Breast enlargement: surgery, natural causes and when to see a GP

The phrase is used in two ways. In cosmetic surgery, breast enlargement, also known as breast augmentation, is an operation in which implants are inserted into the breasts to increase their size, change their shape or make them more even. The NHS says it is often known as a boob job and is a big decision.

It is also used for breasts becoming larger without surgery, which is common and often normal. This happens in puberty, around periods, in pregnancy, and in men and boys as gynaecomastia. This page covers both, and explains when a change in the breasts should be checked.

The NHS describes the operation as usually carried out under general anaesthetic. A cut is made in the skin next to or below the breast, the implant is placed either between the breast tissue and chest muscle or behind the chest muscle, and the cut is stitched and covered with a dressing. It takes between 60 and 90 minutes, and you may be able to go home the same day or need to stay overnight.

There are 2 types of implant, silicone or saline. The NHS says silicone implants are the most common in the UK and are less likely to wrinkle and feel more natural, but can spread into the breast and cause lumps. Saline implants are more likely to fold, rupture or go down over time, and if they do the saline is safely absorbed.

Recovery takes a few weeks. The NHS says you should take a week or 2 off work, not drive for at least 1 week, and avoid heavy lifting or strenuous exercise for at least a month. After 6 weeks you should be able to return to most normal activities, and after a few months your breasts should start to look and feel more natural.

The NHS lists problems that implants can sometimes cause. It also points out that implants do not last a lifetime, that some women need further surgery after about 10 years, and that you will have to pay for any follow-up surgery you may need.

• Thick, obvious scarring.

• The breast feeling hard because scar tissue has shrunk around the implant (capsular contracture).

• A ruptured implant, which may cause small tender lumps (siliconomas) and means the implant will need to be removed.

• Creases or folds, rotation of the implant, or rippling.

• Changes in nipple sensation, either more sensitive, less sensitive or numb, and slightly less breast milk when breastfeeding.

• Bleeding, blood clots, infection and allergic reactions, as with any operation.

• An association with an uncommon immune system cell cancer called BIA-ALCL, in a very small number of people.

The NHS says you cannot usually get breast enlargement on the NHS, and that you will usually have to pay for implants. There are some circumstances where you might be able to, for example if you have very uneven breasts or no breasts, and it often depends on the area you live in. Your GP should be able to tell you more about the rules in your area.

The NHS website gives a cost guide for breast implant surgery in the UK of around £3,500 to £8,000, which does not usually include consultations or follow-up care. Check that any hospital or clinic in England is registered with the Care Quality Commission, that the surgeon is registered with the General Medical Council and on the specialist register, and consider whether they are members of BAPRAS or BAAPS. Always book an appointment to meet the surgeon beforehand and ask about their experience, complication rates, implant type and follow-up.

The NHS also advises being clear about why you want a change, taking time to decide, being cautious about social media advertising, and being offered a cooling-off period after any consultation.

Breasts change over a lifetime and through the month. The NHS describes the following common, usually harmless, reasons for larger or more tender breasts.

The NHS lists sore breasts among the early signs and symptoms of pregnancy, saying your breasts may become larger and feel tender, just as they might before your period. NHS inform says many women experience tender breasts around the time they would have expected a period, which can be confusing, and that a home pregnancy test is a reliable way of checking whether you are pregnant.

Breast tenderness on its own is not enough to confirm a pregnancy. If you think you may be pregnant, the NHS breast pain page suggests doing a pregnancy test first before seeing a GP about breast pain. Tell a midwife or GP about any lump or nipple changes during pregnancy rather than assuming they are hormonal.

The NHS says gynaecomastia affects men and boys and that the main symptom is getting bigger breasts than usual. The nipples or breasts may also look swollen or feel sore, and one or both breasts may be affected. Causes can include hormone changes in men aged over 50 or during puberty, being overweight, certain medicines, conditions such as an overactive thyroid, kidney disease or cirrhosis, drug use including anabolic steroids, and, in newborn babies, the effect of pregnancy hormones.

It is often harmless and may not need treatment. If it is a problem, the NHS says a GP may recommend medicines that reduce or increase certain hormones, or losing weight if overweight, and that treating an underlying condition may help. Surgery can reduce the breasts if other treatments have not worked, but it may not be available on the NHS. When gynaecomastia happens in newborns or because of puberty, it usually goes away by itself over time.

The NHS says you might be able to have a breast reduction on the NHS if other options such as wearing professionally fitted bras have not worked and you have health problems caused by having very large breasts. These include back, shoulder or neck pain, skin irritation under the breasts, grooves on the shoulders from bra straps, low self-esteem or depression, and not being able to take part in sport or exercise. Your breast size, weight, general health and whether you smoke may also be considered, and the exact criteria depend on where you live.

The NHS says breast reduction is a major operation that usually takes 2 to 3 hours with a stay of 1 or 2 nights in hospital, and that it can take 2 to 6 weeks to recover. Doing it for appearance rather than health reasons means paying privately.

Most breast changes are harmless, but some need checking. The NHS says to see a GP if you notice any of the following, and that the doctor or nurse will be used to talking about these symptoms.

• A lump or swelling in your breast, chest or armpit.

• Changes in your breasts or nipples that are not normal for you, such as the nipple turning inwards or dimpled skin.

• Nipple discharge, particularly if it is bloodstained.

• Persistent breast or nipple pain that is not going away, or pain with a history of breast cancer in the family.

• A rash on or around the nipple, or a change in the size or shape of one or both breasts.

• For men: bigger breasts that worry you, a lump, skin changes or discharge from one or both nipples.

Breast changes that need medical review go through a GP, with referral to a breast clinic if needed; the NHS says breast clinic tests usually show a lump is not cancer, and results of examination, mammogram or ultrasound are often given on the same day. Gynaecomastia and breast reduction on health grounds are also considered by the NHS, depending on local criteria.

Cosmetic breast enlargement is almost always a private decision. Take time before committing, check the registration of the clinic and surgeon, and keep your GP informed. After implants you should still attend breast screening and tell the person doing your mammogram that you have implants, and report any changes in your breasts quickly to your GP.