Despite growing numbers of women opting to undergo breast implant surgery and other cosmetic breast procedures every year, many are left disappointed with the results, even if the procedure has technically been a success.

One of the reasons for this is that the emotional impact of the procedure is frequently overlooked, both by the patient and the surgeon. Without proper preparation, it can take a while to adjust to the way your body looks and feels post-surgery.

In addition, an alteration of the breasts - whether through an enlargement, a reduction or the correction of an imbalance in size - can be an emotionally-charged operation, perhaps more so than other areas of the body, as breasts are connected to a woman’s sense of self and identity, symbolising femininity, maternity and sexuality.

As such, it is vital to prepare emotionally before undergoing a procedure of this kind - we spoke to clinical psychologist Dr Joanne Weston who gave us her advice on what to expect, and how to prepare.

Reasons for undergoing breast surgery

The reasons why women choose to undergo cosmetic breast procedures vary widely, these can include:

• Aesthetic preferences and requirements

• Correcting breasts which are considered to be uneven

• Restoring breast shape and size to the way they looked before pregnancy or breastfeeding

• Reducing breast size which was causing discomfort or pain

It is important to note that breast augmentation patients often have different motivations and psychological profiles compared to those undergoing breast cancer reconstruction.

All of these, and more, can also be connected to emotional reasons - the desire to ‘fit in’, to end perceived social stigma, to boost confidence, to improve self-esteem, or to enjoy greater freedom when it comes to the ability to play certain sports or wear certain clothes.

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 these objectives in detail with your surgeon.

A good surgeon will ask you why you are interested in the procedure, what has led you to conclude it is the best option for you, and what your specific goals are for the final result.

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.

You may also wish to speak with a counsellor or therapist before  undergoing surgery to determine what your exact hopes or needs are from the procedure. Particularly if your motivations include hoping to become a new person, end emotional distress or satisfy the wishes of a partner.

Together with them, you will be able to determine whether an operation is the best option for you or whether there are underlying issues that should be addressed before you commit yourself financially, emotionally and physically. If you are interested in more useful information for deciding which surgeon is best for you, read our guide here.

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. For those who have opted for silicone breast implants, it is crucial to understand the specific post-operative care and potential complications associated with this type of implant.

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 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.

Swollen and raw

Even though you know it will take some weeks before the swelling and bruising from your breast surgery dies down, that does not mean you will not wish to look at your new breasts before then. The first time you see the post-operative results could be upsetting, and the shock may be compounded by the additional side effects of pain medication and so on.

Many women find that their breast tissue becomes deflated and does not return to its previous state after pregnancy, leading to a desire for breast implant surgery.

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 reduction surgery

Even after a successful breast reduction surgery, it is possible for women to experience a personality change after breast augmentation surgery. Those who already struggle with mental health issues such as depression or anxiety may struggle with the emotional impact of cosmetic breast surgery, but it is also common for those who had not previously experienced depression to struggle with their mental health following a procedure.

Typically, depression after cosmetic surgery comes from previous expectations that the surgery will ‘fix’ a perceived flaw. In many cases, the surgery may not meet the high expectations of the patient, and this can lead to depression and anxiety about the patient’s appearance. Additionally, in severe cases, dissatisfaction may also lead to an addiction to cosmetic surgery, especially if the patient struggles with body image issues, such as body dysmorphic disorder (BDD).

Similarly, anxiety after breast surgery augmentation can be caused by these significant changes or concerns about the recovery process.

Before seeking plastic surgery to change your body for your own perception, you should consider the following factors:

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 to 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 ensure you research the potential consequences of it.

How to prevent postoperative depression

As well as being realistic about your expectations of your surgery, there are also a number of ways in which you can aim to ward off the onset of depression immediately following an operation.

Support system

A strong support system will be important to help you in the days and weeks following surgery. Gather friends and family around, let them know what you’re planning to do, how you’re feeling, and what support you might need from them - both physically, practically and emotionally. Don’t be afraid to reach out and ask for help.

Plan ahead

Your surgeon will let you know how long you might expect to need to recover fully from your operation, and so you will know roughly how much time you will need to book off work. Now it is time to prepare your home - make sure your bed is within easy reach of your essentials. These can include bottles of water, snacks, phone and charger, TV, books or magazines, and warm layers. Make sure you are not too far from the toilet, and consider moving your bedroom into a downstairs room before your operation.

Eat healthy, drink healthy

Staying away from alcohol is a good idea. Not only can alcohol disrupt your pain medication, it can also affect your mood, enhancing any depressive thoughts you may have. Instead, drink plenty of water and ensure your body is getting plenty of nutritious food to help it heal.

Be patient

Be patient with yourself and the healing process. Try not to make any judgements about your new breasts until after the bruising and swelling has died down, and you’re in a more relaxed state. At the same time, don’t feel as though you must feel happy or better straight away - you will need time to recover and you should take this at your own pace.

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. 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, or botched, 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.”