What you need to know about Breast Enhancement Surgery

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If your cleavage lacks clout and you feel cheated by Mother Nature with your bee-sting breasts, a solution has never been more accessible. However, if plastic surgery is what you want, it's essential to have the facts before you...

These days, you could be forgiven for feeling that to remain untouched by the plastic surgeon's scalpel is practically abnormal. Botox, collagen fillers, liposuction and, of course, boob-jobs are splashed all over our celebrity gossip magazines, adverts, on TV and in films. Recently, there have been reports that even middle-aged men are taking the plunge and opting for tummy-tucks and 'moob-jobs' in the quest for the appearance of eternal youth.

While breast enhancement has been around for decades (in fact, the first breast-implant surgery was carried out in 1895!), popular opinion dictated that boob-jobs were only for porn-stars, glamour models and 'it' girls. Not so anymore. Perhaps society now views big, firm, pert breasts as the norm - which can surely only worsen any issues women have over their own endowment. There is a lot of information available to women considering breast enhancement, and the following summary is a brief review, set out as simply and clearly as possible.

Who opts for boob-jobs - and why?

The category I want to focus on here is women who (for whatever reason) yearn to change the size, shape and position of their breasts. In studies published in recent years in the medical journal Plastic Reconstructive Surgery, it was found that women who opt for breast enhancement for cosmetic reasons tend to be, on average:
- Young
- Healthy
- Of a high socio-economic status
- Often married with children
- Tending to have slightly higher levels of low self-esteem, depression, or conditions such as body dysmorphic disorder, than those exhibited in the population as a whole The Department of Health explains that women often have breast enhancement surgery because of dissatisfaction with the size and shape of their breasts, to regain size or shape following childrearing, or to correct deformities or asymmetry.

Many flat-chested women feel less feminine and curvy than their big-boobed counterparts, and in this instance a boob-job can bring significant psychological benefits.

It's important to remember that you shouldn't even consider a boob-job unless it's because you want it. Partners and loved ones should like you for who you are - otherwise they're just not worth associating with!

What options are available?

To begin with, there are implants. There are two main types of breast implant - silicone gel or saline. Both of these implants:
- Have a long history of use
- Have not been clinically proven to be unsafe, despite media reports to the contrary
- Are available in a 'teardrop' (anatomical) or round shape
- Consist of a silicone shell with different filling options Saline implants obviously contain a saline filler, which is chemically similar to products found naturally in the body. This means if the implant bursts, the filling will be safely absorbed and then secreted by the body. This implant is less suited to women with very little natural breast tissue, is also more prone to wrinkling, rupture or deflation, and is thought to have a shorter 'shelf-life' than its silicone counterpart.

Silicone implants are available with either a soft or firm filling. The soft filling feels most natural, and the implant is less prone to tell-tale wrinkling, while the firm gel has the security of keeping its shape, even if the implant shell were to rupture, however, it may result in a slightly larger incision scar. There are a couple of other types of implant available, such as the soya oil variety, but these are not licensed in the UK and there is more medical speculation over the dangers of these other types than over silicone and saline varieties.

Surgical procedures

There are different ways to position the implant in your breast, and different places to make that first incision. As with the implants, these each have their own pros and cons. It's worth noting that not all surgeons carry out all the available techniques. In the simplest terms, there are two locations the surgeon can place the implant:
- The subglandular position (the implant is placed between the chestwall muscle and the natural breast tissue)
- The subpectoral position (the implant is placed under both the chest muscle and the breast tissue)

The subglandular position is considered to look the most natural, but any wrinkling or rippling may show more prominently. Subpectoral breast enhancement suffers less from wrinkling problems and is thought to give a more natural look to women with little of their own breast tissue - but some people believe this type is more likely to sag.

Typically, there are four types of incision available to surgeons when performing enhancement surgery:
- Inframammary incision involves cutting under the breast, where a scar will be hidden by the position of the breast. This is most suited to patients who will have breasts of a suitable size to conceal the scar in the fold of the breast
- Periareolar incision involves cutting around the nipple area, and is most common in mastoplexy (breast-lift). Scarring here can be less obvious, depending on the natural colour of a woman's areolas
- Transaxillary incision involves going in from the armpits, producing a scar that will not be easily spotted, even by the keenest eye
- Transuembilical inncision (knowtn as TUBA) - makes an incision in the navel and a saline implant is inserted from there. The obvious benefit of this is that nobody would ever think to look for your boob-job scar in your belly-button, but it is generally recognised that this procedure suffers problems with attaining good symmetry - for obvious reasons.


The Breast Implant Information Society (BIIS) offers some advice on what to expect from your consultations - such as taking a list of questions, and a pen and paper to take any notes. The Department of Health also offers a comprehensive checklist of questions to ask a prospective surgeon - which is a helpful first port of call. The BIIS also point out that the various clinics advertising in the back of many women's magazines are merely agents which give you the easiest access to a surgeon.While this is not necessarily a negative thing, it's important to remember that the free consultations they offer are with surgical 'advisors', and not usually the surgeons themselves.

The BIIS advise that you do not make a decision until you have had a consultation with the actual surgeon who will be performing the procedure. This will be an additional cost, but it's worth it. Don't be afraid to schedule more than one consultation with more than one surgeon; this is your body we are talking about, and you have to be 100 per cent happy with the person about to slice you open before you part with your money... or go under the knife. Try to remember that your surgeon will do everything within their power to give you the look you desire, but they are not miracle-workers, and your finished result will depend on a lot of things
- particularly the size and shape of your breasts prior to surgery. You should try your best to have realistic aims.

How much will it cost?

There doesn't appear to be such a thing as a 'one-price-fits-all' approach to boob-jobs. It boils down to the type and size of implant, the type of surgery, the amount of aftercare you require, and so on. The BIIS give a guideline of between £3,500 and £5,000. One way to reduce the cost is to consider plastic surgery overseas. One clinic in Prague offered a total package from between £2,089 and £2,674. However, it is worth really doing your research on this one. You have to know where you stand once you return home if there should be any complications, and it is incredibly unwise to book a major operation without seeing the clinic and surgeon, so factor in the extra return flight to check out the clinic - and you may find it works out as well in the UK where you have more peace of mind. Boob-jobs aren't cheap, but economising on your aftercare could be very dangerous. Many companies offer finance options, which may suit your financial situation and make payment easier.

The op, after-effects... and complications

The operation lasts a couple of hours, and how long you remain in hospital will vary from person to person - but you can expect to be in for at least one night.

When you wake up you will be covered in dressings and be expected to wear a special support bra until told otherwise.

Initially there will be swelling and your cleavage area may feel very firm. The amount of pain you experience will depend on factors such the surgical technique, your personal pain threshold, the amount of swelling - and smoking is also known to retard the healing process. The Department of Health lists the post-operative 'warning signs' (that is, things happening after your boob-job that require medical attention) as deflated breasts, offensive wound discharge and excessive swelling, and heat or pain in the breasts.

Breast sensation tends to change after the operation too, and many women report a loss of nipple sensitivity - but this will vary from person to person. It may also take a few months for the breasts to look natural.

Telltale scarring

There are two possible types of scar that can linger as a reminder of a boob-job. The first is the incision scar, which may take a long time to heal and be very red, thick and even painful. This can remain after any surgical procedure, but you can take homeopathic arnica tablets to optimise healing, and applying vitamin E oil (or other oils specially formulated for scars) to the wound-mark can help reduce that angry look.

The second is an internal form of scarring known as 'capsular contracture'. The body will put up a wall of scar tissue (effectively a fibrous capsule) around any foreign body, in this instance, the breast implant. This will eventually shrink (known as the capsular contracture), but there is no way of determining by how much - which may distort the implant. Capsular contracture is indicated by the hardening of the breast. It may need further surgery to remove the implant, the capsule of scar tissue, or both.

This is the most common complication with breast-implant surgery, although the latest implants with a more textured shell have been developed specifically to reduce the amount of capsular contracture.

Life expectancy

It is difficult to establish an absolute 'use-by' date for implants. They are expected to last for twenty to twenty-five years according to the BIIS, but it is not fully known as yet. It is important to remember when considering a boob-job, that the implants do not last forever, and that down the line you must expect to shell out more of your hard-earned cash for replacements.

The 'risk' of silicone implants

A number of women have reported serious illness after having silicone implants. Their symptoms included rashes, hair-loss, musclespasms and painful joints. As a result, an independent review was carried out to determine if silicone implants were dangerous. The review concluded that it could not be clinically proven, so the current medical thinking is that silicone implants are safe. However, for the results of a survey like this to be more accurate, many longer-term studies would need to be carried out on women over a period of up to twenty-five years, studying separate groups who do and do not have breast implants, to see if any developing illnesses are only found in those who have gone under the knife. You can read the entire review online, allowing you to draw your own conclusions.

Non-surgical alternatives

Not sure that going under the surgeon's knife is for you? Can't afford implants? Terrified at the thought of it all? Here's a quick look at some other options:
- A good bra - there are so many options out there these days! There are ones that lift, ones with gel inserts - and don't forget chicken fillets and the like!
- Dusting a touch of bronzer down your cleavage creates the illusion that there's more there than there really is (think about how artists use darker paint to give a 3-D impression
- it's the same principle)
- The BRAVA system is a special bra, which claims to encourage the growth of breast tissue nonsurgically. At around £790 it is pricy, but cheaper than a boob-job
- Perfect C is a herbal supplement which contains natural hormone-like substances. This appears to be a favourite with the celebrities. A three-month supply will cost you around £175
- Hypnosis. No, really - some women swear by it. It could set you back up to £1000, depending on how many treatments you have
- DermaBreast products are beauty products containing natural phytoestrogens, which they claim will solve any breast woe (cure sagginess, increase size and firmness etc). The full kit costs $112 US, and they offer free worldwide shipping

Final advice

So, still thinking of taking the plunge? Here are some tips:
- Research, research, research. Ask friends who have had boob-jobs for advice and recommendations; look for related forums on the internet, check out unbiased websites such as those of the Department of Health and the BIIS
- Don't make any rash decisions. This is not a new pair of shoes; this is a major operation on your body
- Don't be afraid to see more than one surgeon. If you don't like the surgeon you have a consultation with, don't let him touch you with his scalpel
- Don't be tempted to settle for the cheapest option - it might not be the best for you. And be aware that this is a lifelong commitment; you will need to replace your implants at a later date - at further cost Remember that women do not all look the same, and this goes for your breasts as much as any other part of you.Without wishing to sound cliched, celebrate your uniqueness!


http://www.dh.gov.uk/en/Publicationsandstatist ics/Publications/PublicationsPolicyAndGuidance /DH_4010394 The Department of Health's Information Booklet

http://www.biis.org The Breast Implant Information Society

http://www.silicone-review.org.uk The Silicone Review website, containing all medical studies carried out on the risk of silicone implants

http://www.mybrava.org.uk The BRAVA non-surgical breast enhancement bra

http://www.perfectcbreastenhancer.co.uk The Perfect C breast enhancement supplement

http://www.biggerbreastsenlargement.org.uk DermaBreast natural breast enhancement products