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Procedure Time: 90 minutes
Recovery Time: 1-4 weeks
Results Duration: Expected implant life is 10+ years
Cost: Approx. £3,000 - £5,000
Anaesthesia: General anaesthesia or sedation
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Breast augmentation or enlargement is now one of the most widely performed and most successful cosmetic surgery procedures available in the U.K. There are currently two types of implant available in the UK; a silicone gel implant and a saline filled implant that is usually placed inside the breast before being filled with salt water. Implants also come in many different shapes and sizes allowing you more choice. Breast augmentation can be performed under a general anaesthetic, although some surgeons use a local anaesthetic, combined with a sedative to make you drowsy, so that you remain awake but feel very little discomfort during the operation. A short incision can be made either in the crease under the breast, around the areola (nipple area) or in the armpit in order to insert the implant. Implants can be positioned either between the breast tissue and the pectoral muscle (sub-glandular) or behind the muscle (sub-muscular). Most people find that they can return to work after a few days recuperation. Private costs for breast implants can range from approximately £3,000 - £5,000.
In 2018, there were 329,914 breast augmentation procedures performed in the USA, demonstrating an decrease of 1% since 2017. These statistics are part of a survey commissioned by the ASAPS. (the American Society for Aesthetic Plastic Surgery) and show breast augmentation as the most popular surgical procedure in the USA. At the moment, similar accurate statistics are not available for the UK, but estimated figures from the major cosmetic surgery providers indicate that cosmetic surgery on breasts is the most popular aesthetic procedure in this country.
The first breast implants of the kind that are used today underwent medical trials during the 1960’s, but before that, breast augmentation had dubious origins. We know that Japanese prostitutes sometimes had their breasts injected with substances such as paraffin, and non-medical grade silicone to enlarge them as they believed that American servicemen favoured women with larger breasts!
Twenty years later, the first breast implants were developed by two plastic surgeons from Texas: Frank Gerow and Thomas Cronin. These were filled with silicone and signalled the beginning of the breast implant revolution which continues today. Saline (a salt water solution) filled implants were introduced in 1965 and in 1974 further developments led to the production of inflatable implants.
In the early 1990s, breast implants became the subject of heated controversy as reports of women claiming their silicone implants had seriously damaged their health became widely publicised in the media. In 1991, U.S. implant manufacturer Dow Corning lost a multi-million dollar lawsuit based on claims that its silicone implants were the cause of a plaintiff's autoimmune disease: i.e. the woman claimed that her silicone implants had caused her body’s natural antibodies to be damaged, making her much more susceptible to infections and disease. Shortly afterwards, in January 1992, the U.S. Food and Drug Administration (F.D.A.) issued an outright ban on the use of silicone-gel filled implants for cosmetic augmentation. However, some people claimed that the F.D.A.'s actions were not based on any scientific proof that silicone is harmful but, rather, on political and social pressure. (This ban was subsequently lifted in 2006.)
No such ban exists or has ever existed in the UK and silicone implants can be used here without restrictions.
In June 1999 scientists from the Institute of Medicine (I.O.M.) in the U.S. released a very detailed report on breast implants. After the earlier controversies and legal action relating to the use of silicone implants, much scientific research had been undertaken to establish whether there really is a link between silicone and damage to the immune system or cancer. The report concluded that there is no solid scientific evidence of a connection between breast implants and any disease. Similar findings were published by health agencies in the United Kingdom and Europe.
Simultaneously, doctors were trying to discover a substance which might be a substitute for silicone in breast operations. For a while, an implant- filler made from the oil of the soya bean seemed promising, but in June 2000, questions of the long-term safety and effectiveness of this product led to its use being discontinued in the UK.
A handful of doctors from various areas of medicine are currently promoting breast enlargement by fat injection as a safe and effective alternative to implants. However this method may produce only temporary results due to the injected fat being absorbed into the body. An even more serious complication of such a procedure is fat calcification which is caused when the fat which has been absorbed into the body forms little lumps in the breast. These lumps can then show up on a mammogram (breast x-ray) and may cause some women and doctors to be alarmed at the possible existence of “tumours” in the breast. These lumps are not cancerous, of course, but are the lumps of fat which were earlier injected as implants.
The use of sustained mechanical force to promote tissue growth in the breasts, and hence cause the breasts to enlarge, has recently been touted as a new method to achieve a modest improvement in breast size. This involves a large bra-like device which is fitted with a motor and worn by the patient for a minimum of ten weeks for ten hours a day (usually at night). The principle of the procedure is that the breasts are gently stretched by the motor in the bra which causes them to expand during the night. This device is marketed under the name of “Brava”. While some doctors have reported promising results with this technique, others claim widespread failure to achieve satisfactory results. Consequently, patients have often been disappointed with this treatment.
Even allowing for the controversy surrounding breast implants, surveys have shown that the overwhelming majority of women who undergo breast augmentation say they would make the same decision again and that they are pleased with the improvement in their appearance as a result of breast enhancement.
If you are considering breast implants, the following information will give you a basic understanding of the procedure. It can't answer all your questions, since a lot depends on the individual patient and the surgeon. Please ask a surgeon about anything you don't understand.
It is important to be clear about your reasons for having breast implants. Women may seek breast enlargement because they:
Breast implants can bring psychological benefits for women who may feel that their breasts are unwomanly and inadequate.
They can help restore lost self-esteem and improve the quality of life. However, you should think carefully about your reasons for having implants and be sure that breast implants are the best solution to your particular anxiety or dissatisfaction.
Your surgeon will wish to explore with you the psychological aspects of having breast implants, as well as the physical details of the operation.
There are two main parts to an implant: the outer shell and the inner filler.
All breast implants are surrounded by a firm, silicone elastic (or elastomer) shell. The surface of the implant may be smooth or textured.
There are currently two types of implant filler available in the U.K.:
Implants come in many different shapes and sizes, and with a number of different implant manufacturers and distributors active in the U.K. there is usually no problem in finding the appropriate implant for you.
Please see our Products section at the top of the page for more information on implants available in the U.K..
It is important that during your first discussion with a surgeon, you should explain clearly what you expect from the treatment and how you would like to look afterwards.
Careful discussions regarding the reasons for wanting implants, and the suitability of implant surgery are very important at this stage. Make sure that you obtain as much information as you can to enable you to make a fully informed choice about the procedure. You need to think about the type and size of implant that may be suitable for you before your operation, as well as the point at which the implant will be inserted into your breast, how it will be placed inside your breast and the type of anaesthetic used.
A medical history should also be taken, to ensure that there are no reasons why you shouldn’t have this operation. At this point, you would normally be asked to sign a consent form stating that you have understood the potential benefits and risks associated with breast implantation.
Photographs may also be taken by the practitioner, as the basis for a “before and after” comparison at a later date.
The surgeon will wish to write to your G.P. giving details of the operation so that if there are any problems associated with surgery in the short- or long-term, the G.P. is aware of the procedure and can help you as you recover.
Your surgeon should also send information about your operation to the National Breast Implant Registry (N.B.I.R.) so that information about breast implants can be collected from all over the country and used in further research or in the gathering of statistics about cosmetic surgery. This has proved to be very important in recent years when some types of implants have had to be recalled by their manufacturers and their patients informed immediately.
However, you do not have to register your implant operation with the N.B.I.R.. This is a purely voluntary action to help future research. If you do choose to do this, you will be asked to sign a form that will contain all the information given to the Registry including your implant details.
Breast augmentation can be performed under a general anaesthetic, although some surgeons use a local anaesthesic, combined with a sedative to make you drowsy, so that you remain awake but feel very little discomfort during the operation.
Remember that a general anaesthetic will always carries a greater risk than a local anaesthetic, but you should discuss your thoughts about this with your surgeon before you undertake the treatment. He/she will offer you the best advice for your comfort.
Every patient’s needs are assessed individually and it depends entirely on your body as to which method of inserting the implant is used. A short incision can be made either in the crease under the breast, or around the areola (the dark skin around the nipple) in the armpit, or even via the navel (belly button). The latter is generally not recommended, however. It may reduce the level of scarring in a much less obvious area than the breast, but it is a more complicated procedure and can only be used for inflatable saline implants.
Implants may then be positioned either between the glandular tissue of the breast and the pectoral muscle (sub-glandular - as in the right hand picture below) or behind the muscle (sub-muscular - left hand picture below).
Drainage tubes are rarely needed following the operation. The surgery generally takes about ninety minutes to complete. Slow dissolving stitches are usually used to sew up the wounds.
You should be able to return home soon after the surgery. Often patients go home in the afternoon following surgery in the morning, or they may require just a night’s stay in the clinic. Most patients find that they can return to work after a few days’ recuperation.
You will feel sore and tired for a few days after the operation, just as you would after any surgery.
You may also experience a burning sensation in your nipples for some days after the operation, which will ease as the bruising starts to go down. Both the bruising and the slight discomfort afterwards are normal parts of the healing process.
The swelling in your breasts can take 3 - 5 weeks to go completely. Scars will be pink for several weeks, but they will begin to fade after a few months, although they will never disappear completely.
It is quite common for women to experience a change in sensation in their breasts after surgery with silicone or saline implants. Mostly, women say that their breasts are less sensitive than they were before the operation. This is usually only a temporary stage and soon your breasts will return to being as sensitive as they were previously. It is estimated that 1 in 7 women may experience loss of or a lessening in nipple sensation after breast enhancement, and in a minority of cases, this can be a permanent state.
Other side effects include developing an infection which may rarely result in the implants having to be removed.
A condition known as “Capsular Contracture” is one of the most common risks or complications after having breast implants.
If a “foreign body”, such as a silicone implant, is introduced into the chest, your body will automatically grow a wall of "scar tissue" around it as a protective process. Fibrous scar tissue does shrink, but by just how much varies from person to person and even from breast to breast.
Recent evidence in the U.K. suggests that in approximately 1 in 10 women who have had breast implants, the scar tissue can contract, pushing into the implant and causing it to deform. Often, the implant becomes hard and, in some cases, painful. The implant may have to be removed along with the capsule and replaced, if appropriate, with another implant.
Recent changes in implant design and technology with the more common use of textured implants (implants that have a roughened surface) claim that they help to reduce the likelihood of capsular contracture, with the rates of occurence having reduced from about a 10-15% chance to 5-6% according to some surgeons.
Can implants split and how long will they last?
Implants can split, or rupture by developing a hole in the silicone shell wall of the breast implant. Rupture was common with early, thin-walled implants, but happens much less often now.
There is little information about how often ruptures have occurred in U.K. patients who have had implants. However, as science develops stronger materials, the rupture rates appear to be going down. As to the life expectancy of an implant, since the treatment is still relatively new, we have little idea as to how long they can last.
Rupture does not necessarily create a medical problem: different fillers will react differently. If a split occurs in the majority of cases of silicone gel filled implants, the silicone gel will remain within the capsule that the body forms and can be removed if the ruptured implant is removed.
Occasionally, the silicone can spread outside the capsule into the breast and create a series of lumps known as siliconomas. These may give rise to symptoms such as tenderness in the breasts. In a small number of cases where gel has been found in the breast tissue, the muscles under the breast, the armpit or, rarely, around the nerves to the arm, some of the breast tissue may be lost when the implants are removed. These cases are very rare.
The Independent Review Group (I.R.G.) set up by The Department of Health to review the safety of silicone gel filled breast implants published its report in 1998 (information is archived on the MHRA website).
No relationship was shown between silicone gel implants and long-term “systemic illness” (or illness affecting the whole body).
The fact that implants are encased in an outer shell means that the chances of creasing or rippling in the “new” breast are unlikely. “Wrinkled breasts” are seen most frequently in women who had very little breast tissue before the implants.
There is no evidence that breast implants affect fertility, pregnancy, or the ability to breast feed a baby. If you have been breast feeding in the year before your surgery, you may produce milk for a few days after surgery. This can be treated with prescription medication to stop the milk flow.
There is no evidence that implants cause breast cancer, but you should let your doctor know that you have had implants before a mammogram (breast x-ray). You should then go to a radiology centre where staff are experienced in the special techniques needed to get reliable x-rays of implanted breasts. Ultrasound examinations may help to detect breast lumps in some women with implants.
It is very important that you follow the advice of your surgeon very carefully after your surgery.
Post-surgery advice may include:
There are few absolute medical reasons why you should not undergo a breast augmentation procedure as long as you are in good general health and have realistic expectations of the results.
If you have experienced healing problems with any past surgical treatments or if you are prone to keloid (red, angry, raised) scars, your surgeon may not recommend breast augmentation or may caution you that scars could be very visible.
Only fully trained and qualified Surgeons should perform a Breast Implant procedure.
For more information about practitioner training, qualifications and relevant medical organisations please view the information contained within the Legislation section of the Consulting Room.
It is unlikely that anyone considering breast implants for cosmetic reasons would be able to access this free of charge on the National Health Service (unless you have lost a breast through disease or trauma).
However certain regions do make special cases and we would always recommend that you visit your General Practitioner before embarking upon a major cosmetic procedure.
As well as their advice and guidance they may also be able to refer you to a local NHS Hospital who can treat you.
The NHS has set out the following guidelines on how to get cosmetic surgery through the NHS:
"To qualify for surgery on the NHS you must meet specific criteria as set out by your local health authority. The NHS will not pay for surgery for cosmetic reasons alone. Reconstructive and cosmetic surgery to correct, or improve, congenital abnormalities and injuries will usually be carried out free of charge.
NHS reconstructive surgery is performed by plastic surgeons who have had extensive training and belong to the British Association of Plastic Reconstructive and Aesthetic Surgeons. Surgeons who carry out cosmetic surgery through the NHS also belong to the British Association of Aesthetic Plastic Surgeons.
To receive cosmetic surgery from the NHS, you will normally need a referral from your GP. You will have a consultation with a plastic surgeon and an assessment by a psychiatrist, or psychologist. It will then be decided whether there is enough social, psychological, or physical benefit to be gained to justify surgery."
Prices for a private breast implants procedure can range from £3,000 - £5,000.
Breast enlargement or augmentation is now one of the most widely performed and most successful cosmetic surgery procedures available in the U.K. As with all aesthetic surgery, however, it is vital that you ensure that you are in the hands of a qualified surgeon who has experience of carrying out the kind of operation you require. It is also crucial that you have a realistic idea of the results you desire from the treatment and that they can be achieved to your satisfaction.
Breast implants can be useful for both those women who have suffered some physical damage to their breasts and those who merely want to change the way they look so as to feel better about their physical appearance.
Implantation is a surgical procedure and requires skilful medical techniques as well as proper after-care. As long as you follow the advice of your Surgeon carefully as your breasts heal, most patients find that they are delighted with the results!
However, please take into account that current evidence shows that breast implants do not last forever, so be prepared for the possibility of future surgical procedures.
Please note that results of cosmetic surgery vary enormously, depending upon both the patient and the skill of the individual surgeon, so outcomes for procedures will always be more variable than those for less invasive non-surgical treatments.
(All before and after photographs featured are real patients treated by highly experienced surgeons, your results may differ).
B cup sized natural breasts before and 3 months after breast implant surgery with a D cup sized augmentation
Photographs courtesy of Consultant Plastic Surgeon, Mr Christopher Inglefield, BSc, MBBS, FRCS (Plast) at London Bridge Plastic Surgery.