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Breast enlargement Q&As

Published by Bupa's health information team, July 2009.

Answers to questions about Breast enlargement

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

Does having a breast implant affect breast screening?

Breast implants do affect breast screening, and your nurse or radiographer may need to use different screening techniques. But there is no evidence that breast cancer is picked up any later in women with implants. There is also no evidence that women with breast implants have an increased risk of breast cancer.

Explanation

Mammography (a low-dose X-ray of the breast tissue) is an effective way to screen for breast cancer in women with breast implants. Women in the UK aged 50 and above are invited for screening every three years, as part of the national breast cancer screening programme. It's important that you go for your mammography appointments when you're invited. It's always important to be aware of any breast changes whatever your age, and whether you have had implants or not, and to get your doctor's advice.

Silicone gel-filled breast implants - the most commonly used type of implant - may interfere with mammography. Silicone implants can make taking an image of the breast more difficult and can also make it more difficult for the radiographer to interpret the results. This is because the silicone in the implant blocks the X-rays used in mammography. The implant may also block out part of your breast tissue. The amount of interference that is caused by an implant can depend on how your implants have been positioned.

Breast implants can be placed under your chest muscle or under your breast tissue. Having implants under your chest muscle makes it easier for your radiographer to understand the results of your mammography.

Deposits of calcium salt can build up around an implant. Although they are not a worry in themselves, they can interfere with the findings of mammography.

Always tell your radiographer that you have breast implants and what type they are. The radiographer can then use different views of your breasts to get the best image possible. Mobile breast screening units may not have the facilities for these special techniques, so you may need to go to a screening clinic in a hospital.

Some people may worry that the pressure on the breast during a mammogram may cause an implant to burst, but there is little evidence that this is a problem.

If you're considering having breast implants, talk to your GP or your surgeon at your initial consultation about any concerns you have.

Further information

Sources

  • Information for women considering breast implants. Medicines and Healthcare products Regulatory Agency. www.mhra.gov.uk, accessed 23 February 2009
  • Silicon gel breast implants - the report of the independent review group. Medicines and Healthcare products Regulatory Agency, www.mhra.gov.uk, 1998
  • NHS breast screening programme. NHS. www.cancerscreening.nhs.uk, accessed 25 February 2009
  • Breast augmentation, submuscular. eMedicine. www.emedicine.medscape.com, accessed 23 February 2009
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What are the different types of implant available?

There are two main types of implant available in the UK: those filled with silicone gel and those that are filled with saline (salt water). Your surgeon will discuss the best options with you.

Explanation

Silicone gel-filled implants are the most commonly used type in the UK. The silicone filler can either be a fluid-like gel or a firmer jelly-like gel. Both of these are surrounded by a firm elastic shell (made of silicone elastomer) that may be smooth or textured. The more solid gel has the advantage of keeping its shape if the implant shell ruptures. However, the softer silicone gel is less prone to wrinkling, and has a more natural feel than other implants. Choosing the more solid gel implants may mean you're left with a slightly larger scar.

Saline-filled implants have the advantage of being filled with a substance that is found naturally in the body. However, saline implants may be more likely to rupture and cause wrinkling of the skin, and they may also feel and look less natural. Saline implants may be inserted empty and filled by your surgeon once they are in place.

Both silicone and saline breast implants come in a variety of shapes and sizes. Broadly, implants can either be round or teardrop-shaped, more like a natural breast. Your surgeon will talk through the options with you.

Two types of breast implant are no longer available in the UK. Soya bean oil-filled Trilucent implants and hydrogel implants have both been withdrawn from the UK market, and it has been recommended that women who have had Trilucent implants, have them removed.

Sources

  • Information for women considering breast implants. Medicines and Healthcare products Regulatory Agency. www.mhra.gov.uk, accessed 23 February 2009
  • Breast augmentation. The British Association of Aesthetic Plastic Surgeons. www.baaps.org.uk, accessed 23 February 2009
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What causes an implant to rupture or leak and how will I know if it has happened to me?

The reasons why an implant ruptures or leaks can vary. If it happens to you, the symptoms you experience will vary depending on the type of implant you have.

Explanation

Rupture means a hole or split in the shell of an implant. As a result, the implant will either leak slowly or may do so suddenly. Rupture is less of a problem now than in the past when implants had thinner outer shells. Saline-filled implants are more prone to rupture compared to silicone gel-filled implants.

Causes of rupture can include:

  • direct damage to the implant, for example, due to being thrown against a steering wheel in a car accident
  • damage to the implant that was not noticed during surgery
  • a manufacturing defect
  • deterioration of the implant shell over time

There is very little evidence that the pressure placed on the breast during mammography can cause an implant to rupture.

It's normal for your body to react to a breast implant by forming a capsule of scar tissue around it. If a silicone gel-filled implant ruptures, the silicone gel is likely to stay within this capsule. This is often called a silent rupture, as you or your doctor may not notice it has happened. Your body may react to any leaking silicone gel by forming an even thicker capsule of scar tissue. This may distort the breast shape and cause pain or discomfort.

The silicone gel can spread outside the capsule to form lumps in the breast, and rarely, may move to other parts of the body. As well as pain and discomfort, other signs that a silicone implant has ruptured may include hard knots or lumps around the implant or in your armpit. You may also feel aching, burning or hardness in your breast. You may also notice that your breast has changed shape or size. There is thought to be no serious medical harm from leaking of silicone implants.

Saline-filled implants can rupture through a break in the implant shell or though a damaged or unsealed valve. If a saline-filled implant ruptures, it usually does so immediately but it can happen over a number of days. If this happens you will notice that your breast loses shape or gets smaller.

If you notice any of the signs mentioned here or you are at all concerned, talk to your doctor. A rupture will need to be confirmed by your doctor. He or she may use some form of scanning of your breast, such as ultrasound, an MRI (magnetic resonance imagine) or a CT (computerised tomography) scan.

If you do experience a ruptured breast implant your surgeon will discuss what is best for you, which will probably include removing the implant.

Sources

  • Information for women considering breast implants. Medicines and Healthcare products Regulatory Agency. www.mhra.gov.uk, accessed 23 February 2009
  • Breast implant consumer handbook. FDA, www.fda.gov, 2004.
  • Breast augmentation. The British Association of Aesthetic Plastic Surgeons. www.baaps.org.uk, accessed 23 February 2009
  • Breast augmentation, Submuscular. eMedicine. www.emedicine.medscape.com, accessed 23 February 2009
  • Silicon gel breast implants - the report of the independent review group. Medicines and Healthcare products Regulatory Agency, www.mhra.gov.uk, 1998
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What qualifications should my surgeon have?

There is no single qualification for cosmetic surgery so you will need to do your homework. Your GP is a good starting point.

Explanation

It's best to discuss any sort of surgery with your GP first. He or she may know of surgeons in your area and will also be able to pass on any important health information from your medical records to the surgeon. If you don't want to involve your GP, you can find a surgeon yourself, but it's important to get as much information as possible about your surgeon's qualifications and experience. Don't be guided by price, and be wary of advertising claims.

There is no central registry of surgeons trained in cosmetic surgery. Doctors performing cosmetic surgery can be trained in any of the nine surgical specialities that are recognised by the Royal College of Surgeons. Most surgeons who do cosmetic surgery have been trained in plastic surgery. Doctors from other specialities such as ENT (ear, nose and throat), ophthalmology (eyes) and dermatology (skin) may carry out some cosmetic surgery. Doctors with only basic medical qualifications should not do cosmetic surgery (basic qualifications are shown by the letters MBBS or MBChB).

Check that your surgeon is on the General Medical Council's specialist register - you can do this by looking at the General Medical Council's website.

Before deciding to go ahead with cosmetic surgery, you should have an initial consultation with your surgeon. Don't be afraid to ask the surgeon questions about his or her qualifications and experience. Ask whether he or she belongs to a professional association, such as the British Association of Plastic, Reconstructive and Aesthetic Surgeons or the British Association of Aesthetic Plastic Surgeons.

Further information

Sources

  • Information about healthcare providers: Cosmetic surgery. Care Quality Commission. www.cqc.org.uk, accessed 23 February 2009
  • Questions about cosmetic surgery. Royal College of Surgeons of England. www.rcseng.ac.uk, accessed 19 February 2009
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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: July 2009

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