Background

How many women are affected?

How many private patients have had NHS help?

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?

Is it safe to have a mammogram with PIP implants?

Your rights

What happens if I got a PIP implant through the NHS?

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?

Official government advice is that there is no medical need for PIP implants to be removed early if they are intact. But the NHS has pledged to remove PIP implants without charge whether they have ruptured or not. So, if you are worried and want your implants removed before they rupture, see your GP or surgeon.

How many women are affected?

In the UK, around 47,000 women are thought to have the implants. Private clinics fitted 95% of these for women seeking cosmetic breast augmentation. The remaining 5% were fitted on the NHS.

The NHS provides breast implants only where there is clinical need. For example, women who have a mastectomy (breast removal surgery) as part of treatment for breast cancer are often offered implants as part of reconstructive surgery.

What happens if I got a PIP implant through the NHS?

If you received a PIP implant from the NHS you should have been contacted to let you know that.

You can speak to your GP or with the surgical team that carried out the original implant for advice on the best way forward. This could include a scan to see if there is any evidence that the implant has ruptured.

The NHS will offer removal and replacement of PIP implants if a woman and her doctor decide that it is the right thing to do.

What if I got 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 Health 
• Ramsay Health Care 
• Spire Healthcare 

If a private clinic that provided PIP implants no longer exists or refuses to help, then the NHS will offer you clinical advice and support, including referral to an appropriate NHS specialist.

The NHS will also cover the cost of the removal of PIP implants if you and your doctor agree. This would not include the replacement of private cosmetic implants.

How many private patients have had NHS help?

Around 7,000 women who had their PIP implants put in privately have been referred to a specialist on the NHS. So far, 4,349 scans have been done and 490 women have decided to have their implants removed on the NHS.

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, 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?

There have been media reports of a possible link between PIP implants and a rare type of cancer called anaplastic large cell lymphoma (ALCL).

The reports arose after a French woman with PIP implants developed the cancer and died.

However, after reviewing the evidence, the British independent expert review led by Sir Bruce Keogh agreed that there was no specific link between PIP implants and 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 in the implant’s casing. A rupture 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

What are the signs of rupture?

If you have any of the following signs or symptoms, you should discuss them with your GP, 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

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 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.

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 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.

Read more about combining NHS and private treatment.

Is it safe to have a mammogram with PIP implants?

During mammography, the breast has to be squeezed fairly tightly, which could theoretically cause a breast implant to leak or rupture. Also, scarring and calcium deposits around the implant may look like cancerous tissue and make the mammogram harder to interpret.

If you have PIP breast implants and need to have a mammogram, tell the technician when you arrange the appointment. You may need more views taken than during a typical screening.

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.

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. 

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, you may need to stay in hospital overnight if the operation is scheduled late in the day. Depending on the procedure you are having, the operation should take between 60 and 90 minutes to complete.

The incision

Breast implant surgery starts with your surgeon making a cut (incision). Your surgeon will discuss with you the exact location of the incision before the procedure. This 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
• transumbilical breast augmentation (TUBA) – the incision is made near the 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 because of 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. The stitches may dissolve on their own over time or they may need to be removed a week or two later.

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 to treat 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, thighs or buttocks.

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. You will also 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.

Read more about breast reconstruction.

Breast implant surgery – also called breast augmentation or enlargement – is the most common type of cosmetic surgery carried out in the UK.

It’s estimated more than 30,000 such procedures are carried out in the UK every year. Most of these are carried out privately, with fewer than 4,500 operations to fit breast implants carried out on the NHS during 2012-13.

Why are breast implants used?

Breast implants can be used for two purposes:

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

Generally, breast implants used for purely cosmetic reasons are not available on the NHS and need to be paid for privately.

In the UK, the average cost of private breast implant surgery is around £3,500-5,000, but you will also have to take into consideration the cost of any consultations or follow-up care that may be needed.

Read more about why breast implants are used.

Deciding to have breast implants

The decision to have breast implants should be an informed one that takes into account the potential health risks and financial costs.

If you are considering having breast implants, it’s a good idea to speak to your GP and a cosmetic surgeon beforehand about why you want them, your expectations of surgery, the procedure itself, and the potential risks.

Take your time to find out as much as you can beforehand, and don’t feel rushed or pressured into making a decision.

Read more about things to consider before having breast implants.

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 people choose to use implants filled with silicone. 

Breast implants generally have a life expectancy of 10 to 15 years, after which they may need to be replaced.

Read more about the different types of breast implants available.

Breast implant surgery

Breast implant surgery is usually carried out under general anaesthetic, and takes between 60 and 90 minutes.

During the operation, a cut (incision) will be made in the skin next to the treated breast(s). Your surgeon will discuss with you the location of the incisions 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.

You’ll usually be able to go home the same day you have the operation, or you may need to stay in hospital overnight. When you return home, you’ll need to take things easy at first, before gradually returning to most of your normal activities within the next four to six weeks.

You may be worried your breasts look unnatural at first, but this is normal and in most cases temporary. Your breasts will usually start to look and feel better within a few months.

Read more about what happens during breast implant surgery and recovering from breast implant surgery.

Possible complications

If you are contemplating having breast implants, you should make sure you are aware of the potential risks.

Some of the problems that can occur as a result of having breast implants fitted include:

• infection or bleeding after surgery
• scarring
• the shrinkage of scar tissue around the implant (capsular contracture)
• the implant splitting (rupturing)
• the implant becoming creased or folded
• temporary or permanent changes to nipple sensation

In some cases, further surgery may be needed to treat problems that develop.

Read more about the risks of breast implants.

Women with PIP implants are not at higher risk of cancer or other long-term health conditions, says the Department of Health.

An independent expert panel, chaired by Sir Bruce Keogh, was appointed by the Department of Health to investigate the consequences of the PIP scandal.

They concluded in their final report of June 2012 that “PIP implants have not shown any evidence of significant risk to human health”.

The review concluded that all breast implants are associated with a slight excess risk of a rare form of cancer called anaplastic large cell lymphoma (ALCL), but there is no evidence of an additional risk for PIP implants compared with other breast implants.

The expert group, led by Professor Sir Bruce Keogh, collected and reviewed available data including estimated rupture rates, data on clinical findings when implants were removed, and further examination of the chemical make-up for PIP silicone gel.

The group studied information on 240,000 implants of different makes used throughout England, which had been given to 130,000 women, along with detailed findings from 5,600 removal operations.

Conclusions regarding PIP implant 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 to six times higher than other breast implants.
• If the implant does rupture, it can cause inflammatory reactions around the implant area in some women, which can result in symptoms such as tenderness or swollen lymph glands. There is no evidence these reactions causes any significant health concern.

For more information, read the British expert review group’s final report (PDF, 163kb).

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

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’ve had them in the past.

If you have asthma, ibuprofen may also be unsuitable for you. Check with your GP or pharmacist if you’re 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.

After 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 may be asked to attend some postoperative appointments so your surgeon can monitor your recovery.

Your surgeon will be able to give you specific advice about any activities you need to avoid and for how long, but generally you should take a week or two off work and avoid heavy lifting or strenuous exercise for at least a month.

You will usually be able to return to most of your normal activities within six weeks, although you should keep the incision sites out of direct sunlight for about a year because the skin in these areas is more delicate.

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

Note your implant details

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 seek medical help

Contact your GP or the clinic where the operation was carried out as soon as possible 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)
• any lumps or aching causing you concern

Results of surgery

Although most women are pleased with the eventual appearance of their breasts after surgery, the 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

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.

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.

Your options for removal and replacement of PIP implants depend to a large extent on the circumstances in which they were fitted.

NHS PIP implant removal

If you had PIP breast implants as part of breast reconstruction surgery under the NHS, you can go back to the NHS to have your implants removed at no cost.

The NHS will fund PIP implant removal if they are showing symptoms of rupture, or if you are worried about the possibility of future problems.

Private PIP implant removal

If you had your PIP breast implants at a private clinic and you want to have them removed, your first move should be to go back to that clinic to have an assessment. Some private clinics have agreed to remove PIP breast implants free of charge, others charge a fee.

The government expects private providers who used PIP implants to take their responsibility of duty of care towards their patients seriously and treat you with dignity and compassion.

Unfortunately, this hasn’t been the experience of some women who have been blocked or thwarted by private clinics in their quest to have their implants removed and replaced.

If you find that the original private clinic won’t help you with removal either because it has closed or because it’s unwilling to do so, be reassured that you will be able to have your PIP implants removed free of charge by the NHS.

NHS PIP implant replacement

Normally, the NHS will remove but not replace PIP implants, with the following exceptions:

• If your original PIP implant surgery was performed by the NHS, you will also be able to have new breast implants fitted by the NHS after the PIP implants have been removed.
• If you live in Wales. The NHS in Wales will remove and replace both NHS and privately fitted PIP implants.
• If you had private breast augmentation surgery for medical rather than cosmetic reasons, your GP can make what’s called an “exceptional aesthetic referral” on your behalf to your local NHS hospital trust. Medical reasons for NHS breast augmentation include assymmetry of more than two cup sizes; no natural breast tissue or a psychological need because of mental health problems such as body dysmorphia.

Private PIP implant replacement

Some private clinics have agreed to replace PIP implants free of charge, but others have not.

These private clinics have said they will replace PIP implants free of charge if clinically necessary:

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

 These private clinics charge a fee to replace PIP implants:

• Harley Medical Group
• Transform
• The Hospital Group

‘Top-up’ schemes for implant replacement

Initially, certain NHS hospitals offered women with private PIP implants a “top-up” scheme, whereby they could have free implant removal followed by private implant replacement in a single operation.

However, top-up schemes are no longer available, as they contravene Department of Health guidance that states 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.

How are PIP implants removed and replaced?

The operation to remove/replace PIP breast implants is done wherever possible in the conventional way and through the original surgical cut.

Read more about breast implant surgery.

Like any type of operation, surgery to fit breast implants is associated with a number of complications.

These may be related to the operation itself, or they may occur later as a result of a problem with the implants.

In some cases, additional surgery may be needed to treat problems that develop.

General risks of surgery

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
• infection
• blood clots

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. This 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 to resolve the problem will be needed in the future.

Rupture

A rupture is a split that occurs in the implant’s casing. It can be caused if the implant’s outer shell gets weaker over time, the implant is damaged during the operation, there is a flaw in the implant, or the breast is injured.

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

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

It is not always possible to tell if a breast implant has ruptured, but signs can include lumpiness, swelling, redness and tenderness in the breast.

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. 

If you have silicone implants, the silicone that leaks out of a ruptured implant may cause problems, such as siliconomas or a gel bleed.

If your implant was fitted privately, you may need 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 known as siliconomas developing.

Siliconomas can be tender to touch and they may need to be removed if they are causing significant pain. 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. 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 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.

Seroma

After having breast implant surgery, fluid can build up around your implant. This is known as a seroma and is fairly common. Further surgery may be needed to drain away the fluid in severe cases, but most seromas resolve without needing to be drained.

Scarring

After breast implant surgery, you will have some degree of scarring. In most cases the scarring is relatively mild.

However, in a few cases the scarring is more severe. For these women, their scars may be red, lumpy, thick or painful.

These symptoms should improve gradually and over time the scars will begin to fade. But 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 your skin has creases, kinks, folds or ripples.

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

Altered nipple sensation

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

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

If your nipples are painful, speak to your GP or surgeon about it.

Breastfeeding problems

Having breast implants should not stop you breastfeeding, although some women will find they are not able to breastfeed 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.

Infection and bleeding

Infection and bleeding are relatively rare after breast implant surgery. However, if you are having an implant fitted for breast reconstruction after a mastectomy (breast removal), you may have a greater risk of infection and bleeding.

Most infections can be treated using antibiotics. But 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 reinserted after the infection has cleared up.

However, it is important the implant is not reinserted too soon, as this can increase the risk of infection. Waiting a few 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. Your surgeon may recommend not smoking before your operation to reduce the risk of developing complications.

Cancer

All types of breast implants are associated with a slightly increased risk of a very rare form of cancer called anaplastic large cell lymphoma (ALCL). However, it is not clear if the implants themselves directly cause this condition, and the overall risk is still extremely small.

In the US, figures from the National Cancer Institute state only around 1 in every 500,000 women is diagnosed with ALCL each year, and only around 3 in every 100 million are diagnosed with ALCL in the breast.

Breast cancer

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

Breast implants can affect breast screening as it may be more difficult to interpret the mammograms of women who have implants fitted. You should tell the healthcare professional taking the scan you have implants so they can ensure the best possible images are taken. 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.

Silicone implant safety concerns

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

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

It was thought these complications may have 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). These implants are filled with a type of silicone gel that has not been approved.

As yet there is no evidence to suggest the gel inside them is harmful. However, speak to your GP or the clinic where the implants were fitted if you have these gel implants and have any concerns.

Read more about PIP breast implants.

Having any type of cosmetic surgery, such as breast implants, is a major decision. It can be expensive, time consuming and the results can’t be guaranteed.

It’s important to ask yourself why you want to have breast implants, find out as much as you can about the procedure, and consider everything from the potential benefits to the financial costs and health risks.

Don’t be pressured by someone else into having breast implants or be rushed into making a decision.

Speak to medical professionals

If you’re considering having breast implants, it’s best to speak to your GP about it first. They can talk to you about your options and give you more general information about what surgery involves. They can also advise you about the possibility of having the procedure on the NHS.

If your GP thinks cosmetic surgery may be a suitable treatment option for you, they may refer you to a consultant who can talk to you in more detail about the availability of the procedure on the NHS, what it involves, and what your expectations of surgery are. You need to be realistic about what the surgery can achieve so you are not disappointed with the results.

If you decide to have breast implants fitted at a private hospital or clinic, it’s still a good idea to discuss your plans with your GP first as they will be familiar with your medical history and may be able to recommend particular surgeons.

Consider the financial costs

An important issue to consider when deciding whether to have breast implants is the overall financial cost.

Breast implants on the NHS

It is rare for the NHS to fund any type of cosmetic surgery, including breast implants. Most people who want to have breast implants fitted do so by paying for private treatment.

However, there are a few circumstances where breast implants may be available on the NHS. For example, you will be able to have a breast reconstruction, which may include the use of breast implants, on the NHS if you have had breast removal surgery (mastectomy) as part of your treatment for breast cancer.

You may also qualify for breast implants on the NHS if it is clear the appearance of your breasts is causing you significant psychological distress or your breasts have not developed normally. For example, you may be able to have NHS-funded breast implants if your breasts are significantly uneven or breast tissue has failed to develop.

The availability of breast implants on the NHS may also depend on your local clinical commissioning group (CCG) and the amount of funding they allocate for breast implant surgery. Your GP may be able to advise you about availability in your area.

Private treatment

In most cases, you’ll need to pay for breast implants to be fitted privately. This can be an expensive option and it is important to be aware of all the potential costs involved.

The average cost of having breast implants in the UK is in the region of £3,500-5,000. You may also have to pay additional costs for any consultations you have and any follow-up treatment you require.

For example, if an implant has to be replaced at any point, this will usually need to be paid for privately. The NHS may be able to remove an implant if there is a problem with it, but it will not usually be replaced on the NHS unless the original operation to fit it was also performed on the NHS.

Be aware of the health risks

It’s also very important to make sure you are aware of the potential risks of having breast implants fitted, including the complications related to surgery or further problems that may develop at a later stage.

Some of the problems that can occur as a result of having breast implants fitted include:

• infection or bleeding after surgery
• scarring
• the shrinkage of scar tissue around the implant (capsular contracture)
• the implant splitting (rupturing)
• the implant becoming creased or folded
• temporary or permanent changes to nipple sensation

In some cases, further surgery may be needed to treat any problems that develop.

Read more about the risks of breast implants.

Research clinics and surgeons

If you do decide you would like to go ahead and have breast implants fitted, it’s a good idea to spend some time finding out about treatment centres that can perform the operation.

You can do this by checking the Care Quality Commission (CQC) website or calling their customer helpline on 03000 61 61 61. All independent clinics and hospitals that provide cosmetic surgery must be licensed with the CQC.

You should also find out about the surgeon who is going to fit your breast implants. 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
• what qualifications they have – see qualifications to look for in a cosmetic surgeon for more information
• whether or not they are a member of a recognised surgical association, such as the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS), the Association of Breast Surgery (ABS), or The British Association of Aesthetic Plastic Surgeons (BAAPS)
• what sort of follow-up you should expect if things go wrong, even at a much later date

Read more about choosing a cosmetic surgeon.

You should discuss the different types of breast implants available with your surgeon.

There are two types of implant available in the UK – silicone gel or saline (sterile salt water).

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

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

Silicone gel implants

Silicone gel implants are the most common type of breast implant used in the UK. The silicone can vary in its firmness and consistency. Unlike some saline implants, 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 teardrop shaped)
• silicone gel can be a very soft and pliable (supple) implant filler, so 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 scar tissue shrinking around the implant (capsular contracture)

A disadvantage of silicone implants is that if the implant ruptures, the silicone may spread outside of the scar tissue around the implant and into your breast. This can lead to small lumps developing that are known as siliconomas.

Siliconomas can be tender to touch and may need to be removed if they cause significant pain.

Soft and cohesive silicone gel implants

Either soft or firm silicone gel can be used in breast implants. Implants filled with the firmer gel are called cohesive gel implants.

An advantage of cohesive gel implants over softer silicone implants is that in the unlikely event of the implant’s shell rupturing, there is a greater chance the gel would stay inside and not leak into the surrounding tissue.

Cohesive gel implants may also be less likely to wrinkle or fold because of their ability to retain their shape and integrity.

However, cohesive implants may have a slightly less natural feel than the softer silicone implants, and may mean a larger incision has to be made to allow them to be inserted.

Polyurethane-coated silicone implants

It is thought these implants may be associated with a reduced risk of capsular contracture (where scar tissue shrinks around the implant).

However, some surgeons believe they are slightly more difficult to use than other types of breast implants available, and most surgeons in the UK have little experience with their use.

Your surgeon may suggest using these implants as a replacement for your original implants. This is usually if you require further surgery to correct a problem with your implants and you have been experiencing problems with capsular contracture since you had your initial operation.

Saline implants

Saline implants have a strong, silicone shell and are either pre-filled with sterile salt water or 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
• they are available in round or anatomical shapes

Disadvantages of saline implants include:

• they may rupture or deflate earlier than silicone implants
• they are more prone to wrinkling or folding
• they may feel less natural than 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.

PIP implants

In 2010, French PIP implants caused concern after it was revealed they contained industrial silicone rather than medical-grade fillers and were more prone to rupture than other implants.

Around 47,000 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 the implants were originally fitted privately, they may be removed by the NHS, but you will usually need to pay privately to have them replaced.

If you are worried about your implants, speak to your GP or the clinic where the implants were fitted.

Read more about PIP breast implants.

Implant life expectancy

Women who have breast implant surgery rarely keep the same implants for the rest of their lives. Anyone who has a breast implant is likely to need further surgery at some point, either to change the implant or remove the scar tissue that has formed around it.

Most breast implants have a life expectancy of 10 to 15 years, after which 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. You may have to pay for scans if rupture is suspected, as the NHS will not necessarily fund investigations or replace your implant if the surgery was performed privately in the first place.

PIP implants are two to six times more likely to rupture than other silicone implants.

They also leak tiny amounts of silicone through the shell, called gel bleeds, which can result in similar symptoms to a rupture.

How can you tell if an implant has ruptured?

Most women with a ruptured PIP implant will not notice anything different. This is known as a “silent” rupture.

Some women develop symptoms in and around their breast after implant rupture. The breast may change shape or feel harder or lumpy as the implant deflates and scar tissue forms. Also, the leaked silicone gel can act as an irritant, causing pain and inflammation and swollen glands in the armpit.

Is it dangerous if an implant ruptures?

The prospect of a ruptured implant is alarming, but all the research to date has shown no evidence that a ruptured PIP implant can cause cancer or other lasting health problems.

However, there clearly are unpleasant symptoms associated with implant rupture, including pain, swelling and redness of the breast. It can also be more difficult to remove an implant once it has ruptured.

Spotting signs of implant rupture

If you have any of the following signs of implant rupture discuss them with your GP, who will refer you to a specialist:

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

What to do if you suspect an implant has ruptured

See your GP to arrange a hospital scan, either by ultrasound or MRI, to confirm whether an implant has ruptured.

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 but you are still anxious or experiencing symptoms, then you are entitled to an MRI scan, as this is a more sensitive method.

If the scan shows that an implant has ruptured, you should have the burst implant (and any intact implant in the other breast) removed as soon as possible.

Read about PIP implant removal and replacement.

Breast implants can be used to increase breast size, improve breast shape and make breasts more even in size.

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

• you may be unhappy about the size, shape or unevenness of your breasts – possibly as a result of developmental problems
• your breasts have changed in appearance – for example, with age, weight loss, or after having children
• you are having, or have had, surgery to remove one or both breasts (mastectomy)

There is no specific medical advantage to having breast implants in cases such as these, 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 or feelings of anxiety and depression, having breast implants will not necessarily lead to an improvement in these feelings.

If the operation is carried out privately, when making your decision you need to consider the potential financial cost of any consultations you have, the initial operation to insert the implants, and any follow-up treatment you may need.

You also need to be aware of the risk of side effects and complications associated with this type of surgery.

Read more about things to consider before having breast implants and the risks of breast implants.

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)
• significant unevenness (asymmetry) in size
• abnormal development of 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 unusually shaped breasts, or where differences in breast size or shape are pronounced, breast implants may have an important psychological benefit.