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Breast Enlargement -
Silicone Implants
Which implants?
Only implants from the leading manufacturers are used. There is no one ideal implant for all patients. The main differences lie between the shape and projection (pertness) of the implant and obviously the size.
All breast implants are made of a silicone shell, which can be filled with either silicone (usually used) or saline. The silicone implants feel better than saline. This difference is less noticeable if the placement is under the muscle.
Silicone implants are available in round shape or tear drop shaped (anatomical) implants. The anatomical implants have slightly less volume in the upper part of the implant which can avoid some fullness in the upper aspect of the breast. Hence they may give a more natural look in patients with very small or ‘empty’ breasts where the implant will decide most of the breast shape. They are available in many differing proportions (some taller than they are wide and visa- versa) and this can be useful for selected patients. However, round implants give excellent results in many patients, especially if they are starting with a B-cup breast or larger. Also many patients want a fuller rounder breast shape which is offered by round implants. These options will be discussed and advice offered.
Implants also come in different profiles, low, medium and high profile. The higher the profile the more pertness it creates and again will be discussed at consultation.
The silicone within implants was traditionally quite runny. Now most implants have thick gel (like a jelly baby), and is called cohesive gel. However, the thickness of the gel does vary. The cohesive gel implants have been designed to help maintain implant shape and theoretically to prevent gel movement if the implant shell weakens. All anatomical implants are cohesive gel. It must be stressed there is no evidence this makes a difference to apparent ‘safety’.
What size implants should I have?
This is partly a matter of patient preference but also a matter of what is ideal for your body size and shape. You will probably be asked to do the "freezer bag technique’. Fill sealable freezer bags with varying volumes (mls) of water or uncooked rice while ensuring all air is removed from the bag. Try differing volumes with 25-50 ml differences. Then place these into a new bra of your preferred size. Try on different clothes to get an impression of your new shape. As an approximate guide, if you are an A cup breast a 300ml implant will take you to a C/D cup. However, the implants come in volume (mls) sizes not cup sizes, ranging from 80-800mls. The most commonly used range from 200-400 mls. A more formal assessment can be done at consultation with silicone implants but this is not always required.
Is silicone safe?
Yes. Silicone is the most used of all medical substances. There is now over four decades of experience. Large studies have shown no increased association of breast cancer, arthritis, autoimmune diseases, fatigue syndromes or other associations. On the evidence available I am happy to use these implants in my patients. However, if a patient feels uncomfortable about the use of silicone implants I recommend saline filled implants.
Are there problems associated with implants?
Yes. Although not in themselves dangerous there are potential problems associated with implants. These include scar or capsule formation around an implant. For the majority of patients this is thin and soft and holds the implant nicely in place. However, in a small number this scar becomes thick resulting in the implants ‘going firm’. It can also result in distortion of the breast and discomfort. Treatment is by removal of the scar and replacement of the implant (often in a different position). This can solve the problem for about 50% of those affected. This problem is now quite rare in the early years but may affect 10% patients over the first decade.
Less common but catastrophic is infection. Infection is rare in cosmetic augmentation but can result in the need for temporary removal of an implant.
How long to implants last?
Another important question that is difficult to fully answer. There is evidence to suggest that the implant shell weakens over the first two decades resulting in a number rupturing. There is however, no evidence to suggest this is in itself problematic. The answer in short is implants last between 10-40 years. If they change in shape or texture then they can be imaged with ultrasound or MRI scan, which can detect a rupture in 95%. If found I do recommend replacement. I tell all patients, especially younger patients that they may well need the implants replacing at some point in life. It may be after one to four decades. Good information can be found at the department of health website www.silicone-review.gov.uk
Is there a problem with breast cancer, breast screening or self-examination?
Breast cancer and silicone implants have no causal association. Indeed the incidence of breast cancer in patients with implants is marginally lower. The implants are solid on X-rays and can therefore obscure breast tissue on mammogram. This does make mammaography more difficult to do but can usually be overcome by taking more views. In some patients it helps by pushing the breast tissue forward. The same is true of self-examination for breast lumps. In summary there are no major concerns with relation to breast cancer and implants. However, if you have a very strong family history of breast cancer and are anxious about breast screening you should consider this before proceeding.
