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Breast implants

Introduction

Breast implants can be used for two purposes:

  • reconstructive - to reconstruct the breast mound following a mastectomy (the surgical removal of the breast) 
  • cosmetic - to enhance the size and shape of the breast.

Breast implants

Breast implants are prosthetic (artificial) implants. In the UK, two types of breast implants are commonly used:

  • silicone gel implants
  • saline (sterile salt water) implants

Most breast implants are made out of silicone rubber and each type has associated advantages and disadvantages. See Breast implants – Considerations for more information about the different types of implants available.

Silicone is a durable material that is available as a liquid, a gel or a solid form similar to plastic.

How common are breast implants?

In the UK, breast implant surgery is the most common cosmetic procedure to be carried out on women. Each year, an estimated 8,000 women have breast implant surgery, either to make their breasts larger or for reconstructive purposes. 

Important decision

Having breast implant surgery is not something to be taken lightly.  Your decision to have breast implants should be an informed one which takes into account the potential risks and side effects.

You also have realistic expectations about the results of your breast implant surgery so that you are not disappointed with the results. Find out about the procedure, the recovery period and any possible complications.  Ask your GP or surgeon if you are unsure about anything.

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Why is it necessary?

There are a number of reasons why you may want to have breast implants. For example:

  • You may be unhappy about the size or shape of your breasts.
  • Your breasts may be uneven in size (asymmetrical).
  • Your breasts may have changed in appearance, for example, after having children.
  • If you have undergone a mastectomy (removal of one breast, or both breasts), you may need to have reconstructive breast surgery.

Most breast implant procedures are carried out to:

  • make the breasts larger
  • make the breasts firmer - with age, breast shape changes and the breasts gradually begin to droop (ptosis)
  • even out unequally sized or irregular breasts
  • reconstruct a breast after a mastectomy

Developmental problems

Sometimes a woman’s breasts do not develop "normally" during puberty. Abnormal development can affect one or both breasts. Examples of abnormal breast development include:

  • complete failure of breast tissue development (amastia)
  • marked under-development (hypoplastic growth)
  • marked asymmetry (unevenness) of size
  • abnormal development of contour and shape. For example, tubular breasts (where early growth is limited, resulting in unusually small, drooping and uneven breasts).

It is normal for breast size and breast shape to vary between women, and many women have one breast which is slightly larger than the other. However, in some cases where a woman has particularly small or large breasts, or where differences in breast size or shape are very pronounced, it can cause problems and lead to the woman becoming particularly self-conscious about her appearance.

Psychological effects

There is no specific medical advantage of having breast implants, but they can have positive psychological effects. For example, if a woman feels as though her breasts are unwomanly or inadequate, having breast implants may help to improve her self-esteem and confidence.

However, it is very important not to regard breast implants as a 'quick fix' and you should take your time when considering whether or not to have them. When making your decision, you need to balance the potential benefits with the risk of developing possible side effects and complications. See Breat implants -complications for further information about this.

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When should it be done?

When breast implants should be considered

If you are thinking about having breast implants, you should seek medical advice from a qualified surgeon who has experience in reconstructive and cosmetic breast surgery. This may be an oncoplastic breast surgeon or a plastic surgeon.

Eligibility

Not everyone is eligible for breast implant surgery.  Your surgeon will need to take a detailed look at your medical history and your overall health. You may not be able to have breast implant surgery if:

  • you are under 18
  • you are pregnant
  • you have malignant (cancerous) or pre-malignant breast cancer that has not been fully treated
  • you have an infection anywhere in your body.

Unrealistic expectations about the results of breast implant surgery is another factor that could affect whether you are able to have surgery. Before a decision is made about whether you are suitable for surgery, you need to be emotionally stable and have realistic expectations about what it will achieve.

Only have breast implants once you are satisfied that it is the best option for you. Take time to make an informed decision, weigh up the advantages and disadvantages, and talk it through with a trusted friend, partner or family member.

It is also important that you are not pressured by someone else into having breast implants. It is your body and your decision.

Mastectomy

If you have had a mastectomy (breast removal surgery) as part of your treatment for breast cancer, you will be offered free reconstructive surgery that may include the fitting of a breast implant. See Breast implants – How it is performed for more information.

See the Health topic about Mastectomy for more information about this surgical procedure.

Cost of surgery

Most women who have breast implants pay to have the operation done privately. The NHS rarely funds cosmetic breast implant surgery.

Currently in the UK, the average cost of having breast implants is about £4,000. However, the cost will vary depending on the treatment centre you choose.

As well as paying for the initial operation, you must also be prepared for the cost of having further surgery if necessary – for example, if an implant has to be replaced or removed.

To qualify for breast implants on the NHS, you would need to show that the appearance of your breasts is causing you significant psychological distress. Significant distress may be caused by:

  • complete failure of development of breast tissue
  • severe asymmetry (significantly uneven breasts)

The availability of NHS-funded breast implants may also depend on your local health board and the amount of funding they allocate for breast implant surgery. Your GP will be able to advise you about availability in your area.

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Considerations

Your expectations

If you are considering having breast implants, the first step is to discuss it with your GP. They will be able to advise you based on your previous medical history.

If you have specific questions about breast implant surgery, your GP will be able to refer you to a surgeon with experience in this area. The surgeon will be able to answer your questions in more detail and provide you with all the information you need to make a final decision.

Before deciding to have breast implant surgery, you should discuss your expectations with your surgeon. You need to be realistic about what the surgery can achieve so that you are not disappointed with the results.

Important research

It is a good idea to find out about the treatment centre where you will be having your implants fitted. You can do this by contacting Health Inspectorate Wales (HIW), which is responsible for regulating independent healthcare providers. They can be contacted on 029 2092 8850 during office hours.

When discussing the procedure with your surgeon, find out about their level of experience. For example, you may want to find out:

  • the number of successful breast implant operations they have carried out over the past two years
  • how many breast implant operations they have performed where there have been complications
  • whether or not they are a member of a recognised surgical association, such as the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS)

Types of breast implant

Discuss the different types of breast implants (silicone and saline) with your surgeon. There are advantages and disadvantages of each type of implant. The most suitable implant for you will depend on your individual circumstances and your personal preference.

Both silicone and saline implants are surrounded by a firm, elastic shell that helps to prevent the implant from rupturing (bursting). The surface of the shell can either be smooth or textured.

Silone gel implants and saline (sterile salt water) implants are discussed in more detail below.

Silicone gel implants

Silicone gel implants are filled with a silicone substance that can vary in its firmness and consistency. They are pre-filled before they are inserted.

Advantages of silicone gel implants include:

  • They have a long history of safe use.
  • They are less likely to wrinkle than other types of implant.
  • They are available in round or breast-shaped (anatomical) shapes.
  • Silicone gel is a very soft and pliable (supple) implant filler, which means it allows for movement and gives you a natural feel.
  • Some types of silicone gel have a textured surface, which may decrease the chances of causing problems, such as hardening.

Cohesive gel implants have a silicone shell made of several layers that make the implant strong and durable. The filler used for cohesive gel implants has a thick consistency, which means that if the implant were to rupture (split), the silicone would stay inside and the implant would retain its shape.

Like other types of silicone gel implants, cohesive gel implants have a soft, natural feel. They are also unlikely to wrinkle or fold due to their ability to retain their shape and integrity.

Saline implants

Saline implants have strong, silicone shell and are filled with a sterile salt water solution. They are either pre-filled or can be filled through a valve once they have been inserted into your breast.

Advantages of saline implants include:

  • They have a long history of safe use.
  • They have a soft texture and a natural feel.
  • As the saline solution is similar to your body fluids, it can be safely absorbed or excreted (got rid of) by the body if the implant ruptures (splits).

Disadvantages of saline implants include:

  • They may rupture or deflate at an earlier stage than other implants.
  • They are more prone to wrinkling or folding.
  • They are only available in round and not breast-shaped (anatomical) shapes.

Other types of implant

Some types of breast implant, such as soya bean oil-filled implants and hydrogel implants, are no longer in the UK.

In 2000, the Medicines and Healthcare products Regulatory Agency (MHRA) recommended that women with soya bean implants should have them removed.

Although hydrogel implants are no longer available in the UK, women who have them have not been advised to have them removed because they are not thought to cause an immediate risk. However, the MHRA is continuing to monitor their safety. See the MHRA’s website for more information about hydrogel breast implants.

Safety

In 1991, polyurethane coated silicone implants were withdrawn from use in the UK following fears that they could increase the risk of cancer. However, research has shown that the risk is very low (less than one in a million) and in 2005 polyurethane-coated implants were re-introduced.

Implant life expectancy

Women who have breast implant surgery rarely keep the same implants for their entire lives. Most breast implants have a life expectancy of between 10 to 15 years, after which time they may need to be replaced.

However, breast implants can last for longer periods without any problems, and some manufacturers guarantee against certain types of implant rupturing for the lifetime of the patient.

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How is it performed?

Anaesthetic

Breast implant surgery is usually carried out under general anaesthetic. This means that during the procedure you will be asleep and unable to feel any pain or discomfort. 

As with any surgical procedure there are risks associated with the use of general anaesthetic. However, the risks are very small (less than one in 10,000 cases experience serious complications). See the Health topic about General anaesthetic for more information.

In some cases, your surgeon may choose to use local anaesthetic to numb your chest area and you may be given a sedative to help you relax. Your surgeon will discuss this with you before your operation.

Breast implant surgery

Breast implant surgery is sometimes carried out as day surgery, which means you will be able to go home the same day. However, in some cases you may need to stay in hospital overnight. Depending on the procedure you are having, the operation should take between one to one-and-a-half hours to complete.

The incision

Breast implant surgery starts with your surgeon making an incision (cut). The position of your incision will be something that your surgeon discusses with you before the procedure. It will depend on the shape and size of your breasts and where you would like the scars to be.

There are three different types of incision, which are located in different places: 

  • Inframammary fold - the most common type of incision; a small cut is made in the fold underneath each breast
  • Periareolar incision - the incision is made around the nipple and usually causes minimal scarring but, nipple sensation may be affected
  • Axillary incision - the incision is made in your armpit area and may result in more obvious scarring

Fitting the implants

After the incision has been made, the implants can be fitted. The implant can either be positioned between your breast tissue and your chest muscle (subglandular) or behind your chest muscle (submuscular).

In some cases, the surgeon is able to place the implant partly behind the breast and partly behind the muscle (dual plane operation).  Your surgeon will advise you about what position is best for you.

Once the implants are in place, the incisions can be sealed using stutures (stitches), which will usually be covered with a dressing.

Reconstructive breast surgery

Breast implant surgery for reconstructive purposes is slightly different from implant surgery carried out for cosmetic reasons. Reconstructive surgery is often carried out after a mastectomy (where one or both breasts are surgically removed, usually after breast cancer).

For reconstructive surgery, as well as using prosthetic (artificial) breast implants natural tissue implants may also be used.  This is where skin, tissue and muscle are taken from another part of your body and are used to create a new breast. Tissue may be taken from the:

  • abdomen (tummy)
  • back
  • thigh
  • buttock

Alternatively, your surgeon may use a tissue expander that consists of an outer shell made of silicone.  The tissue expander is inserted under your chest tissue and gradually inflated using saline (sterile salt-water) over a period of a few months. After the expander has stretched your skin and muscle enough to create healthy new tissue, it can be replaced with a silicone implant or left in.

Women who have had one breast or both breasts removed (a single or double mastectomy) can choose to have immediate or delayed reconstruction.

Immediate reconstruction

The advantages of immediate reconstruction are:

  • You will have your new reconstructed breast as soon as you wake up.
  • You will undergo fewer operations and anaesthetics.
  • The new breast may look better because the surgeon uses breast skin that is already there.
  • There will be less scarring on the new breast.

The disadvantages of immediate reconstruction are:

  • You will have less time to make a decision about the type of reconstruction that you would like.
  • Any radiotherapy treatment that you have after surgery could damage the reconstructed breast.
  • Any chemotherapy treatment you have after surgery could be delayed if there are complications during reconstructive surgery.  

Delayed reconstruction

The advantages of delayed reconstruction are:

  • You will have more time to make an informed decision about the type of reconstruction that you would like.
  • Your breast cancer treatment will be finished and will not affect your reconstructive surgery.

A disadvantage of delayed reconstruction is that you may have a larger scar on your reconstructed breast.

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Results

Breast implant surgery results can vary and depend on your circumstances.  For example, the appearance of your breasts after the operation may be affected by:

  • your age
  • your overall health
  • your ability to heal
  • your existing breasts
  • the position of your nipples
  • your skin texture

Most women are pleased with the appearance of their breasts following surgery. Having realistic expectations and making a considered and informed decision will help to ensure that you are happy with the results of your operation.

Look and feel

After having breast implant surgery, you may be worried that your breast implants look unnatural. This is normal and to begin with your breasts are likely to feel quite taut or rigid.

You may also experience changes in the way your breasts feel, with different areas becoming more or less sensitive than they used to be. In most cases, any changes in sensation are temporary, although they can occasionally be permanent.

Your breasts will usually start to look and feel more natural within a few months of having breast implant surgery, as the breast tissue, muscle and skin stretches to accommodate the implants.

Breastfeeding

Having breast implants will not stop you breastfeeding. However, you may produce slightly less breast milk than you would without implants. Your baby will not experience any side effects if you breastfeed and have implants.

Flying

You may have heard that flying with breast implants is dangerous. However, this is not true and the risk of an implant rupturing (splitting) is not increased because the implant will not be put under any extra strain.

Breast cancer

Having breast implants will not increase your risk of developing breast cancer and there is strong scientific evidence to support this. However, it is still important for women who are over 50 to attend breast screening appointments when invited.

Every three years, the NHS Breast Cancer Screening Programme invites all women who are 50 to 70 years old and registered with a GP to attend a breast screening appointment.

It is important to be aware that breast cancer screening is part of a national routine screening programme and is not aimed at women who already have symptoms.

Visit your GP if you notice anything unusual about your breasts, such as a lump. The majority of breast lumps (90% of cases) are benign (non-cancerous), but it is still important that you have a breast lump investigated as soon as possible. Do not wait to be invited for a routine breast screening appointment. See the Health topic about Breast cancer – Symptoms for more information.
 
The Breast Test Wales screening programme website provides further information about the programme and what to expect when attending an appointment.
 
Breast implants can affect breast screening, so tell the radiographer if you have implants (a radiographer is a health professional trained in taking X-rays) so they can ensure that the best possible images are taken.

If you have implants and you develop breast cancer, your chances of making a full recovery will not be affected.

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Recovery

After surgery

Immediately after having breast implant surgery, you will experience some swelling, pain and bruising. Your chest may feel tight and your breathing may feel restricted. This is normal and your symptoms will start to improve over the next few weeks.

You will usually rest at the hospital or clinic in a semi-upright position.  This will help to minimise any swelling, and help you to feel more comfortable. You will be given painkillers if you need them.

You can continue to take over-the-counter painkillers medicines, such as paracetamol or ibuprofen, once you are at home. However, do not take ibuprofen if you have, or have had in the past, stomach, kidney or liver problems. Ibuprofen may also be unsuitable for you if you have asthma. Check with your GP or pharmacist if you are unsure.

Going home

After having breast implant surgery, you may either be allowed home the same day or you may need to stay in the hospital or clinic overnight.

Once home, you will need to rest to give your body time to recover. Avoid excessive use of your arms and chest area because doing so may cause irritation and bleeding.

Following surgery, your breasts may feel hard, and you may experience some painful twinges or general discomfort. These symptoms will sometimes last for a few weeks.

Aftercare advice

To get the best results, you should follow the aftercare advice that your surgeon gives you. You will usually need to attend a series of post-operative appointments so your surgeon can check your recovery.

Following breast implant surgery, avoid:

  • getting your wounds wet for one week
  • sleeping face down for one month
  • physical exercise for four weeks
  • heavy lifting for 3-4 weeks
  • driving for at least one week or until you can perform an emergency stop without discomfort.

Some surgeons also recommend that you wear a tight-fitting sports bra 24 hours a day for up to three months following breast surgery.

It is recommended that you take around two weeks off work after your breast implants are fitted to fully recover.  You should be mobile from day one and back to full exercise within six weeks. You should keep the incision sites out of direct sunlight for about a year.

Make sure you keep a record of all the details of your implants. You need to make a note of the:

  • manufacturer
  • style
  • catalogue number
  • batch number

If your surgeon has not given you this information you should ask for it and keep it in a safe place.

When to get help

If you experience any symptoms that you were not expecting, or you are in severe pain, you should contact your GP or surgeon immediately. Possible warning signs include:

  • severe pain in your breast(s)
  • an intense burning sensation in your breast(s)
  • unusual, unexpected or excessive swelling in or around your breast(s)
  • deflated breast(s)
  • a smelly or coloured discharge from your wounds
  • fever (a high temperature) of 38C (106F) or more
  • any lumps or aching that are causing you concern
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Complications

After having breast implant surgery, about 30% of women will require further surgery within 10 years of their initial operation. 

Additional surgery may be needed as a result of complications such as capsular contracture (hardening of the scar capsule around the implant, see below), age-related changes to the breast or the shell of the implant rupturing (splitting).

Any operation carries some degree of risk. Complications which can affect anyone having surgery include:

  • an adverse reaction to the anaesthetic
  • excessive bleeding
  • risk of infection
  • developing blood clots (where the blood thickens to form solid lumps)

There are also a number of complications that are associated with breast implant surgery specifically. Some of these are outlined below.

Capsular contracture

After having a breast implant, your body creates a capsule of scar tissue around the implant as part of the healing process. This is a natural reaction that occurs when any foreign object is implanted into the body.

Over time, the scar tissue will begin to shrink. The rate and extent at which the shrinkage occurs will vary from person to person. This shrinking is known as capsular contraction. In some people the capsule can tighten and squeeze the implant, making your breast feel hard.  You may also experience pain and discomfort.

Capsular contracture is an unavoidable complication of breast implant surgery. Everyone who has breast implants will experience capsular contracture to some degree and it is likely that further surgery will be needed in the future. 

There are three methods of reducing the tightness that is caused by capsular contracture.  These are:

  • closed capsulotomy
  • open capsulotomy
  • open capsulectomy

Closed capsulotomy

In a closed capsulotomy, the surgeon will try to tear the layer of scar tissue by squeezing the capsule. If successful, the tightness around the implant will be relieved and the implant will feel soft.

However, sometimes the scar tissue is so tough that it cannot be torn, and there is also a risk of the implant rupturing (splitting). If the implant ruptures, further surgery will be required to replace it. A closed capsulotomy can also cause bleeding and bruising.

Due to the risk of further complications, a closed capsulotomy is not the preferred method of treatment for capsular contracture.

Open capsulotomy

The aim of an open capsulotomy is to relieve the tightness that is caused by capsular contracture and to give the implant more room to move inside the breast pocket.

The procedure will be carried out under general anaesthetic and involves the surgeon making an incision (cut) into the breast pocket to remove the implant. They will then make a series of cuts in the scar tissue to help relieve the tightness around the implant. The implant will then be re-inserted and the incision closed.

Open Capsulectomy

An open capsulectomy is the most successful treatment for capsular contracture. As with an open capsulotomy, it is carried out under general anaesthetic and involves the surgeon removing the scar capsule completely. This allows the body to form a new capsule around the implant.

Rupture

A rupture is a split that occurs in the implant’s casing. A rupture can be caused if:

  • the implant’s shell (that holds the silicone or saline) gets weaker over time
  • the implant is damaged during the operation
  • there is a flaw in the implant
  • the breast is injured

 

When implants were first developed, they had very thin walls and rupturing was a common problem. However, modern implants, which have been used in the UK since the 1990s rupture much less frequently.

If your implant ruptures, it is recommended that you should have it removed and replaced with a new one.

If you have a saline (salt water) implant, any leakage from the implant should not cause you any problems. This is because your body can safely absorb saline because it is a sterile salt water solution.  However, if you have silicone implants, silicone that leaks out of a ruptured implant may cause problems, such as siliconomas or a gel bleed (see below).

Siliconomas

If you have a silicone breast implant that ruptures, the silicone may spread outside of the scar capsule and into your breast. This can cause small lumps to develop known as siliconomas.

Siliconomas can be tender to touch moved and if siliconomas are causing significant pain they may need to be removed.  In rare cases, the silicone can spread to your muscles under your breast, your armpit or around the nerves to your arm.

Gel bleed

A gel bleed is where tiny particles of silicone are released from the surface of a silicone breast implant. This can occur when the breast implant ruptures, or sometimes it can happen when there is no rupture.

If the silicone particles get into the lymphatic system (the network of vessels that help the body to fight infection), they can be transported to nearby lymph nodes (glands), such as those in the armpit. This may cause the lymph nodes to become slightly swollen. This is usually a minor problem, although in some cases the enlarged lymph nodes may become uncomfortable.

Scarring

Following your breast implant operation, you will have some degree of scarring. In most cases, the scarring is relatively mild. However, in approximately 1 in 20 women, the scarring is much more severe. For these women, breast implant scars may be:

  • red, or highly coloured
  • lumpy
  • thick
  • painful

The symptoms of severe scarring should gradually improve and over time the scars begin to fade. However, it may take several years before there is a noticeable improvement.

Creasing and folds

Sometimes, a breast implant can affect the appearance of the skin on your breast. For example, following your operation you may find your skin has:

  • creasing
  • kinking
  • folds
  • rippling

Creasing and folds tend to be more common in women who have very small breasts before having breast implant surgery.

Nipple sensation

Approximately 1 in 7 women find that their nipples are less sensitive or completely desensitised (no sensation at all), following their operation.

Alternatively, some women who have breast implant surgery find that their nipples may be more sensitive.  Sometimes the nipples can be so sensitive that they are painful. Increased sensitivity usually lasts for between three to six months.

If your nipples are very painful, speak to your GP or surgeon for advice about how to deal with it.

Infection and bleeding

Infection and bleeding following breast implant surgery are relatively rare, occurring in less than 1% of cases. It is also unusual to experience internal bleeding.

However, if you are having an implant fitted for breast reconstruction following a mastectomy (breast removal) you may be at greater risk of infection and bleeding.

Most infections can be treated using antibiotics. However, if your breast becomes severely infected, you may need to have the implant removed to prevent further complications developing. You should be able to have the implant re-inserted once the infection has cleared up.

Some research suggests that you may be more at risk of infection and bleeding if you smoke because your wounds will take longer to heal. The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) recommends that you do not smoke before your operation to reduce the risk of developing complications.

Seroma

After having breast implant surgery, fluid can build up around your implant. The medical term for this is called seroma and it is fairly common. In severe cases, further surgery may be required in order to drain this fluid away.  However, seromas usually resolve without needing to be drained.

Silicone implant safety

In recent years, the safety of silicone breast implants has been debated. A small number of women have reported serious complications following silicone gel breast implant surgery. These complications include:

  • muscle spasm and pain
  • swollen and painful joints
  • rashes
  • changes in eye and saliva fluid
  • hair loss

It was thought that these complications occurred as a result of silicone gel leakage that spread to other parts of the body.

In response to these concerns, the Department of Health set up an organisation known as the Independent Review Group to investigate the safety of silicone implants. The Independent Review Group found no scientific evidence to support the relationship between silicone implants and illness in women.

However, in March 2010 the Medicines and Healthcare products Regulatory Agency (MHRA) advised surgeons not to use certain implants produced by a company called Poly Implant Prothese (PIP). The implants are filled with a type of silicone gel that has not been approved.

The non-approved silicone gel implants were manufactured between 2001 and 2009 and have the following model numbers:

  • IMGHC-TX
  • IMGHC-MX
  • IMGHC-LS

Tests are currently being carried out to determine whether there are any patient safety issues associated with these unauthorised implants. As yet there is no evidence to suggest that the gel inside them is harmful. However, speak to your GP or surgeon if you have these gel implants and you are concerned.

See the MHRA’s press release for more information regarding PIP’s silicone breast implants.

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