue cover is adequate, the pocket can be placed directly behind the breast tissue. Where there is less subcutaneous fat and your sporting activities permit, it may be better sited behind the pectoral muscle plane.

    After sealing any bleeding blood vessels, carefully selected implants are then inserted and the tissues sutured in layers. Drains, thin suction tubes which clear away unwanted blood and serum, are often avoided but in some cases, it is more prudent to insert them. The final skin closure will be with absorbable sutures and a small dressing.


    You may need to stay in hospital for one night and there will be some initial discomfort which will be controlled with analgesia. This rapidly settles and by the time of discharge, you will be on prescribed oral medication. You will be asked to wear a supportive sports bra day and night for the first six weeks and we like you to sleep on your back for the first few weeks.

    Take shallow baths to keep the small dressing dry until it is changed at the first follow-up visit. Any sutures that require removal can be taken out then.

    Beginning 4 weeks after surgery, the fine scar lines should be gently massaged for five minutes, twice a day, with a cream which can be supplied by us. Continue until they have fully softened and turned pale. Avoid sun exposure of the scars in the first year and consider using sunblock thereafter.


    There may be some bruising and a little swelling but this is usually modest following breast augmentation. This should have settled after 3 weeks.

    Nipple feeling depends upon small nerves that follow a variable path in different individuals. This may result in altered sensitivity and sometimes numbness following augmentation. This usually returns to normal over several months but there can be permanent loss of sensation.

    Depending on your occupation, you should be able to return to work after 2 weeks. Bear in mind that you will be unable to lift or complete strenuous tasks. (If you have had a simultaneous breast lift, return to work may need to be delayed a further 2 weeks.) Physical exercise should be avoided for the first 6 weeks and this includes housework such as ironing and vacuuming. Strenuous exercise including jogging, exercise classes, gym workouts and heavy housework should be avoided for 12 weeks.

    Scars may take 12 to 18 months to mature and their final appearance varies from person to person. Some lumpiness may persist for several months and a few individuals make very poor scars. They are usually aware of this. In general, breast augmentation scars are inconspicuous.

    Breastfeeding is quite possible after breast augmentation as the implant lies behind and not in the breast itself. Diminished nipple sensation may interfere with breastfeeding.

    Standard mammography, as used in screening for breast cancer, is not possible with implants in place but there are effective alternatives. You should continue normal self-examination remembering that all your breast tissue is in front of the implant.


    You will have in your mind an image of how you expect your breasts to look in terms of size, shape, cleavage and symmetry. While we will do our utmost to match those expectations and aspirations, it is not possible to give precise predictions. The same implant will produce differing changes in different patients. Where hopes are clearly not achievable, we offer advice on what is practical within the constraints of your tissues and good aesthetics. There can be no concept of a guarantee as to the outcome.

    Occasionally a patient becomes accustomed to her new larger breasts and may seek further enlargement. Fortunately, the tissues respond to the presence of the implants and it may be possible to increase the implant size after several months. Very occasionally, the patient cannot adjust to the larger breast volume and despite no other reason wishes the implants removed.The patient must accept the cost implications of this further surgery whether as a result of a complication or unmet expectations.

    Despite all these necessary cautions, we hope and expect you to have a trouble free and enjoyable experience from breast augmentation. We like to keep in contact and we ask you to make an appointment for a free of charge outpatient review every two years.


    Capsule formation: A natural membrane barrier known as a capsule forms rapidly around a new implant. This is normally very thin and undetectable. Occasionally, for reasons not well understood, the capsule can thicken and compress the implant, making it feel hard and misshapen. This can be mild or severe and may require surgical intervention. With modern textured implants, the incidence has fallen to 8% of cases meaning that one patient in 12 will experience some degree of firmness which is referred to as capsule formation.

    Implant rupture: The latest implants have a very tough and flexible outer shell but if it does rupture, the risk of silicone leakage is greatly reduced by the soft, non-liquid, gel nature of the cohesive filling. Rupture might present as an irregular bump on a previously smooth breast. It is not an emergency but we favour replacement of the implant as soon as convenient to avoid possible inflammation.

    Late haematoma and seroma: The spontaneous accumulation of blood or serum around the implant can occur without obvious explanation. If it does not spontaneously disappear it will cause asymmetry and require surgical intervention.

    Infection: This is fortunately rare and every precaution is taken to prevent its occurrence. If it does occur, the implant may need to be removed until it settles.

    Hypertrophic scarring: Lumpy red scars that take time to settle are more prevalent in certain races and parts of the body. It is uncommon in breast augmentation scars.