Breast implants

Breast implants can be used for two purposes:

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

Breast implants

Breast implants are prosthetic (artificial) implants. Two types of breast implants are commonly used:

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

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

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

Important decision

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.

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

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

  • You may be unhappy about the size or shape of your breasts.
  • Your breasts may be uneven in size (asymmetrical).
  • Your breasts may have changed in appearance, for example, after having children.
  • You may need to have 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 (ptosis)
  • even out unequally sized or irregular breasts
  • reconstruct a breast after a mastectomy

Developmental problems

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

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

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

Psychological effects

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

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

Useful Links

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

Eligibility

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

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

  • are under 18 
  • are pregnant
  • have malignant (cancerous) or pre-malignant breast cancer that has not been fully treated
  • have a medical condition that could increase your risk from surgery or the general anaesthetic, or increase your risk of infection
  • have an infection anywhere in your body

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

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

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

Mastectomy

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

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

Useful Links

Your expectations

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

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

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

Important research

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

  • the number of successful breast implant operations they have carried out over the past two years
  • how many breast implant operations they have performed where there have been complications
  • whether or not they are a member of a recognised surgical association

Types of breast implant

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

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

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

Silicone gel implants

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

Advantages of silicone gel implants include:

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

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

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

Saline implants

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

Advantages of saline implants include:

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

Disadvantages of saline implants include:

  • They may rupture or deflate at an earlier stage than other implants.
  • They are more prone to wrinkling or folding.
  • These implants deflate over time

Safety

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

Implant life expectancy

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

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

Useful Links

Anaesthetic

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

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

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

Breast implant surgery

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

The incision

Breast implant surgery starts with your surgeon making an incision (cut). 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 three different types of incision, which are located in different places:

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

Fitting the implants

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

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

Once the implants are in place, the incisions will be sealed using sutures (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 are 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 will undergo fewer operations and anaesthetics.
  • The new breast may look better because the surgeon uses breast skin that is already there.
  • There will be less scarring on the new breast.

The disadvantages of immediate reconstruction are:

  • You will have less time to make a decision about the type of reconstruction that you would like.
  • some patients may require chemotherapy or radiotherapy,and this may not be known until after surgery.

Delayed reconstruction

The advantages of delayed reconstruction are:

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

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

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. Having realistic expectations and making a considered and informed decision will help ensure you are happy with the results of your operation.

Look and feel

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

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

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

Breastfeeding

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

Having breast implants will not increase your risk of developing breast cancer and there is strong scientific evidence to support this. However, it is still important for women who are over 50 to attend breast screening appointments when invited.
It is important to be aware that breast cancer screening is part of a national routine screening programme and is not aimed at women who already have symptoms.
Every two years, BreastCheck invites all women who are 50 to 64 years old and registered with a GP to attend a breast screening appointment.

Visit your GP if you notice anything unusual about your breasts, such as a lump. The majority of breast lumps (90% of cases) are benign (non-cancerous), but it is still important that you have a breast lump investigated as soon as possible. Do not wait to be invited for a routine breast screening appointment. See the Health A-Z topic about Breast cancer - Symptoms for more information.
 
Breast implants can affect breast screening, so tell the radiographer if you have implants (a radiographer is a health professional trained in taking X-rays) so they can ensure that the best possible images are taken.
 
If you have breast implants and you develop breast cancer, your chances of making a full recovery will not be affected.

Useful Links

After surgery

Immediately after having breast implant surgery, you will experience some swelling, pain and bruising. Your chest may feel tight and your breathing may feel restricted. This is normal and your symptoms will start to improve over the next few weeks.
 
You will usually rest at the hospital or clinic in a semi-upright position. This will help to keep you comfortable and will minimise any 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, do 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 GP or pharmacist if you are unsure.

Going home

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

On returning home, you will need to rest to give your body time to recover. You should avoid excessive use of your arms and chest area because 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, you should 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 that 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
  • catalogue number
  • batch 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 GP or surgeon immediately if you have any symptoms you were not expecting or if you experience severe pain. Possible warning signs include:

  • severe pain in your breast(s)
  • an intense burning sensation in your breast(s)
  • unusual, unexpected or excessive swelling in or around your breast(s)
  • deflated breast(s)
  • a smelly or coloured discharge from your wounds
  • a high temperature (fever) of 38C (100.4F) or more
  • any lumps or aching that are causing you concern

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

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

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 a number of complications that are 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 will vary 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 that further surgery will be needed in the future.

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

  • open capsulotomy
  • open capsulectomy

Open capsulotomy

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

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

Open capsulectomy

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

Rupture

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

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

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

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

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

Siliconomas

If you have a silicone breast implant that ruptures, the silicone may spread outside of the scar capsule and into your breast. This can 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 armpit or around the nerves to your arm.

Gel bleed

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

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

Scarring

After having 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 that 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 that they are painful. Increased sensitivity usually lasts for between three to six months.

If your nipples are very painful, speak to your GP or surgeon who will be able to give you advice about 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. 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 re-inserted once the infection has cleared up.

Some research suggests that 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 that 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 it is fairly common. In severe cases, further surgery may be needed in order 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 that these complications occurred as a result of silicone gel leakage that spread to other parts of the body.

In response to these concerns, the Department of Health in the UK 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.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

Browse Health A-Z