Breast augmentation — an implant is not a lifetime object but one you will come back to

Breast augmentation changes size and shape with an implant. Moving your own fat is another route, but it comes with its own limits on volume per session and on how much survives. This page covers implants only.

Three things have to be decided.

Where it goes — under the chest muscle, under the breast tissue, or a variation between them. The position changes how it feels to the touch, how visible the implant edge is, and which later problems are more likely.

Where the incision goes — the fold under the breast, the armpit, or around the areola. This decides where the scar sits.

Which implant and what size — surface, shape, and a size that matches the width of your chest. The size you want and the size your body can carry are different questions.

It is done under general anaesthesia, and lifting the arms is restricted for several days.

An implant is not something you keep for life. Rupture, capsular contracture, movement, a change of mind about size — it is more accurate to decide on the assumption that you will be operated on again at some point. This is the explanation most often left out.

Capsular contracture is the characteristic complication. The capsule the body forms around the implant can thicken and tighten, making the breast hard, changing its shape and hurting. Once it happens it usually needs another operation.

Sensation can change. The nipple and areola may become dull or oversensitive; this usually recovers, but not always.

Breastfeeding and mammography can be affected. Feeding does not become impossible, but it depends on incision and implant position. When you have a mammogram you must say that you have implants — it changes how the images are taken.

Some rare things matter. A lymphoma associated with certain implant surfaces, and a cluster of symptoms reported under the heading of implant-associated illness, have both been described. Which implant is going in, and what regulators in various countries have said about that product, are questions to ask before surgery.

If one side swells again, if the shape changes suddenly, or if you run a fever, report it immediately.

The width of your chest sets the limit on size. An implant wider than the base of the breast shows its edge, drifts outward, and thins the skin over it. The number that fits comes before the number you want.

Check your existing asymmetry first. Breasts are not symmetrical to begin with. Identical implants leave that difference in place — sometimes more visible than before.

Get the product name, manufacturer and warranty in writing. You will need that information if something goes wrong later.

Not smoking matters especially here. It bears directly on wound healing and infection risk.

You will need checks afterwards. Rupture can progress without symptoms, so it is better to agree in advance how and how often it will be looked at.

Read 'reversible' carefully. The implant can be removed. But removing it does not return you to how things were: the skin and the tissue beneath have already been stretched once.

This operation generates decisions later. It is worth thinking about what options the version of you ten or twenty years from now will have.

Size is hard to settle from photographs. The same implant reads differently against a different height, shoulder width and ribcage.

If you plan to have children, discuss the timing with a doctor. Shape and volume change after pregnancy and breastfeeding.

Whether to have it done is settled with a doctor, and it is better not to settle it on one consultation alone.