Breast implants - How breast implant surgery is performed

Breast implant surgery is usually performed under general anaesthetic. This means you will be asleep and unable to feel any pain or discomfort during the procedure.

In some cases, your surgeon may choose to use local anaesthetic to numb your chest area and you may be given a sedative to help you relax.

You will be awake during surgery, but have very little awareness of what is going on during the procedure.

Your surgeon will discuss this with you before your operation.

Breast implant surgery

Breast implant surgery is sometimes carried out as day surgery, which means you will be able to go home the same day.

However, you may need to stay in hospital overnight if the operation is scheduled late in the day. Depending on the procedure you are having, the operation should take between 60 and 90 minutes to complete.

The incision

Breast implant surgery starts with your surgeon making a cut (incision). Your surgeon will discuss with you the exact location of the incision before the procedure. This will depend on the shape and size of your breasts and where you would like the scars to be.

There are different types of incision located in different places:

inframammary fold – the most common type of incision; a small cut is made in the fold underneath each breast
periareolar incision – the incision is made around the nipple and usually causes minimal scarring, but sensation in the nipple may be affected
axillary incision – the incision is made in your armpit area and may result in more obvious scarring
transumbilical breast augmentation (TUBA) – the incision is made near the belly button and a tunnel is formed with a blunt instrument to reach the breast; a saline implant is then placed and filled once in position (this technique is generally not offered in the UK because of problems with achieving the correct placement and shape of the implant)

Fitting the implants

After the incision has been made, the implants can be fitted. The implant can either be positioned between your breast tissue and your chest muscle (subglandular) or behind your chest muscle (submuscular).

In some cases, the surgeon is able to place the implant partly behind the breast and partly behind the muscle (dual plane operation). Your surgeon will be able to advise about the position that is best for you.

Once the implants are in place, the incisions will be sealed using stitches, which will usually be covered with a dressing. The stitches may dissolve on their own over time or they may need to be removed a week or two later.

Reconstructive breast surgery

Breast implant surgery for reconstructive purposes is slightly different from surgery carried out for cosmetic reasons. Reconstructive surgery is often carried out after a mastectomy (where one or both breasts are surgically removed, usually to treat breast cancer).

For reconstructive surgery, as well as using prosthetic (artificial) breast implants, natural tissue implants may also be used. This is where skin, tissue and muscle are taken from another part of your body and used to create a new breast. Tissue may be taken from the abdomen (tummy), back, thighs or buttocks.

Another option involves using a tissue expander that consists of an outer shell made of silicone. The tissue expander is inserted under your chest tissue and gradually inflated using saline (sterile salt water) over a period of a few months.

After the expander has stretched your skin and muscle enough to create healthy new tissue, it can be replaced with a silicone implant or left in.

Women who have had one breast or both breasts removed (a single or double mastectomy) can choose to have immediate or delayed reconstruction.

Immediate reconstruction

The advantages of immediate reconstruction are:

you will have your new reconstructed breast as soon as you wake up
you may undergo fewer operations and anaesthetics
the new breast may look better because the surgeon may use breast skin already there
there may be less scarring on the new breast

The disadvantages of immediate reconstruction are:

you will have less time to make a decision about the type of reconstruction you would like
any radiotherapy treatment you have after surgery could damage the reconstructed breast
any chemotherapy treatment you have after surgery could be delayed if there are complications during reconstructive surgery

Delayed reconstruction

The advantages of delayed reconstruction are:

you will have more time to make an informed decision about the type of reconstruction you would like
your breast cancer treatment will be finished and will not affect your reconstructive surgery

A disadvantage of delayed reconstruction is that you may have a larger scar on your reconstructed breast. You will also have to live with a mastectomy until your treatment is completed, although you will be offered an external prosthesis (breast-shaped bra filler) to maintain your shape in clothes.