What are breast implants?
Breast implant surgery is the most common type of cosmetic surgery carried out on women.
Breast implants can be used for two purposes:
- reconstructive – to reconstruct the breast mound following a mastectomy (the surgical removal of the breast often used to treat breast cancer)
- cosmetic – to enhance the size and shape of the breast
Read more about why breast implants are used.
Types of breast implants
Breast implants are artificial (prosthetic) implants. In the UK, two types of breast implants are commonly used:
- silicone gel implants – available as a liquid, a gel or a solid form similar to plastic
- saline (sterile salt water) implants
Each type has associated advantages and disadvantages, although most breast implants are made out of silicone. Read more about the different types of implants available.
Breast implant surgery
Your surgeon will discuss with you the location of the incisions (cuts) beforehand so you're aware of where the scars will be.
After the incision, the implant is positioned between your breast tissue and chest muscle, or behind your chest muscle. Once the implants are in place, the incision is stitched and covered with a dressing.
Read more about what happens during breast implant surgery.
Following surgery, areas of your breasts will feel more or less sensitive than before. You may also be worried that your breasts look unnatural. This is normal and in most cases temporary.
Your breasts will usually start to look and feel more normal within a few months.
Deciding to have breast implants
Having breast implant surgery is not something to be taken lightly. Your decision to have breast implants should be an informed one that takes into account the potential risks and side effects.
Try to have realistic expectations about the results so you are not disappointed. Find out about the procedure, the recovery period and possible complications of breast implant surgery. Ask your doctor or surgeon if you are unsure about anything.
How are breast implants performed?
Breast implant surgery is usually performed under general anaesthetic. This means you will be asleep and unable to feel any pain or discomfort during the procedure.
As with any surgery there are risks associated with the use of general anaesthetic. However, they are very small (less than one in 10,000 cases experience serious complications).
In some cases, your surgeon may choose to use local anaesthetic to numb your chest area and you may be given a sedative to help you relax. So you will be awake during surgery but have very little awareness of what is going on during the procedure.
Your surgeon will discuss this with you before your operation.
Breast implant surgery
Breast implant surgery is sometimes carried out as day surgery, which means you will be able to go home the same day.
However, if the operation is scheduled late in the day, you may need to stay in hospital overnight. Depending on the procedure you are having, the operation should take between 1 and 1.5 hours to complete.
Breast implant surgery starts with your surgeon making an incision (cut). Your surgeon will discuss with you the exact location of the incision before the procedure. It will depend on the shape and size of your breasts and where you would like the scars to be.
There are different types of incision located in different places:
- inframammary fold – the most common type of incision; a small cut is made in the fold underneath each breast
- periareolar incision – the incision is made around the nipple and usually causes minimal scarring, but sensation in the nipple may be affected
- axillary incision – the incision is made in your armpit area and may result in more obvious scarring
- trans-umbilical breast augmentation (TUBA) – the incision is made near the umbilicus (belly button) and a tunnel is formed with a blunt instrument to reach the breast. A saline implant is then placed and filled once in position. This technique is generally not offered in the UK due to problems with achieving the correct placement and shape of the implant.
Fitting the implants
After the incision has been made, the implants can be fitted. The implant can either be positioned between your breast tissue and your chest muscle (subglandular) or behind your chest muscle (submuscular).
In some cases, the surgeon is able to place the implant partly behind the breast and partly behind the muscle (dual plane operation). Your surgeon will be able to advise about the position that is best for you.
Once the implants are in place, the incisions will be sealed using stitches, which will usually be covered with a dressing.
Reconstructive breast surgery
Breast implant surgery for reconstructive purposes is slightly different from surgery carried out for cosmetic reasons. Reconstructive surgery is often carried out after a mastectomy (where one or both breasts are surgically removed, usually after breast cancer).
For reconstructive surgery, as well as using prosthetic (artificial) breast implants, natural tissue implants may also be used. This is where skin, tissue and muscle are taken from another part of your body and used to create a new breast. Tissue may be taken from the:
- abdomen (tummy)
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.
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.
The advantages of delayed reconstruction are:
- You will have more time to make an informed decision about the type of reconstruction you would like.
- Your breast cancer treatment will be finished and will not affect your reconstructive surgery.
A disadvantage of delayed reconstruction is that you may have a larger scar on your reconstructed breast and that you will have to live with a mastectomy until your treatment is completed, although you will be offered an external prosthesis (breast shaped bra filler) to maintain your shape in clothes.
Complications of breast implants
After having breast implant surgery, about one in three women will require further surgery within 10 years of their initial operation.
Additional surgery may be needed as a result of complications such as capsular contracture (hardening of the scar capsule around the implant, see below), age-related changes to the breast (sagging) or the shell of the implant rupturing (splitting).
All forms of surgery carry some degree of risk. Complications that can affect anyone who has surgery include:
- an adverse reaction to the anaesthetic
- excessive bleeding
- risk of infection
- developing blood clots (where the blood thickens to form solid lumps)
There are also complications specifically associated with breast implant surgery. Some of these are discussed below.
After having a breast implant, your body will create a capsule of fibrous scar tissue around the implant as part of the healing process. This is a natural reaction that occurs when any foreign object is surgically implanted into the body.
Over time, the scar tissue will begin to shrink. The shrinkage is known as capsular contraction. The rate and extent at which the shrinkage occurs varies from person to person. In some people, the capsule can tighten and squeeze the implant, making the breast feel hard. You may also experience pain and discomfort.
Capsular contracture is an unavoidable complication of breast implant surgery. Everyone who has breast implants will experience capsular contracture to some degree and it is likely further surgery will be needed in the future.
There are three methods of reducing the tightness caused by capsular contracture. These are:
- closed capsulotomy
- open capsulotomy
- open capsulectomy
In a closed capsulotomy, the surgeon will try to tear the layer of scar tissue by squeezing the capsule. If successful, the tightness around the implant will be relieved and the implant will feel soft.
However, sometimes the scar tissue is so tough it cannot be torn, and there is also a risk of the implant rupturing (splitting). If the implant ruptures, further surgery will be required to replace it. A closed capsulotomy can also cause bleeding and bruising.
Due to the risk of further complications, a closed capsulotomy is not the preferred method of treatment for capsular contracture.
The aim of an open capsulotomy is to relieve the tightness caused by capsular contracture and give the implant more room to move inside the breast pocket.
The procedure will be carried out under general anaesthetic and involves the surgeon making an incision (cut) into the breast pocket to remove the implant. They will then make a series of cuts in the scar tissue inside the breast to help relieve the tightness around the implant. The implant will then be re-inserted and the incision closed.
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.
A rupture is a split that occurs in the implant’s casing. A rupture can be caused if:
- the implant’s shell (which holds the silicone or saline) gets weaker over time
- the implant is damaged during the operation
- there is a flaw in the implant
- the breast is injured
When implants were first developed, they had very thin walls and rupturing was a common problem. However, modern implants that have been used in the UK since the 1990s rupture much less frequently.
If your implant ruptures, it is recommended that you should have it removed and replaced with a new one.
If you have a saline (salt water) implant, any leakage from the implant should not cause you problems. As saline is a sterile, salt water solution, your body is able to safely absorb it. However, if you have silicone implants, the silicone that leaks out of a ruptured implant may cause problems, such as siliconomas or a gel bleed (see below). You may be expected to pay for any special investigations needed to confirm a suspected implant rupture.
If you have a silicone breast implant that ruptures, the silicone may spread outside of the scar capsule and into your breast. This can lead to small lumps developing that are known as siliconomas.
Siliconomas can be tender to touch and if they are causing significant pain they may need to be removed. In rare cases, the silicone can spread to the muscles under your breast, your lymph nodes (glands) under your armpit or around the nerves to your arm.
Gel bleed occurs to some degree in all breast implants, and has recently been a problem with PIP breast implants.
It is where small molecules of silicone polymer separate from the surface of the implant and are taken up into the surrounding tissues or lymphatic system (the network of vessels that help the body fight infection and are found in several places around the body, including in the armpit).
If the silicone molecules get into the lymphatic system, they may cause your lymph nodes (glands) to become slightly swollen. This is usually a minor problem, although in some cases the enlarged lymph nodes can become uncomfortable.
After breast implant surgery, you will have some degree of scarring. In most cases, the scarring is relatively mild. However, in approximately 1 in 20 women, the scarring is more severe. For these women, their scars may be:
- red, or highly coloured
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:
Creasing and folds tend to be more common in women who have very small breasts before having breast implant surgery.
Following breast implant surgery, about one in seven women find their nipples are less sensitive or completely desensitised (have no sensation at all).
Alternatively, after having breast implant surgery your nipples may be more sensitive. Sometimes, the nipples can become so sensitive they are painful. Increased sensitivity usually lasts for between three to six months.
If your nipples are painful, speak to your doctor or surgeon who will advise how to deal with it.
Infection and bleeding
Following breast implant surgery, infection and bleeding are relatively rare, occurring in less than 1% of cases. Internal bleeding is also unusual.
However, if you are having an implant fitted for breast reconstruction following a mastectomy (breast removal) you may have a greater risk of infection and bleeding.
Most infections can be treated using antibiotics. However, if your breast becomes severely infected, you may need to have the implant removed to prevent further complications developing. You should be able to have the implant re-inserted after the infection has cleared up.
However, it is important that the implant is not re-inserted too soon, as this can increase the risk of infection. Waiting a minimum of three months after the implant was removed is usually recommended.
Some research suggests your risk of infection and bleeding may be increased if you smoke, because your wounds will take longer to heal. The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) recommend you do not smoke before your operation in order to reduce the risk of developing complications.
After having breast implant surgery, fluid can build up around your implant. This is known as a seroma and is fairly common. In severe cases, further surgery may be needed to drain away the fluid. However, seromas usually resolve without needing to be drained.
Silicone implant safety
In recent years, the safety of silicone breast implants has been debated. A small number of women have reported serious complications following silicone gel breast implant surgery. These complications include:
- muscle spasm and pain
- swollen and painful joints
- changes in eye and saliva fluid
- hair loss
It was thought these complications occurred as a result of silicone gel leakage that spread to other parts of the body.
In response to these concerns, the Department of Health set up an independent review group to investigate the safety of silicone implants. The group found no scientific evidence to support the relationship between silicone implants and illness in women.
However, in March 2010 the Medicines and Healthcare products Regulatory Agency (MHRA) advised surgeons not to use certain implants produced by a company called Poly Implant Prothese (PIP). The implants are filled with a type of silicone gel that has not been approved.
The non-approved silicone gel implants were manufactured between 2001 and 2009 and have the following model numbers:
Tests are currently being carried out to determine whether there are any patient safety issues associated with these unauthorised implants. As yet there is no evidence to suggest the gel inside them is harmful. However, speak to your doctor or surgeon if you have these gel implants and you are concerned.
See the MHRA’s press release for more information regarding PIP’s silicone breast implants.
You should discuss the different types of breast implants (silicone and saline) with your surgeon.
There are advantages and disadvantages with each type of implant. The most suitable implant for you will depend on your individual circumstances and personal preference.
Both silicone and saline implants are surrounded by a firm, elastic silicone shell that helps prevent the implant from rupturing (bursting). The surface of the shell can either be smooth or textured.
Silicone gel implants and saline (sterile salt water) implants are discussed in more detail below.
Silicone gel implants
Silicone gel implants are filled with a silicone substance that can vary in its firmness and consistency. They are pre-filled before they are inserted.
Advantages of silicone gel implants include:
- They have a long history of safe use.
- They may be less likely to wrinkle than other types of implant.
- They are available in round or anatomical (contoured) shapes (often referred to as tear-drop shaped).
- Silicone gel is a very soft and pliable (supple) implant filler, which means it allows for movement and gives you a natural feel.
- Most silicone gel implants used in the UK have a textured surface, which can reduce the risk of excessive movement, and may also avoid problems, such as hardening, due to capsular contracture.
The silicone gel used in cohesive gel implants is firmer than the gel used in traditional silicone implants. Due to its firmness and thick consistency, in the unlikely event of the implant’s shell rupturing (splitting), there is a greater chance that the gel would stay inside and not leak into the surrounding tissue.
Like other types of silicone gel implants, cohesive gel implants have a soft, natural feel. They are also less likely to wrinkle or fold, due to their ability to retain their shape and integrity.
Saline implants have a strong, silicone shell and are filled with a sterile salt water solution. They are either pre-filled or can be filled through a valve once they have been inserted into your breast.
Advantages of saline implants include:
- They have a long history of safe use.
- As the saline solution is similar to your body fluids, it can be safely absorbed or excreted (got rid of) by the body if the implant ruptures (splits).
Disadvantages of saline implants include:
- They may rupture or deflate at an earlier stage than other implants.
- They are more prone to wrinkling or folding.
- They are only available in round and not breast-shaped (anatomical) shapes
- They may not feel as soft and natural as silicone implants
Other types of implant
Some types of breast implant, such as soya bean oil-filled implants and hydrogel implants, are no longer licensed for use in the UK.
In 2000, the Medicines and Healthcare products Regulatory Agency (MHRA) recommended that women with soya bean implants should have them removed.
Although hydrogel implants are no longer available in the UK, women who have them have not been advised to have them removed because they are not thought to cause an immediate risk. However, the MHRA is continuing to monitor their safety. See the MHRA’s website for more information about hydrogel breast implants.
In 2011, French PIP implants caused concern after it was revealed they contained industrial silicone rather than medical-grade fillers. They may also be more prone to rupture. Some 40,000 women in the UK are believed to have had the implants, with the majority of operations done for cosmetic reasons through private clinics.
There is not enough evidence to recommend the routine removal of PIP breast implants, a government expert review has concluded. However, any implants put in by the NHS can be removed and replaced without charge.
If you are worried about your implants speak to your surgeon or doctor.
For more information read our NHS PIP implant removal Q&A.
In 1991, polyurethane-coated silicone implants were withdrawn from use in the UK following fears they could increase the risk of cancer. However, research has shown the risk is very low (less than one in a million) and in 2005 polyurethane-coated implants were re-introduced.
Implant life expectancy
Women who have breast implant surgery rarely keep the same implants for their entire lives. Anyone who has a breast implant inserted (for whatever reason) will need further surgery at some point, either to change the implant or remove the scar capsule that has formed around it.
Most breast implants have a life expectancy of 10-15 years, after which time they may need to be replaced. However, breast implants can sometimes last longer without problems, and some manufacturers guarantee against certain types of implant rupturing for the lifetime of the patient.
Sometimes it is difficult to detect implant rupture.
Why is it necessary
There are a number of reasons why you may want breast implants. For example:
- you may be unhappy about the size or shape of your breasts
- your breasts may be uneven in size (asymmetrical)
- your breasts may have changed in appearance, for example, after having children
- you may need reconstructive breast surgery, for example, after having a mastectomy (where one or both breasts are surgically removed)
Most breast implant procedures are carried out to:
- make the breasts larger
- make the breasts firmer – with age, breast shape changes and the breasts gradually begin to droop (known as ptosis)
- even out unequally sized or irregular breasts
- reconstruct a breast after a mastectomy
Sometimes a woman’s breasts do not develop "normally" during puberty. Abnormal development can affect one or both breasts. Examples of abnormal breast development include:
- complete failure of breast tissue development (amastia)
- marked under-development (hypoplastic growth)
- marked asymmetry (unevenness) of size
- abnormal development of contour and shape, for example, tubular breasts (where early growth is limited, resulting in unusually shaped, small, drooping and uneven breasts)
It is normal for breast size and breast shape to vary between women, and many women have one breast which is slightly larger than the other. However, in some cases where a woman has particularly small or large breasts, or where differences in breast size or shape are pronounced, it can cause problems and lead to the woman becoming particularly self-conscious about her appearance.
There is no specific medical advantage for having breast implants, but they can have positive psychological effects. For example, if a woman feels her breasts are unwomanly or inadequate, having breast implants may help improve her confidence and self-esteem.
However, it is important not to regard breast implants as a "quick fix", and you should take your time when considering whether or not to have them.
When making your decision, you need to balance potential benefits with the risk of developing possible side effects and complications. Read more about the complications of breast implants.
Recovery from breast implants
You will experience some pain, swelling and bruising immediately after breast implant surgery.
Your chest may feel tight and your breathing may be restricted. This is normal and your symptoms will start to improve over the next few weeks.
You will usually rest at the hospital or clinic in a semi-upright position. This will help keep you comfortable and minimise swelling. You will be given painkillers if you need them.
After returning home, you can continue to take over-the-counter painkillers, such as paracetamol or ibuprofen. However, you should not take ibuprofen if you have stomach, kidney or liver problems, or if you have had them in the past.
If you have asthma, ibuprofen may also be unsuitable for you. Check with your doctor or pharmacist if you are unsure.
After having breast implant surgery, you may either be allowed home the same day or you may need to stay in the hospital or clinic overnight.
On returning home, you will need rest to give your body time to recover. Avoid excessive use of your arms and chest area as it may cause irritation and bleeding.
Following surgery, your breasts may feel hard and you may experience some painful twinges or general discomfort. These symptoms will sometimes persist for a few weeks.
To get the best results, follow the aftercare advice of your surgeon. You will usually need to attend a series of post-operative appointments so your surgeon can check your recovery.
Following breast implant surgery, avoid:
- getting your wounds wet for one week
- sleeping face down for one month
- physical exercise for four weeks
- heavy lifting for three to four weeks
- driving for at least one week or until you can perform an emergency stop without discomfort
Some surgeons also recommend wearing a tight-fitting sports bra 24 hours-a-day for up to three months following breast surgery.
It is recommended you take around two weeks off work after the operation to fully recover. You should be mobile from day one and back to full exercise within six weeks. You should keep the incision sites out of direct sunlight for about a year.
Make sure you keep a record of the details of your breast implants. You should make a note of the:
- serial number
- batch number (also known as 'lot' number)
If your surgeon does not provide you with this information you should ask for it and keep it in a safe place.
When to get help
Contact your doctor or surgeon immediately if you have any unexpected symptoms or if you experience severe pain. Possible warning signs include:
- severe pain in your breast(s)
- redness of the skin of your breast(s)
- an intense burning sensation in your breast(s)
- unusual, unexpected or excessive swelling in or around your breast(s)
- deflated breast(s)
- a smelly or coloured discharge from your wounds
- a high temperature (fever) of 38°C (100.4°F) or more
- any lumps or aching that are causing you concern
Breast implant surgery results can vary and depend on your circumstances.
For example, the appearance of your breasts after the operation may be affected by:
- your age
- your overall health
- your ability to heal
- your existing breasts
- the position of your nipples
- your skin texture
Following surgery, most women are pleased with the appearance of their breasts. An American study of 1,500 women who had undergone breast implant surgery found the majority were satisfied with their results.
Having realistic expectations and making a considered and informed decision will help ensure you are happy with the results of your operation. You should expect that the feel and look of your breasts will change as you get older and implants will not stop your breasts from sagging.
Look and feel
After having breast implant surgery, you may be worried your breast implants look unnatural. This is normal and to begin with, your breasts are likely to feel quite taut or rigid.
You may also experience changes in the way your breasts feel, with different areas becoming more or less sensitive than they used to be. In most cases, any changes in sensation will be temporary, although they may occasionally be permanent.
Your breasts will usually start to look and feel more natural within a few months of surgery, as the breast tissue, muscle and skin stretches to accommodate the implants.
Having breast implants should not stop you breastfeeding, though some women will find they are not able to breast feed after breast implants. You may also produce slightly less breast milk than you would without implants. Your baby will not experience any side effects if you have implants and breastfeed.
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.
There is strong scientific evidence to suggest that having breast implants will not increase your risk of developing breast cancer. However, it is still important for women over 50 to attend breast screening appointments when invited.
Visit your doctor if you notice anything unusual about your breasts, such as a lump. The majority of breast lumps (90% of cases) are benign (non-cancerous), but it is still important that you have a breast lump investigated as soon as possible. Do not wait to be invited for a routine breast screening appointment.
Read more about the symptoms of breast cancer.
Breast implants can affect breast screening because it may be more difficult to interpret the mammograms of women who have implants fitted. You should tell the radiographer if you have implants so they can ensure the best possible images are taken. A radiographer is a healthcare professional trained in taking X-rays.
Having a mammogram is unlikely to cause rupture of an implant unless it is already damaged.
If you have breast implants and develop breast cancer, your chances of making a full recovery will not be affected, but it is likely you would need to have your implants removed during the course of your treatment.
It's important to be aware of the signs that your PIP implant may have ruptured, and to know what to do.
A rupture is a split that occurs in the implant’s casing. It can happen if:
- the implant’s shell gets weaker over time
- the implant is damaged during the operation
- there is a flaw in the implant
- the breast is injured
If you have any of the following signs or symptoms, you should discuss them with your doctor, who will refer you to a specialist:
- lumpiness of the breast
- lumpiness or swelling in the area around the breast
- change in shape of the breast
- deflation of the breast
- tenderness of the breast
- swelling of the breast
- pain or sensitivity
When should it be done
If you are considering having breast implants, the first step is to discuss it with your doctor. They will advise you based on your previous medical history.
Before deciding to have breast implant surgery, you should discuss your expectations with your surgeon. You need to be realistic about what the surgery can achieve so you are not disappointed with the results.
It is a good idea to find out about the treatment centre where you will be having your implants fitted.
Implant surgery is usually carried out by either a plastic surgeon or a breast surgeon. When discussing the procedure with your surgeon, find out their level of experience. For example, you may want to find out:
- the number of successful breast implant operations they have carried out over the past two years
- how many breast implant operations they have performed where there have been complications
- whether or not they are a member of a recognised surgical association, such as the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) or the Association of Breast Surgery (ABS)
- what sort of follow-up you should expect if things go wrong, even at a much later date
Not everyone is suitable for breast implant surgery. Your surgeon will need to take a detailed look at your medical history and overall health.
You will not be able to have breast implant surgery if you:
- are pregnant
- you have breast cancer or screening shows you have abnormal cells that make you more likely to develop breast cancer at a later date (read more about screening for breast cancer)
- have an infection anywhere in your body
Before a decision is made about whether you are suitable for surgery, you will need to be emotionally stable and have realistic expectations about what the breast implants will achieve.
Only have breast implants once you are satisfied it is the best option for you. Take time to make an informed decision, weigh up the advantages and disadvantages and talk it through with a trusted friend, partner or family member.
It is also important you are not pressured by someone else into having breast implants. It is your body and your decision.
Read more about how breast implants are fitted.
Cost of surgery
Most women who have breast implants for cosmetic purposes pay to have the operation done privately. The NHS rarely funds cosmetic breast implant surgery.
As well as paying for the initial operation, you must also be prepared for the cost of having further surgery if necessary – for example, if an implant has to be replaced or removed. Breast implants stretch your natural tissues and may thin your natural breast tissue over time. If you have implants permanently removed at a later date, you may need breast lift surgery (mastopexy), to correct breast sagging. This may leave you with more scars on your breast.
Significant psychological distress may be caused by:
- complete failure of development of breast tissue
- severe asymmetry (significantly uneven breasts)