What is a breast augmentation operation like? The day of surgery step by step

This page describes the day: what time you arrive, what happens before going into theatre, how long it takes, how you wake up and when you go home.

And it adds something almost never explained that is the most useful information of all: how much of the recovery depends on the technique and the protocol, and not on you.

Before going in: what happens at the clinic

Arriving. You come having fasted, with your paperwork and with someone to accompany you, because you cannot drive afterwards. The fasting instructions come from the anaesthetic team and may differ from the usual ones if you take certain medicines — it is explained in the pre-operative page.

The marking. 🔑 It is done standing, with the patient awake and in front of a mirror. It is the last check before surgery and the one least talked about: the inframammary fold, the midline, the axes of each breast and the boundary of the pocket the implant will go into are drawn on the skin.

It is done standing for a specific reason: on lying down, the breast shifts sideways and the landmarks change. Marking horizontally would mean marking an anatomy that is not the one seen when dressed.

The anaesthetist’s visit. They go over your history, your medication and the fasting, and explain how the process will go. It is the moment to mention anything you have forgotten.

And the signature. The consent form is signed beforehand, not in a rush on the day: it is a document with information about the procedure and its risks, and it is explained in the consent and paperwork page.

In theatre

The anaesthetic. Usually general. What it involves, who administers it and how you are monitored is in the anaesthesia page.

🔑 And there is a preliminary step that is always done here and that almost nobody mentions: before the surgery starts, the anaesthetist places an intercostal nerve block with ropivacaine. It is a long-acting local anaesthetic that dampens the pain signal from the chest wall and the breast, and it serves to improve the pain of the first 12 hours — the ones that are hardest. It does not replace the general anaesthetic or the painkillers: it is added to both. In aesthetic breast surgery, nerve blocks are associated with less pain at 2, 6, 12 and 24 hours, fewer opioids and less nausea, without lengthening the operation. It is set out, with its limits, on the anaesthesia page.

How long. Between 60 and 90 minutes for a simple augmentation. If it is combined with another procedure — a lift, a fat graft — the time is longer.

What is done, in order:

1. The incision, by the agreed route: inframammary fold, edge of the areola or armpit. Where each one leaves its mark is in the page on the scar by incision.
2. The pocket is created where the implant will go, in the agreed plane — subglandular, subfascial, submuscular or dual plane. The dual plane technique is on its own page.
3. The pocket is checked and bleeding controlled. This step matters more than it seems: in the series that achieved the fastest return to normal activity, one of the factors identified was prospective haemostasis with zero tolerance for bleeding.
4. The implant is placed and the symmetry checked, often by sitting the patient up on the table to see it upright.
5. It is closed in layers and the dressing and the bandage are applied. The post-surgical bra comes later, at 2-3 days.

⚠️ A note of honesty about this, because you will see both versions out there: some surgeons put the bra straight on at the end and skip the dressing phase. There is no scientific evidence supporting one option over the other: both are valid. Here the dressing is used for the first few days; another team doing the opposite does not mean either of us is doing it wrong.

⚠️ What is NOT decided in theatre: the volume, the implant model, the plane and the incision. All of that is agreed and consented to beforehand. What does get adjusted are fine details within the plan.

Afterwards: waking up and going home

Waking up. You go to a recovery area under observation. What you usually feel on waking is pressure and tightness in the chest rather than pain, and muscular discomfort if the implant has been placed under the pectoral muscle.

Pain relief starts there, to a schedule, and with it most patients describe mild to moderate discomfort.

Discharge. Most people go home the same day; in some cases a night under observation is advised. You leave with:

• The dressing on. The post-surgical bra, which is what holds the implant in position, goes on at 2-3 days. (And as you have read above: putting it on straight after theatre is equally valid; it is a team preference, not a difference in quality.)
• The medication schedule.
• The care instructions and the date of your first appointment.
• 🚨 And one piece of information worth asking for expressly if you are not given it: what number to call, at what hours and what counts as a reason to call. It is in the warning signs page.

The regimen, the medication and the appointments

The regimen is your choice, because both options are offered here: day case or with an overnight stay. It is not a decision communicated to you the day before.

The pain relief schedule is three synergistic oral painkillers: two base ones taken alternately and one rescue for when it is needed. It is designed so that you do not have to wait until it hurts, and it is usually more than enough — on top of the intercostal block covering the first few hours.

And the appointment schedule: at one week, at 2 weeks, at one month, at 3 months, at 6 months and at one year. After that, an annual ultrasound.

⚠️ It is a protocol schedule, not a rigid one: it depends on each case and can vary slightly. It adapts to how you are getting on — if something is slower, you are seen more often.

How long recovery takes

Why there is no figure

It is the question everyone asks and the honest answer is that it does not depend on one thing alone. It comes down to your anatomy, how your body reacts — which varies a great deal from person to person and cannot be entirely predicted — how you handle the recovery and also the surgical technique. All of that together.

⚠️ Be wary of anyone selling you the idea that their technique is what decides. It is a convenient commercial argument because the surgeon controls it and it sounds like a guarantee, and it does not hold up: two patients operated on the same day by the same surgeon with the same technique recover at different rates.

What has been published

There is a classic paper that took the matter to an extreme and is worth knowing about, with its limits stated first. It prospectively studied 627 augmentation patients applying a series of technical refinements, and more than 96% were able to return to full normal activity within 24 hours or less: raising their arms above their head, carrying objects of normal weight and driving.

The factors its authors identified as decisive:

• Prospective haemostasis, with zero tolerance even for the smallest bleeding.
• A “no-touch” technique on the periosteum and perichondrium.
• Eliminating all blunt dissection.
• Carrying out all dissection under direct vision.
• Simplified instrumentation.
• Optimal use of muscle relaxants during subpectoral dissection.

⚠️ How to read this honestly. It is a single surgeon’s series, highly refined, with its own patient selection, and the 24-hour figures are not what most patients experience or what you are going to be promised here. What it teaches is that surgical care — bleeding little, not manhandling the tissues — affects how much it hurts afterwards. Not that technique decides everything.

🔑 The useful question for the consultation is not which technique is used, but how long their patients typically take to go back to each thing — and if you are given a single figure for everyone, that figure is not real.

Frequently asked questions

How long does the operation take?

Between 60 and 90 minutes for a simple augmentation under general anaesthetic. If it is combined with another procedure, longer.

Do I go home the same day?

Most patients do; in some cases a night under observation is advised. Either way you need someone with you, because you cannot drive.

Why am I marked standing up?

Because on lying down the breast shifts and the landmarks change. The fold, the midline and the axes of each breast are only where they should be with the patient upright.

Is the size decided in theatre?

No. Volume, implant model, plane and incision are agreed at the consultation and recorded in the consent form. In theatre, fine details are adjusted within the plan.

Does it hurt a lot on waking?

What is usually described is pressure and tightness rather than pain, with added muscular discomfort if the implant goes under the pectoral. And there are two layers for that: the intercostal nerve block with ropivacaine placed before starting, which covers the first 12 hours, and a schedule of three synergistic oral painkillers — two alternating base ones plus one rescue — designed to stay ahead of the pain rather than chase it.

Do you leave theatre in a bra or in a dressing?

Here, in a dressing; the post-surgical bra goes on at 2-3 days. Other teams put the bra straight on at the end. There is no scientific evidence favouring one option over the other: both are valid, and that is why it is worth being wary of anyone presenting their way of doing it as the only correct one.

Is it true you can be back to normal within 24 hours?

It has been published: in a series of 627 patients from a single surgeon, more than 96% returned to full normal activity within 24 hours or less. It is not what most people experience, and it is not what is promised here. How long you take depends on your anatomy, on how your body reacts and on how you handle the recovery, as well as on the technique.

When does the breast start to settle into place?

At first the implants sit high and the whole thing feels firm; they descend and soften over the weeks. It is explained on the warning signs page, because it is the question that generates the most calls.

Sources

• Tebbetts JB. Achieving a predictable 24-hour return to normal activities after breast augmentation: Part II. Plastic and Reconstructive Surgery, 2002. PMID 11786828. — A prospective series of 627 patients in which more than 96% returned to full normal activity within 24 hours or less — including raising their arms above their head, carrying objects of normal weight and driving; factors identified: prospective haemostasis with zero tolerance for bleeding, a no-touch technique on the periosteum and perichondrium, elimination of all blunt dissection, complete dissection under direct vision, simplified instrumentation and optimal use of muscle relaxants in subpectoral dissection.
• Risks and Complications of Breast Implants. U.S. Food and Drug Administration, updated 14 December 2023. fda.gov. — Haematoma, infection and seroma among the local complications of the immediate post-operative period occurring in at least 1% of patients.

• Ou Y, et al. Efficacy and Safety of Nerve Block for Postoperative Analgesia in Patients Undergoing Breast Cosmetic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Aesthetic Plastic Surgery, 2024. PMID 36939869. — A meta-analysis of 10 randomised trials and 565 aesthetic breast surgery patients: less pain at 2, 3-4, 6-8, 12-16 and 24 hours, lower opioid consumption in the first 24 h, less need for additional analgesia and less nausea or vomiting, with no difference in the length of the operation. ⚠️ It pools different types of block and with high heterogeneity in several outcomes.

Book your consultation

If you are arranging a date, there are two specific questions worth taking to the consultation: what perioperative protocol is followed and how long their patients typically take to go back to each thing. The literature shows that a good part of the recovery is decided there. At our practice in Valencia they are answered with your case in front of us.

Clinical confirmation by the surgeon

Dr Enrique Salmerón González

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624077

Dr Elena García Vilariño

Specialist in Plastic, Aesthetic and Reconstructive Surgery
Registration no. 46/4624503