Breast augmentation, better known as a "boob job," is not something that should be entered into lightly. Whether you want to increase your cup size, reduce your breasts or lift them post-pregnancy or weight loss, you want to enter into the process with your eyes wide open and fully informed. I spoke to Patrick Mallucci, founder of Mallucci London, to find out all there is to know about breast augmentation from the consultation to the recovery. Mallucci is a world-renowned breast surgeon who not only performs the procedures at his state-of-the-art clinic but also lectures on the subject of "perfect" breasts.
If you're thinking about undergoing breast surgery, keep scrolling for your straight forward guide to breast augmentation.
What does the consultation involve?
It involves a few things: Trying to get to know the individual and understanding the motivation that led them here. I learn about their medical background, in case there is anything relevant that may have significance when it comes to the surgery. Finally, I examine the patient physically, as this plays an important role whether going bigger, smaller or adjusting. Combining all those factors I get to a picture of what the patient wants, their expectations and what is realistically achievable.
The key is managing expectations. As you can imagine, people come in with a view of what can or can’t be done and I always use the phrase, "It’s not what you want, but what you can have." This is largely determined by your own anatomy and is true whether you're considering implants or a reduction. It's all about tailoring everything for that particular individual.
What questions should you be asking and what should the specialist be telling you?
People need to be well-informed about the procedure. Ask about the competence of the practitioner. Is this something they do often? How many cases do they do? What are their complication rates? Ask them to show you examples of their work and check that they are a member of a recognised organisation such as BAAPS or BAPRAS (you can look up who is registered on the websites). You could also ask your GP for recommendations.
How do you decide the size and shape?
One of the things I talk about is an aesthetic goal. I spent a lot of time trying to define what a naturally attractive breast should look like. Essentially, there are four key features of the breast that render it attractive. The end goal is trying to achieve this same attractive look whether lifting, going bigger or smaller:
The magic ratio between the upper pole and lower pole (meaning the amount of tissue above and below the nipple). It should be a 45:55 ratio—45% above the nipple and 55% below it. You want the breasts to be slightly fuller below than above.
With that ratio, you get a slight upward angulation of the nipple.
A natural upper pole slope from chest to the nipple.
A tight convex curve of the lower pole, from nipple to breast fold.
I use this as an aesthetic template. The size and volume then depend on the anatomy of the individual. Some will have more capacity than others. Some people are slim, and others are broader. This is called tissue-based planning.
Women can often fluctuate in weight, so what size should someone be going into surgery?
I think the key is stabilisation of weight if you tend to yo-yo. The extremes of weights are no-no's—obese or anorexic people are not good candidates. You should be at your ideal or stabilised weight. Some people say, "I’m a few pounds overweight, but this is me, and realistically, being lighter isn't going to happen," and that's okay.
Are there different types of implants?
There are many different brands of implants. I compare it to trainers (there’s Adidas, Nike, Reebok, New Balance and so on). In general, terms there are two different shapes: round or teardrop. They do different things and offer slightly different looks. People who want a more natural look will go for teardrop, while those after a less natural look will go for round. Anatomy may favour one over the other. In some instances, I may say you need a teardrop for your particular breast shape, or, on the other hand, round.
There was a lot of news about PIP implants a while back. How can you ensure the implants are safe?
Implants are never far from controversy. Ask the surgeon what implants they use, why they use them and for what reason they have been selected.
If someone doesn't live in London, how can they go about finding a reputable surgeon?
Talk us through the different types of breast surgery.
You can simply enlarge the breasts or reduce the breasts. Or, typically post-pregnancy or weight loss, where there is a dropping of the breast, you can opt-in for lifting. If the droopy breast has enough volume, then lifting alone is sufficient. Sometimes you have to lift and add volume. You can either add an implant or quite often we add fat using fat transfer. This way you, kill two birds with one stone. We carry out lipo from somewhere where there is excess fat then, rather than chucking that fat out, we use it to naturally enhance the breasts.
Of course, it depends on the patient's expectation, those that definitely want to see a volume difference might find the fat transfer is too subtle for them. On the other hand, the main problem may be the droop, so if you can want a little volume as well, then a fat transfer is ideal. Understanding the patients' preference and expectations is key.
What does under or over the muscle mean?
Very simplistically, the muscle is an extra layer of cover—if you’re thin we will put the implant under the muscle. In somebody that has a good amount of breast tissue to cover the implant, it can sit on top. Aesthetics comes less into play here, and anatomy more so. Even those who like the fake look won’t want a visible implant; they don’t want things like skin rippling or the edges of the implants to be seen.
Who are the best candidates for breast surgery? Are there people who this wouldn't be suitable for?
Someone that has a stable weight, in good health and, ideally, a non-smoker. People with the right expectations, if your expectations are very far from what can be delivered that would be a real red flag for us.
How long does the operation take? Do you need to stay overnight at the hospital?
For straightforward breast augmentation, it takes around an hour in surgery. Breast reduction and lifting can take two to three hours. Large reductions tend to stay overnight, but everything else can be done as a day case. For smaller lifts and implants, we can do under sedation with a local anaesthetic. It's a more American style, and recovery is much quicker. We started doing this 18 months ago, and it's the biggest change to my practice in the last 19 years.
How long does recovery take and what does it involve?
In general, it takes six weeks to recover. The trend today is that people get up and get going quicker than perhaps they once did. The quicker you get going the quicker you recover, wallowing in bed for seven days can actually set your recovery back.
With breast reduction, there is more scarring as it's like tailoring the breast. Scars are seams of the tailoring, and the excess skin is the cloth. We often treat people with a laser from three weeks after surgery to help with scarring. Topical gels containing silicone are good for scarring—we don’t know why, but they are! Healgel contains silicone and for some reason really seems to help.
What are the potential complications that can occur and how can these be avoided?
There can be some immediate complications related to surgery such as infections and bleeding and longer-term complications. Anybody who has implants may need to change them at some point in the future, so they have to understand that they might be back for more surgery. Reductions and lifts may change over time as we age. It's always good to discuss potential complications with your surgeon at the consultation stage.
What is the typical cost for breast enlargement and reduction?
I would say there is no typical cost. Straightforward breast augmentation with us starts from £9500. We’re probably more expensive than most. Reductions are a bit more, but not too much because there are no implants involved. Some people come to us for surgery to fix a previous surgery they had elsewhere and that is more bespoke and expensive.
Anything else our readers should know?
We always have a cool-off period. You'll come to us once for the consultation, go away and consult friends and family. Perhaps get a second opinion elsewhere. Then you'll come back for a second consultation.
You also have to get on with your practitioner and have trust in that individual. Sometimes those relationships don’t feel right, so we always like to see people twice.