Breast augmentation: a guide to breast surgery

Breast augmentation, which people also search for as breast surgery or breast enlargement, is the operation that changes the volume, contour and symmetry of the breasts, either with implants or by using your own fat. In this guide from Clínica EGOS we explain how the technique and size are chosen, what recovery is like and what a quote should make clear, so that you arrive at your first consultation knowing what to ask.

If what you want to know is where we see patients, at the bottom of the page there is a link for each city with its own page: Madrid, Barcelona, Girona, Málaga, Granada and Alicante.

What is breast augmentation?

Breast augmentation, also known as augmentation mammoplasty, is a cosmetic surgery procedure that improves the size, shape and symmetry of the breasts so that the bust is in harmonious proportion with the rest of the body. The ASPS (American Society of Plastic Surgeons) notes that it can also restore volume lost after pregnancy or weight loss and even out breasts of different sizes.

Many people call it breast surgery; you will also hear breast enlargement or augmentation mammoplasty. They all refer to the same operation, the one that seeks more volume, and it is always considered after an in-person assessment, never from a catalogue. When the aim is to lift a sagging breast, the surgery is called a breast lift (mastopexy); if you want smaller breasts, it is a breast reduction.

How breast surgery is done: with implants or with your own fat

There are alternatives in this surgery that allow it to be adapted to each patient. The way in depends on your anatomy and on the surgeon's preferences; the choice between an implant and your own fat depends on how much change you want and on the tissue available. These are the pieces of the decision.

With breast implants

The most common technique places an implant in a pocket created beneath the breast. SECPRE explains that it goes either directly under the breast tissue or under the pectoral muscle, and the ASPS describes those same two planes: under the muscle (submuscular) or behind the gland and over the muscle (submammary or subglandular). Which plane suits you depends on the type of implant, the change in volume you want, your build and what the surgeon recommends after examining you; there is no single best option in the abstract.

Implants also vary in shape and profile. It is one of the decisions discussed in the consultation, with the surgeon in front of you: what each option changes in the result and which one fits your body and what you want to see when you look in the mirror.

With your own fat (fat transfer)

When fat from your own body is used, it is called breast augmentation with fat transfer (lipotransfer): according to the ASPS, the fat is taken from another part of the body and placed in the breasts. It is an alternative for those who prefer not to have an implant and want a moderate change, provided there is enough fat to harvest. SECPRE points out that methods using the body's own tissue are used mainly in reconstructive surgery and that the usual method for increasing volume is implants.

Where it goes in: the three incisions

The incision is designed so that the scar sits somewhere hard to see. It can be made around the areola, along the edge where the skin changes colour; in the fold under the breast, which according to SECPRE is the most common approach and leaves the scar hidden in the crease; or in the armpit, which avoids a scar on the breast although it is technically more complex. The ASPS adds that the choice varies according to the type of implant, the augmentation wanted, your anatomy and the preferences of the patient and the surgeon.

Who can have a breast augmentation?

An adult in good health, whose breasts have finished developing, can consider this operation. Many women think about it after a pregnancy or breastfeeding, when the breasts have lost volume, or because they want a different size or shape. The ASPS also lists other reasons: feeling that the breasts are too small, that the upper part looks empty, or that one or both breasts did not develop normally.

The ASPS puts three conditions first: that you are physically healthy and neither pregnant nor breastfeeding, that the decision is yours and not someone else's, even if that person offers to pay for it, and that your expectations are realistic. SECPRE advises against this cosmetic surgery for minors (patient decalogue, 2014). At the first consultation, the plastic surgeon assesses every aspect of your case and your state of health before recommending anything.

Before the operation: preparation and first consultation

SECPRE details what is discussed at the consultation: whether you smoke, what medication or vitamins you take, how many pregnancies you have had and whether you plan to become pregnant or breastfeed again. The breast is also examined and, in some cases, a mammographic study is requested. Before the operation you receive instructions about food and drink, tobacco and medication, including iron supplements, and the society notes that a blood transfusion is not usually needed in breast augmentation.

It is worth organising the day of discharge: SECPRE advises that someone should take you home and, if necessary, help you for a couple of days.

Questions worth bringing written down

These are the questions that help you decide calmly: which technique and which implant placement plane the surgeon recommends for you and why, which route is used, what anaesthetic is used and whether there is a hospital stay, how many check-ups are part of the follow-up, who the surgeon operating on you will be (with their registration number), where the operation will take place and what the quote includes. If an answer does not convince you, ask for it to be explained again; the decision is yours.

How is the implant size chosen?

There is no ideal size that is the same for everyone. Size is decided at the consultation, and what is examined weighs more than a number: the width of the breast base, the amount and quality of your own tissue, the firmness of the skin, the proportion with your shoulders and hips and what you are looking for. SECPRE states that at the first visit the surgeon assesses the size and shape of the breast and the firmness of the skin, and afterwards you discuss what size and shape they will have after the operation.

That is why a specific bra size is not promised: it depends on each body and also on the bra model. Bring to the consultation photographs of breasts you like and of others you do not, and ask how the clinic chooses the volume and whether there is a way to visualise it before deciding.

Recovery from breast surgery, stage by stage

Each patient progresses at her own pace, but plastic surgery societies describe a fairly similar course after breast operations.

The first few days

After the operation the breasts are covered with dressings and held with an elastic bandage or a support bra, which limits swelling while they heal, according to the ASPS. SECPRE notes that it is normal to feel tired for a few days and that almost normal life returns within 24-48 hours. At Clínica EGOS we plan an initial rest of 24 hours and an initial recovery of around one week, which the surgeon adjusts to your case. Sharp pain usually eases within one to five days, again according to the ASPS, although some discomfort and swelling may remain for a few weeks.

The first few weeks

The support bra is worn day and night unless the surgeon says otherwise, according to the ASPS. SECPRE places the removal of stitches between 7 and 14 days and the disappearance of the swelling between 3 and 6 weeks, and recommends not lifting weight above the head during the first 2 or 3 weeks.

Going back to work depends on what you do: with a sedentary job it may be a matter of a few days, and with physical effort it is wise to wait longer. For sport, follow the plan your surgeon gives you; on the blog you will find a guide on exercise after breast augmentation and another on recovery after breast augmentation.

The first few months

Implants give volume from the first day, but the result settles over the weeks, as the swelling goes down and the skin adapts, according to the ASPS. Scars start out pink and, according to SECPRE, improve continuously from the sixth week; the ASPS adds that incision marks take several months, and sometimes a couple of years, to soften. If you are concerned about how the scar is developing, you can read about how to improve the scar after breast augmentation.

How long implants last and what check-ups you need

The ASPS makes clear that breast implants are not considered lifetime devices and may need replacing, and recommends an annual check-up with the surgeon to assess the health of the breast and the condition of the implant.

Over the years, moreover, the breast changes with age, weight, hormones and gravity, and so some patients end up considering an implant exchange or a mastopexy. SECPRE adds regular check-ups and the mammograms appropriate for your age as a way of detecting any problem in time. Like all surgery, breast augmentation has risks, which are explained in the consultation before you make your decision.

Pregnancy, breastfeeding and mammograms

SECPRE states that there is no evidence that breast implants affect fertility, pregnancy or breastfeeding, and that they do not prevent mammograms, although you must tell the radiographer that you have them. What can happen, according to the same society, is that the breasts sag somewhat after a later pregnancy. If you are thinking of becoming pregnant soon or at some point, say so at the first visit, because it forms part of the planning. You will find more detail in our article on whether pregnancy is compatible with breast implants.

When augmentation is not enough: sagging breasts and asymmetry

According to the ASPS, breast augmentation does not on its own lift breasts with marked sagging: in that case a mastopexy may be needed, either in the same operation or in a later one. If you are concerned about sagging breasts, on the blog we explain the options, from clothing to surgery.

When the reason is that one breast differs from the other, the surgeon measures them and sets out how to even them up; you have a guide on breast asymmetry and, if the breast has a tubular shape, another on tuberous breasts.

The cost of breast surgery: what it depends on

The amount for breast surgery differs from one patient to another and is made up of the technique chosen, the implant, any combination with another surgery and the follow-up afterwards. That is why we do not give figures before seeing you. After the assessment you receive a written quote in which each item is itemised, including what happens if an additional check-up is needed.

According to SECPRE, cosmetic breast augmentation is not included in the Spanish social security catalogue of services; marked breast asymmetry and reconstruction after breast tumour surgery are.

Where to have a breast augmentation

For each of these cities there is a page with its clinics, how to get there and how to request the first assessment: breast augmentation in Madrid, breast augmentation in Barcelona, breast augmentation in Girona, breast augmentation in Málaga, breast augmentation in Granada and breast augmentation in Alicante.

If your city is not on this list, the full list of clinics is at the bottom of the page, so that you can choose the one that suits you best.

Read more:

• One Breast Is More Swollen After Augmentation: What Should I Do?