Breast implants

Women concerned about French-made PIP breast implants can find all the latest NHS information about the issue on these pages.

Introduction

Women concerned about French-made PIP breast implants can find all the latest NHS information about the issue on these pages.

Worries about the implants have emerged since news of a major investigation into them in France was widely covered in the media in December 2011.

What’s the problem?

The French implants caused global concern after it was revealed they contained industrial silicone rather than medical-grade fillers and that they may be more prone to rupture and leakage.

Initially reports also linked the implants to a rare form of cancer known as ALCL. This cancer link has been now been firmly discounted by medical experts here and in Europe.

Tests have shown that PIP implants are more likely to rupture or leak silicone than other implants.

However, there appears to be no risk of dangerous toxic effects in the event of a rupture. Rigorous worldwide testing of the PIP gel material has not revealed anything that could cause a threat to human health.

If the implant does rupture, it may cause symptoms including tenderness of the area and/or swollen glands. There is no evidence that this causes any health problems.

For more information, read our pages on safety and regulation and warning signs of a ruptured PIP implant.

What type of implants are involved?

The implants involved are called Poly Implant Prosthèse (PIP) and were made by a French company of the same name.

In a Medical Device Alert in March 2010, the Medical and Healthcare products Regulatory Agency (MHRA) said: " ... most breast implants manufactured by the company since 2001 have been filled with a silicone gel with a composition different from that approved".

That alert was based on advice from French regulators. However, after an investigation by the MHRA, the French authorities reported in March 2012 that PIP implants made before 2001 may also contain unauthorised silicone gel.

PIP gained approval to market its silicone implants in 1997 but it is not clear when it began using a cheap type of silicone gel intended for making mattresses.

The marketing, distribution and use of the PIP implants was suspended in March 2010.

Do my PIP implants need replacing?

About one breast implant in five needs replacing within 10 years, whatever the make, so it is unlikely that all the 7,000 women who had PIP implants before 2001 still have the same implants.

An expert committee was set up to examine the specific risks associated with PIP implants. It concluded that there was not enough evidence to recommend their early removal. That advice has not changed. For more details, read the expert review group's final report (PDF, 162kb).

Some private clinics have said they will replace PIP implants free if clinically necessary.

For more information, read about your rights.

Introduction

Breast implant surgery is the most common type of cosmetic surgery carried out on women.

Breast implants can be used for two purposes:

  • reconstructive – to reconstruct the breast mound following a mastectomy (the surgical removal of the breast often used to treat breast cancer)
  • cosmetic – to enhance the size and shape of the breast

Read more about why breast implants are used.

Types of breast implants

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

  • silicone gel implants – available as a liquid, a gel or a solid form similar to plastic
  • saline (sterile salt water) implants

Each type has associated advantages and disadvantages, although most breast implants are made out of silicone. Read more about the different types of implants available.

Breast implant surgery

Your surgeon will discuss with you the location of the incisions (cuts) beforehand so you're aware of where the scars will be.

After the incision, the implant is positioned between your breast tissue and chest muscle, or behind your chest muscle. Once the implants are in place, the incision is stitched and covered with a dressing.

Read more about what happens during breast implant surgery.

Following surgery, areas of your breasts will feel more or less sensitive than before. You may also be worried that your breasts look unnatural. This is normal and in most cases temporary.

Your breasts will usually start to look and feel more normal within a few months.

Read more about recovering from breast implant surgery and breast implant results.

Deciding to have breast implants

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

Try to have realistic expectations about the results so you are not disappointed. Find out about the procedure, the recovery period and possible complications of breast implant surgery. Ask your doctor or surgeon if you are unsure about anything.

Complications

After having breast implant surgery, about one in three 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 (sagging) or the shell of the implant rupturing (splitting).

All forms of surgery carry some degree of risk. Complications that can affect anyone who has 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 complications specifically associated with breast implant surgery. Some of these are discussed below.

Capsular contracture

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

Over time, the scar tissue will begin to shrink. The shrinkage is known as capsular contraction. The rate and extent at which the shrinkage occurs varies from person to person. In some people, the capsule can tighten and squeeze the implant, making the 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 further surgery will be needed in the future.

There are three methods of reducing the tightness 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 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 caused by capsular contracture and 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 inside the breast 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 (which 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 that 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 problems. As saline is a sterile, salt water solution, your body is able to safely absorb it. However, if you have silicone implants, the silicone that leaks out of a ruptured implant may cause problems, such as siliconomas or a gel bleed (see below). You may be expected to pay for any special investigations needed to confirm a suspected implant rupture.

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 lead to small lumps developing that are known as siliconomas.

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

Gel bleed

Gel bleed occurs to some degree in all breast implants, and has recently been a problem with PIP breast implants.

It is where small molecules of silicone polymer separate from the surface of the implant and are taken up into the surrounding tissues or lymphatic system (the network of vessels that help the body fight infection and are found in several places around the body, including in the armpit).

If the silicone molecules get into the lymphatic system, they may cause your lymph nodes (glands) to become slightly swollen. This is usually a minor problem, although in some cases the enlarged lymph nodes can become uncomfortable.

Scarring

After breast implant surgery, 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 more severe. For these women, their scars may be:

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

The symptoms of severe scarring should improve gradually, and over time the scars will begin to fade. However, in some cases 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, after your operation you may find that your skin has:

  • creases
  • kinks
  • folds
  • ripples

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

Nipple sensation

Following breast implant surgery, about one in seven women find their nipples are less sensitive or completely desensitised (have no sensation at all).

Alternatively, after having breast implant surgery your nipples may be more sensitive. Sometimes, the nipples can become so sensitive they are painful. Increased sensitivity usually lasts for between three to six months.

If your nipples are painful, speak to your doctor or surgeon who will advise how to deal with it.

Infection and bleeding

Following breast implant surgery, infection and bleeding are relatively rare, occurring in less than 1% of cases. Internal bleeding is also unusual.

However, if you are having an implant fitted for breast reconstruction following a mastectomy (breast removal) you may have a 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 after the infection has cleared up.

However, it is important that the implant is not re-inserted too soon, as this can increase the risk of infection. Waiting a minimum of three months after the implant was removed is usually recommended.

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

Seroma

After having breast implant surgery, fluid can build up around your implant. This is known as a seroma and is fairly common. In severe cases, further surgery may be needed to drain away the fluid. 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 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 independent review group to investigate the safety of silicone implants. The 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 the gel inside them is harmful. However, speak to your doctor 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.

Recovery

You will experience some pain, swelling and bruising immediately after breast implant surgery.

Your chest may feel tight and your breathing may be 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 keep you comfortable and minimise swelling. You will be given painkillers if you need them.

After returning home, you can continue to take over-the-counter painkillers, such as paracetamol or ibuprofen. However, you should not take ibuprofen if you have stomach, kidney or liver problems, or if you have had them in the past.

If you have asthma, ibuprofen may also be unsuitable for you. Check with your doctor 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.

On returning home, you will need rest to give your body time to recover. Avoid excessive use of your arms and chest area as it 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 persist for a few weeks.

Aftercare advice

To get the best results, follow the aftercare advice of your surgeon. 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 three to four weeks
  • driving for at least one week or until you can perform an emergency stop without discomfort

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

It is recommended you take around two weeks off work after the operation 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 the details of your breast implants. You should make a note of the:

  • manufacturer
  • style
  • serial number
  • batch number (also known as 'lot' number)

If your surgeon does not provide you with this information you should ask for it and keep it in a safe place.

When to get help

Contact your doctor or surgeon immediately if you have any unexpected symptoms or if you experience severe pain. Possible warning signs include:

  • severe pain in your breast(s)
  • redness of the skin of 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
  • a high temperature (fever) of 38°C (100.4°F) or more
  • any lumps or aching that are causing you concern

Considerations

You should discuss the different types of breast implants (silicone and saline) with your surgeon.

There are advantages and disadvantages with each type of implant. The most suitable implant for you will depend on your individual circumstances and personal preference.

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

Silicone 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 may be less likely to wrinkle than other types of implant.
  • They are available in round or anatomical (contoured) shapes (often referred to as tear-drop shaped).
  • Silicone gel is a very soft and pliable (supple) implant filler, which means it allows for movement and gives you a natural feel.
  • Most silicone gel implants used in the UK have a textured surface, which can reduce the risk of excessive movement, and may also avoid problems, such as hardening, due to capsular contracture.

The silicone gel used in cohesive gel implants is firmer than the gel used in traditional silicone implants. Due to its firmness and thick consistency, in the unlikely event of the implant’s shell rupturing (splitting), there is a greater chance that the gel would stay inside and not leak into the surrounding tissue.

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

Saline implants

Saline implants have a 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.
  • 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
  • They may not feel as soft and natural as silicone implants

Other types of implant

Some types of breast implant, such as soya bean oil-filled implants and hydrogel implants, are no longer licensed for use 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.

PIP implants

In 2011, French PIP implants caused concern after it was revealed they contained industrial silicone rather than medical-grade fillers. They may also be more prone to rupture. Some 40,000 women in the UK are believed to have had the implants, with the majority of operations done for cosmetic reasons through private clinics.

There is not enough evidence to recommend the routine removal of PIP breast implants, a government expert review has concluded. However, any implants put in by the NHS can be removed and replaced without charge.

If you are worried about your implants speak to your surgeon or doctor.

For more information read our NHS PIP implant removal Q&A.

Safety

In 1991, polyurethane-coated silicone implants were withdrawn from use in the UK following fears they could increase the risk of cancer. However, research has shown 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. Anyone who has a breast implant inserted (for whatever reason) will need further surgery at some point, either to change the implant or remove the scar capsule that has formed around it.

Most breast implants have a life expectancy of 10-15 years, after which time they may need to be replaced. However, breast implants can sometimes last longer without problems, and some manufacturers guarantee against certain types of implant rupturing for the lifetime of the patient.

Sometimes it is difficult to detect implant rupture.

FAQ's

Background

Are silicone implants banned in the US?

Safety of PIP implants

Do my implants need to be removed early?

What’s the evidence around the safety of PIP implants?

What is a rupture?

What are the signs of rupture?

Can I breast feed safely?

Your rights

What are my rights if I'm concerned?

What if I got a PIP implant privately?

I want a scan – should I ask for an MRI or an ultrasound?

My original provider said they would only accept an MRI image as evidence of a rupture – what should I do?

What should I do if my local hospital only offers me ultrasound, and not MRI?

I received PIP implants as part of reconstruction surgery following breast cancer. What are my rights?

Why can't I pay for a breast implant replacement as part of a combined operation in which the NHS pays for removal of the PIP implants?

Do my implants need to be removed early?

Most breast implants need to be removed or replaced after 10-15 years. About one breast implant in five needs replacing within 10 years.

An expert committee was set up recently to examine the specific risks associated with PIP implants. It concluded that there was not enough evidence to recommend their early removal. That advice has not changed.

What are my rights if I'm concerned?

Every woman who has had breast cancer and has PIP implants will be able to have them removed and replaced without charge (see below).

What if I got a PIP implant privately?

The following private clinics in the UK have said they will replace PIP implants free if clinically necessary:

  • BMI Healthcare
  • HCA International
  • Holly House
  • Highgate Hospitals
  • Make Yourself Amazing/MYA Cosmetic Surgery
  • Nuffield Healthcare
  • Ramsay Health Care
  • Spire Healthcare

What should I do if my local hospital only offers me ultrasound, and not MRI?

Current advice from the Royal College of Radiologists is to start with an ultrasound examination. If this does not show any sign of a rupture or gel bleed but you are still anxious or experiencing symptoms that you think are associated with the PIP implants, then you are entitled to an MRI scan, as this is a more sensitive method.

I received PIP implants as part of reconstruction surgery following breast cancer. What are my rights?

Every woman who has had breast cancer and has PIP implants will be able to have them removed and replaced without charge.

If you originally received your implants from the NHS in the UK, then the NHS will remove and replace them if that is your choice. If you originally received your implants from a private provider, you should in the first instance see if they will remove and replace them free of charge. If not, the NHS will carry out the operation to both remove and replace them.

What’s the evidence around the safety of PIP implants?

During December 2011 UK media had originally focused on a possible link between PIP implants and a rare type of cancer called anaplastic large cell lymphoma (ALCL). This arose after a French woman with PIP implants developed the cancer and died. However, after reviewing the evidence, the expert group conducting the review agreed that there was no link with cancer.

More recently, attention has focused on the rupture rate of the implants, and whether the unapproved gel filling of PIP implants could have a toxic effect.

The review has specifically looked at these issues, and found:

  • PIP implants do have a higher rupture rate than other breast implants.
  • There appears to be no risk of dangerous toxic effects in the event of a PIP implant rupture.

What is a rupture?

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

  • the implant’s shell gets weaker over time
  • the implant is damaged during the operation
  • there is a flaw in the implant
  • the breast is injured

What are the signs of rupture?

If you have any of the following signs or symptoms, you should discuss them with your doctor, who will refer you to a specialist:

  • lumpiness of the breast
  • lumpiness or swelling in the area around the breast
  • change in shape of the breast
  • deflation of the breast
  • redness
  • tenderness of the breast
  • swelling of the breast
  • pain or sensitivity

Can I breast feed safely?

Silicone components are considered highly unlikely to cross the barrier into breast milk and current advice from the MHRA is that women with PIP breast implants should continue to breast feed their infants.

In theory it is possible that some tiny particles could migrate into breast milk; the MHRA have therefore arranged for chemical analysis of a sample of breast milk from a patient with ruptured PIP implants and the results will be published as soon as they are available.

In the meanwhile, there is no reason not to follow the current MHRA advice.

I want a scan – should I ask for an MRI or an ultrasound?

The current consensus is that MRI is more sensitive than ultrasound in detecting ruptures of breast implants. This means it is less likely than ultrasound to produce a 'false negative' result (i.e. suggesting that the implant hasn't ruptured when it actually has).

However, MRI is much more expensive than ultrasound and waiting times for an MRI scan are likely to be longer.

Therefore if you and your doctor feel a scan is necessary to help determine whether your implant needs removing, the Royal College of Radiologists recommend having an ultrasound first, and:

  • if the ultrasound is negative and you are still concerned, proceed to MRI
  • if the ultrasound is positive (detects a rupture), this should be a sufficient basis for the clinical decision to remove the implant

My original provider said they would only accept an MRI image as evidence of a rupture – what should I do?

If you've already had a positive scan and decided to use this as evidence to encourage your original (private) provider to agree to remove or replace the implants, evidence from ultrasound should be sufficient. In the light of the advice from the Royal College of Radiologists, it would be unreasonable for the provider to insist on an MRI image.

Are silicone implants banned in the US?

Although there have been television reports suggesting the US has ‘banned silicone implants’, this is not accurate. Silicone implants are currently approved and readily available for women who want them, although they must be enrolled into studies to collect data about the performance and safety of their implants.

In June 2011 the FDA published an extensive document explaining the US position on silicone implants (PDF, 1.45Mb).

Why can't I pay for a breast implant replacement as part of a combined operation in which the NHS pays for removal of the PIP implants?

At present, this would go against the guidance issued by the UK Department of Health in 2009. This sets out the rules for combining NHS and private treatment and makes clear that the NHS and private components of treatment should normally be carried out at a separate time and place. This is to ensure that the NHS does not inadvertently cross-subsidise private treatment, and that patients are not required to pay for treatment to which they are entitled on the NHS. The rule requiring separation of the two components can be waived only if there is an overriding issue of patient safety. Read more about combining NHS and private treatment.

Further reading

Health news: French breast implants investigated

Medical information about breast implants

[Breast implant clinical trials]

Facebook: PIP Guidance and Support Group

Further information

PIP Breast Implants: Final Report of the Expert Group (PDF, 162kb). Sir Bruce Keogh, NHS Medical Director. June 18 2012

Letter from NHS Medical Director to doctors. June 18 2012

Colleague letter from Chief Medical Officer: PIP silicone gel breast implants (PDF, 58kb). March 15 2012

Colleague letter from Chief Medical Officer: PIP silicone gel breast implants (PDF, 56kb). January 6 2012

Colleague letter from Sir David Nicholson, Chief Executive of the NHS in England: PIP silicone gel breast implants (PDF, 50kb). January 6 2012

Update about silicone gel breast implants from the Chief Medical Officer. January 27 2012

Food and Drug Administration: information on breast implants and ALCL. July 2011

MHRA's summary report on tests performed on extracts of silicone gel filler material from PIP silicone breast implants (PDF, 26kb)

English language summary of the 2010-11 toxicology tests carried out by the French regulator AFSSAPS (PDF, 188kb)

2012 updates from the Therapeutic Goods Administration (the Australian regulator)

How is it performed

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

As with any surgery there are risks associated with the use of general anaesthetic. However, they are very small (less than one in 10,000 cases experience serious complications).

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. So you will be awake during surgery but have very little awareness of what is going on during the procedure.

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, if the operation is scheduled late in the day, you may need to stay in hospital overnight. Depending on the procedure you are having, the operation should take between 1 and 1.5 hours to complete.

The incision

Breast implant surgery starts with your surgeon making an incision (cut). Your surgeon will discuss with you the exact location of the incision 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 different types of incision 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 sensation in the nipple may be affected
  • axillary incision – the incision is made in your armpit area and may result in more obvious scarring
  • trans-umbilical breast augmentation (TUBA) – the incision is made near the umbilicus (belly button) and a tunnel is formed with a blunt instrument to reach the breast. A saline implant is then placed and filled once in position. This technique is generally not offered in the UK due to problems with achieving the correct placement and shape of the implant.

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 be able to advise about the position that is best for you.

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

Reconstructive breast surgery

Breast implant surgery for reconstructive purposes is slightly different from 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 used to create a new breast. Tissue may be taken from the:

  • abdomen (tummy)
  • back
  • thigh
  • buttock

Another option involves using 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 may undergo fewer operations and anaesthetics.
  • The new breast may look better because the surgeon may use breast skin already there.
  • There may 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 you would like.
  • Any radiotherapy treatment 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 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 and that you will have to live with a mastectomy until your treatment is completed, although you will be offered an external prosthesis (breast shaped bra filler) to maintain your shape in clothes.

Regulation and safety

PIP implants are twice as likely to rupture or leak silicone than other implants. However, there appears to be no risk of dangerous toxic effects in the event of a rupture.

An expert group, led by Professor Sir Bruce Keogh, has been collecting and reviewing all available data including estimated rupture rates, data on clinical findings when implants are removed, and further examination of the chemical make-up for PIP silicone gel.

Conclusions regarding safety

The expert group concluded that:

  • Exhaustive worldwide testing of the PIP gel material has not revealed anything that could cause a long-term threat to human health - it is not toxic and does not cause cancer.
  • PIP implants do have a higher rupture rate - around two times higher than other breast implants.
  • If the implant does rupture, it has been found to cause reactions around the implant area in a small proportion of women, which can result in symptoms such as tenderness or swollen lymph glands. There is no evidence this causes any significant health concern.

For more information, you can read the expert group's final report (PDF, 162kb). For reports from other countries on the safety of PIP implants, go to our further reading section.

Learn about the warning signs of a ruptured PIP breast implant.

Recommendations for the future

A team of surgeons, physicians, campaigners and journalists recently helped Professor Keogh to gather more evidence and make recommendations to the government.

The review considered:

  • regulation and safety of products used in cosmetic procedures
  • regulation of the skills and qualifications of people who carry out procedures
  • how to ensure that organisations that do cosmetic procedures are able to look after their patients during their treatment and afterwards
  • what information and advice patients need to make an informed choice – including “time for reflection”
  • how to improve complaints processes so that complaints about cosmetic procedures are listened to and acted upon
  • the introduction of a national implant register, for products such as breast implants and other medical devices

Professor Keogh’s review group concluded that people having cosmetic procedures should be better protected than at present.

It proposed much tighter and rigorous regulation for non-surgical cosmetic procedures such as dermal fillers, Botox and chemical peels.

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

Following surgery, most women are pleased with the appearance of their breasts. An American study of 1,500 women who had undergone breast implant surgery found the majority were satisfied with their results.

Having realistic expectations and making a considered and informed decision will help ensure you are happy with the results of your operation. You should expect that the feel and look of your breasts will change as you get older and implants will not stop your breasts from sagging.

Look and feel

After having breast implant surgery, you may be worried 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 will be temporary, although they may occasionally be permanent.

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

Breastfeeding

Having breast implants should not stop you breastfeeding, though some women will find they are not able to breast feed after breast implants. You may also produce slightly less breast milk than you would without implants. Your baby will not experience any side effects if you have implants and breastfeed.

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 placed under any additional strain.

Breast cancer

There is strong scientific evidence to suggest that having breast implants will not increase your risk of developing breast cancer. However, it is still important for women over 50 to attend breast screening appointments when invited.

Visit your doctor 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.

Read more about the symptoms of breast cancer.

Breast implants can affect breast screening because it may be more difficult to interpret the mammograms of women who have implants fitted. You should tell the radiographer if you have implants so they can ensure the best possible images are taken. A radiographer is a healthcare professional trained in taking X-rays.

Having a mammogram is unlikely to cause rupture of an implant unless it is already damaged.

If you have breast implants and develop breast cancer, your chances of making a full recovery will not be affected, but it is likely you would need to have your implants removed during the course of your treatment.

Warning signs

It's important to be aware of the signs that your PIP implant may have ruptured, and to know what to do.

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

  • the implant’s shell gets weaker over time
  • the implant is damaged during the operation
  • there is a flaw in the implant
  • the breast is injured

If you have any of the following signs or symptoms, you should discuss them with your doctor, who will refer you to a specialist:

  • lumpiness of the breast
  • lumpiness or swelling in the area around the breast
  • change in shape of the breast
  • deflation of the breast
  • redness
  • tenderness of the breast
  • swelling of the breast
  • pain or sensitivity

What are my rights

There is currently not enough evidence to recommend early removal of PIP implants.

An expert committee was set up to examine the specific risks associated with PIP implants. It concluded that there was not enough evidence to recommend their early removal. That advice has not changed. For more details of its findings read the expert review group's final report (PDF, 162kb).

However, the committee also said that the anxiety felt by many women with PIP implants is in itself a form of health risk. Therefore it endorsed the Department of Health's offer to remove and replace the implants without charge if patients that the NHS had operated on remained concerned. The government expects the priv

Women who had a PIP implant privately

The following private clinics have said they will replace PIP implants free if clinically necessary:

  • BMI Healthcare
  • HCA International
  • Holly House
  • Highgate Hospitals
  • Make Yourself Amazing/MYA Cosmetic Surgery
  • Nuffield Healthcare
  • Ramsay Health Care
  • Spire Healthcare

Women who have received PIP implants may be able to bring a legal action against their original cosmetic surgery provider under the Sale of Goods Act, or possibly under the terms of their original contract with the provider. They should seek their own legal advice on exactly what routes might be available.

When should it be done

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

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 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.

Implant surgery is usually carried out by either a plastic surgeon or a breast surgeon. When discussing the procedure with your surgeon, find out 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) or the Association of Breast Surgery (ABS)
  • what sort of follow-up you should expect if things go wrong, even at a much later date

Suitability

Not everyone is suitable for breast implant surgery. Your surgeon will need to take a detailed look at your medical history and overall health.

You will not be able to have breast implant surgery if you:

Before a decision is made about whether you are suitable for surgery, you will need to be emotionally stable and have realistic expectations about what the breast implants will achieve.

Most surgeons would not normally perform surgery on a woman who had a poorly controlled mental health condition such as severe depression or bipolar disorder.

Only have breast implants once you are satisfied 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 you are not pressured by someone else into having breast implants. It is your body and your decision.

Mastectomy

Read more about how breast implants are fitted.

Cost of surgery

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

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. Breast implants stretch your natural tissues and may thin your natural breast tissue over time. If you have implants permanently removed at a later date, you may need breast lift surgery (mastopexy), to correct breast sagging. This may leave you with more scars on your breast.

Significant psychological distress may be caused by:

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

Why is it necessary

There are a number of reasons why you may want 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
  • you may need reconstructive breast surgery, for example, after having a mastectomy (where one or both breasts are surgically removed)

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 (known as 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 shaped, 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 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 for having breast implants, but they can have positive psychological effects. For example, if a woman feels her breasts are unwomanly or inadequate, having breast implants may help improve her confidence and self-esteem.

However, it is important not to regard breast implants as a "quick fix", and you should take your time when considering whether or not to have them.

If you have significant body image issues and /or feelings of anxiety and depression, then having breast implants will not necessarily lead to an improvement in these types of feelings.

When making your decision, you need to balance potential benefits with the risk of developing possible side effects and complications. Read more about the complications of breast implants.

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