Reasons for undergoing breast surgery

The reasons women undergoing breast augmentation choose to do so varies widely, these reasons can include:

• Aesthetic preferences and requirements: such as enhancing volume, shape or symmetry to match personal ideals after events such as weight loss, pregnancy, breast cancer or ageing.
• Reducing breast size that causes discomfort or pain: relieving physical strain on the neck, back or shoulders or addressing skin irritation.
• Wanting to feel more comfortable in their own skin: helping the person feel more at ease with their appearance.
• Seeking to reduce perceived social stigma: addressing feelings of being judged or singled out due to breast size or shape.
• Boosting self-confidence and self-esteem: achieving a physical change that positively impacts mental wellbeing.
• Regaining a sense of normality or identity: particularly following illness or body changes due to pregnancy or ageing.

How to emotionally prepare before surgery

The best way to emotionally prepare yourself before cosmetic breast augmentation surgery is to identify exactly what it is you hope to achieve from the operation. Is it a reduction in pain, to even out breasts or to enhance the size?

Dr Weston says, 'No body is ‘perfect’ and bodies also change as we age, so really be honest with yourself about your reasons for wanting the surgery and what your expectations are about the results - both short-term and long-term'.

'You should only be wanting the surgery for yourself, and not because you think it will change how others will see you.'

With these reasons clear in your mind, the next step is to discuss your goals and expectations in detail with your surgeon. This conversation should cover both the physical outcomes you are hoping to achieve and any emotional or psychological factors influencing your decision. Being open about your motivations will help the surgeon assess your suitability for the procedure and offer guidance on what results are realistically achievable.

It is important to choose a qualified and experienced cosmetic surgeon who is registered with the General Medical Council (GMC). Plastic surgeons who are GMC-registered are required to meet professional standards of practice and conduct. This means they must not only demonstrate technical competence in carrying out cosmetic procedures, but also show a clear understanding of the psychological aspects of surgery while aiming to achieve patient satisfaction.

A GMC-registered surgeon will assess not just your physical suitability for surgery, but also your mental wellbeing and reasons for undergoing the procedure. This helps to protect patients from unnecessary or inappropriate surgery and supports better overall outcomes. By choosing a surgeon who follows these standards in considering what is best for both your physical and mental health, you can feel more confident that your care will be responsible, ethical and centred on your wellbeing.

Dr Weston says, 'Listen to everything the surgeon is telling you - women who want implants can tend to focus on the things they want to hear and filter out the rest. Don’t be afraid to ask as many questions as you need as they might be a professional but you are the customer and need to have realistic expectations of what is on offer.'

It is your surgeon’s job and responsibility to explain how you can expect your breasts to look and feel following the operation. Without this consultation, neither of you will be able to manage your expectations. If the gap between your expectations and the likely outcome of your procedure is too wide, then you may experience a greater sense of disappointment or distress afterwards.

Dr Weston says, 'Speaking with a psychologist beforehand is especially important if you have a history of depression, anxiety or significant body image concerns. Having cosmetic surgery can be the best thing that some women feel they have ever done but sadly that isn’t the case for everyone.'

What to expect immediately following an operation

An important element to remember is that any invasive changes to the breasts require a surgical procedure, and there are a number of after-effects which are normally associated with undergoing a major operation.

Dr Weston says, 'It’s important to remember that low mood is common following surgery, even when it does go well. Your body has been through an operation and will feel a bit battered, bruised and in pain. This might also disturb your sleep, leading to increased fatigue and decreased tolerance to everyday stress.

'Negative emotions can also be exacerbated by dealing with the physical effects of healing, such as sensitive skin, noticeable changes in nipple sensitivity, numb breasts, managing wounds and dealing with scars. This can lead to anxiety or low mood.'

General anaesthesia

These include the effects of general anaesthesia, which can last in the body for up to three weeks. The residual impact of anaesthesia can have both emotional distress and physical symptoms, including lethargy and depression.

Pain medication

Pain medication is also usually prescribed to help you recover following your operation. Painkillers can cause lethargy, and a feeling of disorientation similar to what you would experience due to intoxication.

Swelling and discolouration

It’s common to feel eager to see the results of your breast surgery, even in the early days before swelling and bruising have settled. However, it can be unsettling to look at your breasts too soon after the procedure. The initial appearance may be distorted by post-operative swelling, discolouration and dressings. This, combined with the effects of pain relief or anaesthetic, can sometimes lead to feelings of disappointment or shock.

Dr Weston says, 'Seeing the new breasts for the first time can actually be quite distressing for women as they won’t look like the finished result for some time and might look quite unnatural. This is due to the swelling, bruising and the fact that it takes time for the implants to settle into their final position.

'Women can panic at this point, worrying that their breasts are not the shape or size they desired and can get anxious that this won’t change over time. It’s important to remember that the body needs time to heal and adjust (it can take some months for a complete recovery) - but also your mind needs time to adjust to seeing something different when you look in the mirror.'

Reduced mobility

Following your operation, you may be physically confined to your bed, or restricted to limited movement within the confines of your home. Recovery can take weeks, and so feelings of restlessness, boredom, helplessness and uselessness can arise. This can be compounded if you do not have friends or family who are available to visit regularly, or be on hand to help in the immediate few days following surgery.

Depression after breast surgery

Some people may experience emotional changes such as anxiety disorders after breast augmentation - even after successful breast surgery. This can affect those with pre-existing mental health conditions like depression or anxiety, as well as those with no prior history of having depressive or anxious personality traits. In many cases, low mood develops when surgery does not meet personal expectations or fails to ‘fix’ a perceived flaw. This disappointment can lead to ongoing anxiety or depression about appearance. In more severe cases, unresolved body image issues, including body dysmorphic disorder (BDD), may contribute to repeated procedures and a growing dependence on cosmetic surgery.

• Your surgery may leave visible scarring: everyone heals differently. This means you may find scarring left over from your operation, which causes you to feel uncomfortable about your appearance or dissatisfied with the results. While scarring does usually fade, it will not go away completely.
• You may find a loss of sensation: typically occurring in the nipple, you may find that your breasts are considerably more or less sensitive. This may cause you to feel physically uncomfortable or upset about the loss.
• Your breasts may change in shape: while the surgery may help you to alleviate one thing, it may cause you to have issues with another. If you are seeking the surgery for aesthetic reasons, you may find the results differ from what you initially expected.
• Your breasts will droop over time: cosmetic surgery often involves the removal of important fats or skin. Due to this, the affected area may become less stable and has a higher chance to fail as your body ages. Also, your body will sag naturally as you age - breast augmentation is not a permanent cure-all for your problems and you may find yourself wanting further procedures.
• You may lose the ability to breastfeed: for many mothers, the natural process of childbirth is important; the loss of this can be upsetting, so you should consider your priorities and not make a decision that may have permanent consequences for later in your life.

However, a US study into the effects of bilateral breast reduction on anxiety and depression found that the majority of women in their study who had depression and who chose to undergo breast surgery saw an improvement in their mental health. Like physical health, each person’s mental health and needs are unique, so you should be certain to discuss your decision to have cosmetic surgery with your therapist and research the potential consequences of it.

How to prevent post-surgical depression after breast augmentation

A strong support system can make a big difference during the recovery process after surgery. Let your friends and family know what you’re planning, how you’re feeling, and what kind of help you might need - whether physical, practical or emotional. Don’t hesitate to ask for support.

• Plan ahead by preparing your recovery space before your operation. Make sure your bed is close to essentials like water, snacks, your phone, books and warm clothing. If needed, move your bedroom to a downstairs room to avoid stairs and stay near the toilet. Your surgeon will advise on how much time you may need off work, so plan accordingly.
• Focus on your health by eating nutritious food and staying hydrated. Avoid alcohol, as it can interfere with pain medication and worsen your mood during recovery.
• Give yourself time to heal. Try not to judge your results too early - swelling and bruising will take time to subside. It’s also normal not to feel better straight away. Allow yourself to recover at your own pace, both physically and emotionally.

Long term effects

Once you have recovered from the surgery and the swelling and bruising have died down significantly, it will be time for you to take stock of your new breasts, and hopefully, the shape and size will be as you anticipated.

Many women do feel happy and satisfied with the results of their surgery, and report an improved sense of self-esteem and confidence - however, even if the operation has technically been a success, it is not uncommon for the final results to fall short of your expectations, which can cause distress and depression symptoms. Many women who undergo breast augmentation report long-term satisfaction with their decision, although some may experience ongoing psychological challenges.

Dr Weston says, 'If you’re still in the first few months post-operation, allow time for your body to heal and the implants to settle. To cope during this time, try to 'park' your worries until a certain date (e.g. six months), absorb yourself in the rest of your life, then re-evaluate what your breasts look like at the end of the healing process.'

In addition, individuals who underwent surgery due to unhealthy motivations or with unrealistic expectations may find that their operation has not resolved their concerns, or may even have created further problems.

In these circumstances, you may feel depressed, stressed or experience shame or embarrassment. There are a number of options for you to now explore, including:

• Speak with your surgeon to ascertain whether you can expect your breasts to continue to change shape into what you originally anticipated
• Find out whether further surgery will help you achieve your goals
• To talk to a therapist or counsellor about coming to terms with the way your body now looks and feels

Medical negligence

However, if your breasts have not turned out the way you anticipated due to negligence on behalf of the surgeon or clinic, the situation can become more complex. Again, many women experience a sense of shame, guilt or embarrassment following a failed cosmetic breast surgery. They often feel that it is their responsibility for it going wrong, due to the fact they opted to undergo the procedure in the first place.

Dr Weston says, 'Women can also be left feeling like their breasts aren’t their own anymore and can experience feelings similar to having their body assaulted and damaged by someone that they trusted. In the worst-case outcomes, women can develop serious psychological issues, such as post-traumatic stress disorder, severe clinical depression and adjustment disorders.'

In this situation, affected women are encouraged to:

• Speak to their surgeon, or the clinic where they underwent their operation, to find out if a corrective procedure can be undertaken
• Speak with a therapist or counsellor
• Confide in friends and family and ask for support

They may also wish to consult with legal representation to see if they can claim for emotional and/or physical damages.

Dr Weston says, 'Remember that there is more to you as a person than what your breasts look like. What feels crucially important to us is often insignificant to those around us. Our natural response to body parts that we have issues with is to keep obsessively checking them, examining every tiny detail and seeing all the perceived flaws, from every angle. Nobody else tends to view our bodies in that way!

'And the more we critique a disliked part of our body, the more things we notice that fit with our view that it’s ugly in some way - our minds magnify every perceived deficit and make us increasingly unhappy and fixated on the ‘problem.'

'Instead, look around you, observe a wide range of women of all shapes and ages, and notice what their breasts actually look like. You’ll hopefully realise that there is no ‘normal’ and that the appearance of your breasts does not have to affect the way you feel about yourself or the way you live your life - unless you allow it to.'