Breast Augmentation Implants FAQs

Breast Augmentation is the term used to describe the prosthesis(usually silicone) used to apply change in the form, texture or size of breasts using breast implants. This regains fullness of the breast that has been lost and also helps to regain symmetry of uneven breasts, often caused by ageing, or post pregnancy.

The first silicone breast implant was devised by Thomas Cronin, and Frank Gerow in Texas in 1961 and inserted in 1962.

Silicone gel implants are currently the most common type used in Europe. Currently in America Saline breast implants are the most common, however following the decision of the Food and Drug Administration in the USA (FDA) to allow silicone breast implants to be used from November 2006 the uptake of silicone implant usage has increased dramatically and will overtake saline implants. In Europe current sales figures show a distribution of 90% silicone, 10% saline. As modern silicone gel implants have been available since 1962, surgeons have well over 50 years of experience using these types of implants and in fact there have been over well 5 million women around the world who have had silicone breast implants. This is more than any other type in use.

Saline-filled(salt water) implants are currently the most common implant used in the United States. They are also the only alternative to silicone implants. However with the lifting of the ban on silicone implants from Nov 2006, this has steadily shifted in favour of silicone implants. Although good to excellent results may be obtained with saline implants, compared to silicone gel implants saline implants are more likely to cause cosmetic problems such as rippling, wrinkling, and be noticeable to the eye or the touch. They also have a more “slushy” consistency compared to silicone gel implants. Furthermore if the shell of the implant should develop a small leak the salt water is rapidly absorbed by the body. This results in the breast becoming flat and another operation is needed to insert a new implant. Particularly for women with very little breast tissue, or for post-mastectomy reconstruction, plastic surgeons believe that silicone gel implants are the superior device. In patients with more breast tissue however, saline implants can look very similar to silicone gel although they generally still lack the more “natural” feel of the silicone.

Of course evolution has brought changes and improvements over the years with the introduction of textured surface envelopes made of newer formulations designed to minimise the “bleed” or diffusion of what is usually tiny amounts of the silicone oil fraction of the gel contents. Importantly the standard silicone gel by most accounts, arguably “feels” the most natural of all breast implants. This is probably as a result of the inherent smoothness of the silicone gel content. Newer cohesive silicone gels such as the one used in the newer Motiva implants that Mr. Karidis currently implants, provide even smoother and more natural feeling gel which Mr. Karidis feels has set a new gold standard.

Only a consultation can determine this. A breast augmentation procedure can increase your confidence and self-esteem if you feel your breasts are not how you would like them and if you prefer bigger, fuller, firmer breasts to complement your overall shape, then you are a potential candidate for this procedure. During your consultation Mr. Karidis will ask you about your general medical history including details about any previous breast surgery, family history of breast disease, childbirth and lactation. A discussion will take place, in which Mr. Karidis will try to encompass all the variables present- such as your age, the size and shape of your breast, body proportions and the condition of your skin. The best candidates for a breast augmentation are healthy, emotionally stable women who are realistic about what surgery can achieve. While women of all ages can benefit, it’s usually never performed before the breasts are fully developed. As with any surgical procedure, the decision to undergo breast augmentation should be a personal one and not in order to please anyone else. It should also be mentioned that a breast enlargement procedure is not a one-off procedure as implants are not lifetime devices. Breast implants have a rough life expectancy of around 10-15 years although this can vary. When considering this operation, you must therefore also take into account the cost of replacing the implants and undergoing other surgery in the future.

Due to recent comments in the press about the Silimed implants I feel it would be useful to clarify the situation. Silimed are one of three manufacturers (the others being Allergan and Mentor) whose implants are approved for aesthetic breast augmentation by the Food & Drugs Administration (“FDA”) in the USA. These are also approved by the regulatory bodies in Europe.

There has been some concern raised during an audit of the manufacturing processes where a potential source of “particles” was identified in the laminar flow chambers used during the production of the implant cases. It is important to note that no incident has occurred and the company’s long-term post market surveillance shows no data of concern. However, following this audit, possible adjustments in manufacturing procedures were identified, which may be beneficial.

It would appear the FDA in America looked into this a year ago and found no problem and did not recommend any action be taken. The implants are therefore currently still approved by the FDA in the US. The regulatory body in Europe, TUV, who are based in Germany, have temporarily suspended the CE Mark given to these implants pending further investigations and another site visit. The UK distributor (Eurosurgical) informed us of this earlier this month. This creates a very unusual situation of a product being approved and available in America but, at least temporarily, not in Europe.

It should be stressed however that no adverse incidents have been reported and that this does not constitute a recall notice, and nor is there any need for any action. The company are working closely with the authorities to resolve the situation and I am told that the likelihood is that the CE Mark will be restored in the near future. The MHRA, who are the regulatory body in the UK, are aware of the situation and are also working with the company.

It may be of interest to note that the regulatory body, TUV, were the body responsible for the supervision of the PIP implants where, as you may well recall, there was a major manufacturing issue, since the company was using non-medical grade silicone in their implants. It may be that since this regulatory body failed to pick up on the PIP issues and provide the public with the protection that it rightly expects, it is particularly sensitive area right now and hence the enhanced safety checks.

If you feel you would like more advice please email: london@karidis.co.uk

The simple answer is no. Implants come in a wide variety of sizes and it is possible for any woman to comfortably carry a variety of sizes on her chest and most women have a rough idea as to how big they may want to be in terms of bra sizes. Unfortunately however, as many studies have already shown, most women wear the wrong bra size anyway, and moreover have conflicting and widely differing perceptions with respect to cup sizes. Therefore it is unwise to use the concept of “cup size” alone in determing your ideal breast size. To make matters even more complicated, breast implant sizes from the manufacturer are measured in volume displacement(i.e. 250 cc) rather than using the lettering system (A,B etc) that most bra companies use to size bras. Unfortunately these two different measuring systems do not correlate or coincide with each other. The objective therefore, during the examination will be to determine what look you are trying to achieve with the surgery and not cup size.

As you can imagine different size implants in different framed women gives different results. The secret is to choose a size that will give you a more balanced, proportionate look overall that is more in line with your desires. At the time of your consultation Mr. Karidis will take specific measurements of your breast and chest, and then according to your stated requirements, he will suggest a size which would be suitable for you. A wide range of sizer, sample implants will be then be demonstrated to you and inserted into a sports type bra in order to try and give you an idea of the ultimate size you will have after your operation. Seeing this visual image of yourself in the mirror, wearing a sample implant is the closest you can get, before surgery, of identifying what you will look like after surgery. It is not about cup size per say but more importantly the look of the breast! It is also Mr. Karidis’s experience, that in general, it is probably best to err on the side of going slightly bigger than slightly smaller, as most women, in retrospect, given a second opportunity would opt to have gone slightly bigger!

It is important to understand that ultimately, the limiting factor in choosing an implant size is the space available beneath your existing breast. Moreover as the volume of any breast implant increases, so usually does its width. Therefore if you choose an implant that is excessively large, the edge of the implant may then extend around beyond the breast and potentially even under the arm pit. This would be undesirable for most people. In addition the potential for rippling (see below) and other long-term adverse problems increases. Thankfully the vast majority of women have a realistic outlook of what they wish to look like, and therefore it is not often that a surgeon cannot deliver the desired expectations to his patient.

This is a question that often arises. The bottom line is that breast implants can only be placed directly beneath where your existing breasts lie. So if your breasts have a natural propensity to look outwards(as some do) and you have a large space between them because of this, a breast augmentation will not fill this space sufficiently to give you that “tight” or close together cleavage. Unfortunately breast position in each individual is more of less set. Mr. Karidis will be able to inform you accordingly at the consultation. Nonetheless even in the aforementioned individuals, the cleavage area will be somewhat better after the breast implants. However if the distance between the breasts is too great then there will always be a gap between the breasts. Of course after the operation, and once everything has settled, you can always wear a push up bra to help place the breasts closer together if you wish. If on the other hand your breasts are naturally close together and the natural distance between the breasts in the cleavage area is small, then you will get a significant improvement and boost in the cleavage area.

The first breast implants were round. The majority of all currently used implants are still in fact round. Viewed from the front, they are circular and in profile, they appear to be tear drop shaped. The consistency of most round implants is semi-fluid like and termed “cohesive gel”.
About 20 years ago, a newer, more cohesive silicone gel (McGhan type 410) was introduced which became known as the” tear drop” or anatomical shaped implant. As the composition of this gel is more set, compared to the slightly more fluid gel of the round implants, it acts like a solid unit, and therefore a shape can be produced which mimics the natural profile, or tear drop effect of the breast. These implants are slightly taller than they are wide and are fuller in the bottom. There tends to be a smoother transition from the upper part of the implant to the bottom and don’t have not quite as much of a “step-off” as can sometimes be seen with the round type implants. Therefore in theory this may give a slightly more natural shape. In practice however there is not as much of a difference with round implants as one may think, as round implants will also acquire a “tear drop” effect through gravity. Generally speaking, in comparison, the round implants give the breast a slightly more circular or rounded appearance with more upper half breast fullness, whereas the tear drop shaped implant gives a more sloping profile to the breast with less upper half fullness.

There have been a number of reports of the anatomical implants moving out of place, or turning around within the pocket, with resultant loss of shape. This is one of the shortfalls of the pre-formed shape of the tear drop implant. One must understand that these implants work in only one direction and thus accurate positioning must be performed during the surgery and maintained afterwards, in the right orientation, in order for the benefits of the shape to be seen. Any movement of the implant will result in a loss of the desired shape. The anatomical implants may also feel slightly firmer to touch due to the nature of the cohesive gel within this implant, sometimes making the edges of the implant more palpable. The decision as to which one suits you best will be discussed at the consultation, but as a general guideline, Mr. Karidis believes that although anatomical implants may offer some benefits to a few specific types of patients, in the large majority of women seeking breast enlargement, round implants are very successful and produce an equal or more superior natural looking result whilst minimising any side effects.

Breast implants are classified in order of their size or volume(usually measured in cubic centimeters or cc’s) and of their “profile” or “projection”. The profile of any breast implant refers mainly to it spatial characteristics in as much as how it displaces its volume and is usually classed as low, moderate, high and extra high profile. What this means in simple terms is that for any given volume of a round implant, and depending on its profile, the width and the height of the implant will vary. So in a given volume “low” profile breast implant the base or footprint of that implant is quite wide compared to its height or “projection” which is quite low and resembles more of a flat pancake. This type of implant may benefit a patient who has a very wide breast footprint and does not want the implant to “stand” or “jut” off the chest much. On the other hand, the higher the profile of the breast implant, the narrower the footprint or base of the implant and the greater its “height or projection”. This type of implant benefits women who desire more projection to their breasts. The reality is that for most of Mr. Karidis’s patients moderate and high profile breast implants are the most commonly used. The differences and benefits will be shown and demonstrated to you during the consultation.

There are generally 3 types of incisions used for inserting the breast implants. The inframammary or crease incision, and Mr. Karidis’s preference, is made under the breast at the fold or crease line. The incision is about 4 cm in length. This is the most common incision, and the natural fold of the breast usually hides the scar quite well. It will probably always be covered by the natural droop of the breast tissue as well as even the smallest of bikini tops. Because the incision gives immediate access to the space where the implant will be placed it is possible to very accurately create the size and shape of the pocket for the implant, as well as carefully control the position of the implant within that pocket.
Another method is the peri-areola incision, which is made around the edge of the areola (the darker skin around the edge of the nipple). The disadvantage of this incision is that the scar is not hidden by any folds, and that is can potentially be seen the moment your bra is removed. Moreover subsequent scarring may possibly interfere with milk expression in breast-feeding as well as experiencing reduced sensation in the nipple areola skin region. The third method is the axillary incision, which is made in one of the crease lines of the armpit. This is used less often because it is more difficult to get proper placement of the implant in some patients, and if there is a problem in the future or the need to change the implants, an additional incision on the breast may be required. Although some patients thinking about this surgery may believe this approach is the least conspicuous, in truth this may not always be the case, particularly in light of sleeveless open type clothing which expose the armpit area quite readily and frequently.

Regardless of where the incision is placed it is important to remember that a scar will always be present. As such there are people with good scarring ability(most people) and people with poor scarring tendencies(thankfully quite unusual). This cannot be predicted before the surgery. It is Mr. Karidis’s opinion therefore, that in the event of poor scarring it is best that the scar is positioned in the most hidden and least exposed of positions. This is why Mr. Karidis prefers inserting the scar under the breast, right in the fold, as this is the least conspicuous place. All scars are red and lumpy initially, but then normally settle quite well and become less conspicuous with time. However no surgeon can ultimately predict the appearance of any particular scar.

There are three positions or pockets which are made and where the implant may be placed; Subglandular: Directly under the breast tissue, (i.e.in front of the pectoralis muscle), Subfascial(behind the breast tissue but in front of the muscle in a space developed by lifting the front lining of the pectoralis muscle-the fascia), Submuscular (behind the pectoralis muscle) or more accurately called, Dual plane position(partly under the muscle and partly under the breast or fascia). The pectoralis muscle is the chest muscle that is commonly developed in body builders. Mr. Karidis positions the implants in a Dual plane(submuscular) in approximately 80% of his patients and the remaining 20% under the fascia(subfascial) or breast tissue(subglandular).

The advantage of submuscular placement is that it increases the padding overlying the implant offering more coverage and camouflage to the shape and outline of the implant. This is particularly helpful in women bearing very little or no breast tissue at all. By providing this extra padding in these circumstances, one then substantially decreases some of the adverse effects of visibility and palpability of the implant. Another advantage is that mammography has been reported to be slightly more effective. The disadvantages are that there may be a bit more pain, or discomfort, after surgery, the breast may feel slightly firmer than when the implant is placed in front of the muscle, and that the breast may move momentarily with certain actions of the muscles during exercise. In the subfascial or subglandular placements, the advantage is that there is usually less pain after the operation, and that the breasts usually feel slightly softer.The disadvantage is that the outline of the implant may be more prominent or visible in very slim women. In these situations one can therefore sometimes detect a “step-off” appearance or “stuck-on” look of the breasts on the chest. In these situations you will be advised to have the implant placed submuscularly.

There are some breast shapes that are better suited to the subglandular(in front of the muscle) approach. These women typically have breasts that at one time were much larger than the present. When there has been a very large reduction in the volume of your breast along with little or no shrinkage in the size of the skin envelope surrounding the breast tissue, then the shape approaches that of an “empty bag”. Under these circumstances it is sometimes better to place the implant in the subglandular position in order to allow the implant to fill out the skin envelope of the breast. Of course this would rely on the fact that you still possess enough breast tissue to hide and cover the outline of the implant beneath. If however you are very thin, and don’t possess much breast tissue then a decision will be made to place the implants behind the muscle(Subpectoral or submuscular) in order to avoid the “stuck” on look.The decision, as to which location the implant should be placed in your case, will be discussed at the time of the consultation. In the end Mr. Karidis’s primary concern is to give you as NATURAL a look as is possible!

Inserting a breast implant has the effect of expanding the breast skin envelope giving the appearance of a “lift”. However if there is considerable drooping of the breast before the operation (this will be determined at the time of your consultation), the drooping will recur again due to the effects of gravity and so you will end up with larger, droopier breasts. In these circumstances, a simultaneous breast uplift or mastopexy is usually recommended to give the optimum result. In this event, it will be necessary to tighten the skin envelope around the breast implant and reposition the nipple to a more desirable level.

For many women, breast implants alone are not enough to achieve a satisfactory result. This is because, in addition to the requirements for a volume replacement, which undoubtebly the implants provide, there is also a requirement to correct an element of “drooping”(also called ptosis), and many ladies require a “lift”. In Mr. Karidis’s opinion, breast implants alone will not give you the necessary lift, if your breasts are particularly droopy. Many ladies who have undergone pregnancies or who have lost weight or who are unfortunate to have just developed this way naturally, also require a breast lift. In these situations it is best to have a combination breast augmentation and uplift (also called mastopexy). Mr. Karidis will of course be able to determine this for you at the consultation and advise you accordingly. This operation involves lifting, but not removing, the nipple/areola to a slightly higher level and tightening the breast skin envelope by removing the excess, redundant, portion of skin and some breast tissue in the lower half of the breast. This operation carries with it slightly different scarring than a standard breast augmentation only procedure. In the combination Breast augmentation/uplift procedure, Mr. Karidis utilises a lollipop incision which means a scar around the nipple and then a vertical scar down to the crease. Even though all scars are generally red to start with, scars usually fade as the months go by.

There are many quoted figures and statistics as to how long ultimately any implant lasts before disintegrating or rupturing. An average figure overall for modern breast implants is probably in the order of 10- 20 years. The chance of a rupture within 5 years is only about 1-2 %. There are however wide variations in the wear and tear amongst different individuals. A women therefore who subjects herself to extreme physical exercise for many hours a day on a regular basis with resultant excessive movements of her breasts (i.e. aerobics instructor, marathon runner, regular horse riding etc.) will naturally subject her implants to more wear and tear over a given period of time, than someone who does very little exercise. In the first situation it would be reasonable to assume that the implants may disintegrate sooner than in the latter case. Indeed there is such variability at times, that Mr. Karidis has encountered patients requiring change of implants as early as 2-3 years (very rare) as well as patients needing changing at 40 years! In order therefore to have a proper assessment of the state of your implants it is best advised to have your implants examined by a specialist on a regular basis from about 10 years after your operation and have an ultrasound or MRI performed as necessary.

Rupture of a breast implant occurs when a break, tear or breach of the outer envelope of the silicone implant occurs allowing the internal silicone gel contents to extrude. In many cases, due to the cohesive and solid, gel like state of the silicone, the contents remain within the capsule or scar tissue that forms around the implant. This is termed intracapsular rupture. In some cases however, the silicone contents breach the capsule and thus become “extracapsular”.

Breast implant rupture can have many causes such as trauma from motor vehicle accidents, falls, or even extreme manual compression of the breast. Occasionally rupture has been reported with mammography when the breast is necessarily compressed for the purpose of screening . The majority of ruptures however have no obvious traumatic causes and are due to natural “wear and tear”. Many people forget that implants tend to move along with your body movements. In doing so, the outer shell or casing of the implant is therefore subject to natural friction and rubbing forces against the surrounding tissues. The more extreme, and the more regular these are, then the more “wear and tear” will occur on the implants.

Many studies have found degradation and degeneration in the silicone shell or casing of the implants when a rupture has occurred. Material testing of aged silicone shells has also supported that degeneration of the silicone envelope occurs over time. In fact the breaking pressure required to burst silicone gel implants that have been removed from patients who have had the implants for a various numbers of years, decreased significantly as the time since implantation increased. Furthermore, mechanical testing of explanted shell specimens showed that the strength of the shell declined significantly with age. It is therefore very clear that the risk of an implant rupture increases with the age of the implant.

Silicone gel-filled implant ruptures are most often silent. This means that most of the time you will not know if the implant has a tear or hole in the shell. Occasionally one may detect a slight flattening of the breast or an alteration of the shape, but this may only be very slight and hardly noticeable. This is because 75% of ruptures occur intracapsularly-that is to say that the shell of implant and its contents remain with the capsule or scar tissue the body forms around the implant. This is the reason that patients with implants are usually advised to have scans, either ultrasound or MRI, a few years after implantation, to see the state and condition of their implants. Conversely, 25% of ruptures will be classified as being extracapsular-meaning the contents of the implant will have migrated outside the capsule. In these situations, associated symptoms may arise, such as hard knots or lumps surrounding the implant or in the armpit, change or loss of size or shape of the breast or implant, pain, tingling, swelling, numbness, burning, or hardening of the breast. Contemporary implants however now mostly contain a cohesive gel in which the polymer ingredient is cross linked and the gel “form stable”. This cohesive characteristic of the gel reduces the risks associated with rupture as the gel is “held together” and is less likely to migrate into the breast tissues or the lymphatic system.

Silicone gel bleed is when very small quantities of silicone, primarily silicone oil, diffuse or “sweat” through the implants shell or casing. This happens even though the actual shell or casing of the implant is intact and is not of any clinical significance. All silicone implants exhibit silicone gel bleed to varying degrees, depending on the type of shell used. More modern cohesive gel type silicone implants have less “bleed” than older more liquid type of silicone implants. However it is important to understand that the quantities of silicone oil that “bleeds” is usually extremely small, certainly compared to the overall amount of silicone gel within the implant. There is also currently no evidence available that these small quantities of silicone “bleeds” cause any detrimental effects to ones health. In fact, The Food and Drug Administration in America has investigated whether there are any medical issues associated with exposure to silicones, including the process of silicone gel bleed, and determined there is no evidence of harm. Furthermore, in 1999, the Institute of Medicine in Washington, found the studies exploring human exposure to silicones, even at very high doses, to be reassuring.

The finding of any silicone in bodily fluids should be viewed in perspective; silicone is found abundantly in our environment and indeed probably in most people. Our contact with silicone is extensive throughout all of our lives and in fact it is used widely in medicine. Silicone is used as a lubricant in every disposable needle, syringe and intravenous tubing. Silicones are used in lipstick, suntan lotions, food processing, skin creams, hair spray, and cosmetics. Over 1000 medical products contain silicone as a component or in the manufacturing process including artificial heart valves, joints, and pacemakers.

Many ladies considering this type of surgery will no doubt have heard of frightening stories about silicone toxicity or autoimmune/connective tissue disease, due to gel “bleed” or migration. As a result, breast augmentation has, in the last 20 years, received much unfavourable publicity mainly through the irresponsible actions of the media whereby, regardless of the facts, claims have been made with respect to silicone safety. As a result there has been much activity and debate within the medical community to try to ascertain whether silicone gel breast implants are safe. To this end there have been many numerous statements issued supporting silicone safety from, amongst other medical bodies, the Chief Medical officer, Department of Health( the full 36 page report can be obtained from Silicone Gel breast Implants Independent Review Group on 0207 972 8000 or it can be downloaded on the internet on www.silicone-review.gov.uk) and the American College of Rheumatology. All concluded that “silicone implants expose patients to no demonstrable additional risk for connective tissue or rheumatic disease” and ” there is no reason to discourage women from considering breast implant surgery on the basis of acquiring or worsening a connective tissue or autoimmune disorder”.

There is no definitive evidence that silicone in breast implants specifically causes cancer in humans. However there have been reports in the scientific community that have suggested a possible association between a rare form of cancer, Anaplastic Large Cell Lymphoma (“ALCL”) and breast implants. But with an estimated 5 to 10 million breast implant recipients worldwide over the last 50 years, experts say the known ALCL cases (approximately 60 to date) are too few to say conclusively that breast implants cause the disease. Anaplastic Large Cell Lymphoma (“ALCL”) is a rare type of Non-Hodgkin Lymphoma (“NHL”), a cancer involving the cells of the immune system. Although ALCL is extremely rare, and that currently there is no statistical correlation to confirm this, the Food and Drug Administration(FDA) in America believes that women with breast implants may have a very small but increased risk of developing this disease in the scar capsule adjacent to the implant. At this time, data appears to indicate that the incidence of ALCL is extremely low, even in breast implant patients. Currently it is also not possible to identify a type of implant (silicone versus saline, textured or smooth) or a reason for implant (reconstruction versus aesthetic augmentation) associated with a smaller or greater risk. The small numbers of ALCL has been found more frequently in association with breast implants having a textured outer shell rather than a smooth outer shell. However, most of the ALCL cases reported in all breast implant patients so far, failed to include information about the texture of the shell. Therefore, the FDA cannot determine with any certainty at this point whether ALCL may be found more or less frequently in women with textured breast implants than in women with smooth breast implants. Because ALCL is so rare, even in breast implant patients, a definitive study would need to collect data on hundreds of thousands of women for more than 10 years. Even then, causality may not be conclusively established.

We know the risk of any implant rupture increases with time, and this has been confirmed through a number of studies. It is however very difficult to be entirely accurate with respect to exact rupture rates in general. According to several studies completed on a number of other implants, the current consensus and estimation is that the incidence of rupture increases gradually from the third year onwards. Taking in a summary of the results from some of these studies therefore, there is a reported 2% rupture rate at about five years, an 11-14%% rupture rate at eight years, a 10-19% rupture rate at ten years and a 49 % rupture rate at about 12-13 years.

When any scan suggests signs of a rupture or if there are signs or symptoms of rupture we usually recommend removal of the implant with all of its contents and exchange with a new implant. Conversely it’s also very important to note that a positive scan result suggesting a rupture may not always be correct. This will depend on the experience of the radiologist and the circumstances of the implant. The scan results will be discussed with you at your consultation. Even in the event of undoubted rupture(scan and positive clinic examination) this does not mean that it has to be done as an emergency and there is therefore no need to panic. In these situations surgery should be planned in the near future, ideally within the next few weeks. It is also advised that in the meantime extreme sports and body movements as well as manual handling of the breasts is minimised to avoid the possibility of the gel moving beyond the breast into neighboring tissue.

This is not particularly difficult for an experienced surgeon. It is important to highlight the fact that the silicone gel in all implants, does not “knit” or bind to the inner lining of the breasts in the vast majority of patients and therefore can be removed fairly easily. It may however be necessary, depending on the capsule thickness and quality, to sometimes remove the tissue capsule in addition to the implant. This will be determined at the time of surgery. Moreover its’ important to remember that as the pocket has been made already for the previous implant, recovery with this scenario is usually quicker.

If a lump has come up in the armpit this is usually a lymph gland or lymph node and it probably means that your implant has sustained a rupture and that some of the silicone gel has migrated towards your armpit. This is a natural route for the drainage systems of your breast. What has happened is that small fragments or particles of the silicone gel have moved to this area , getting outside the capsule(extracapsular rupture) and have been trapped by one or more of your lymph glands. As a result, the gland has swollen up. This however, is a natural chain of events, because the lymph glands are essentially filters of the body. They have done their job by stopping the silicone from moving to other more distant parts of your body. Even though you have a swollen gland you must understand, it doesn’t take a lot of silicone to cause the glands to swell. In many instances it is only a few grams of silicone particles that have become lodged in the gland, thus making it swell. There are many other glands present in the area that will continue to filter the region and therefore serve and protect you from any other debris or matter.

If a patient is having a ruptured implant removed, who also happens to have an enlarged lymph gland, it is advised that we do not remove the gland as well. The enlarged glands in most situations are relatively small and removing them does not usually confer any benefit. In fact surgery, to “dig out” a swollen gland could potentially disturb the lymph drainage in the armpit and cause problems with persistent swelling in the area. Therefore as a routine we do not disturb the glands. As mentioned above, the amount of silicone that is trapped in the glands is usually very small and so there is no clinical necessity to remove it. Very occasionally however, if a patient is particularly thin and the gland is particularly large, making it visible to the naked eye, then a decision may be taken to remove the isolated enlarged gland.

The operation is performed under general anaesthesia and can be performed as a day case procedure or if you prefer you can stay overnight. The procedure takes approximately 30-40 minutes to perform.

Of course some pain will be experienced following a Breast Augmentation. It is always difficult to quantify how much pain any one individual will experience. Whilst some women find this procedure painful others actually report very little or even no pain postoperatively. Placement of the implant behind the pectoral muscle is usually, but not always, associated with a greater degree of pain, as it is necessary to cut the muscle in order make space for the implant. In the end it would be fair to suggest that most women experience a moderate degree of pain for the first five days, which is easily controlled with regular painkillers. After a week however most women report a considerable improvement in their symptoms and in fact most do away with any regular painkillers.

This procedure is usually performed under general anaesthetic and you will awaken in a propped up position in your own private room in the hospital. You will experience a feeling of tightness around the chest and may experience a degree of pain that varies from one patient to another, especially in the first five days. We will of course prescribe painkillers for you take as directed over the coming days to ease any discomfort.

Ideally it takes about 6-9 months for the swelling to entirely dissipate and for the implants to settle into position. However from about 2 months after surgery, once the initial swelling subsides, you will be able to get a reasonable idea of what your final result will be like.

Most people are up and about soon after surgery and although you are allowed to move your arms up and down fairly freely, it is very important to avoid any extreme stretching or lifting during the first 2 weeks. Many people feel happy to return to work at around 1 week after surgery however this may depend on the type of job you have. If your job involves lifting or strenuous activity it would be advisable to refrain for another week. Light exercise lower body exercise can be resumed from around 4 weeks after surgery with aim to resume usual sports and more intense and vigorous exercise somewhere between 6 and 8 weeks after surgery.

Learn more about the breast augmentation recovery timeline.

You are allowed to travel by plane within a couple of days if you wish provided this is short haul. For long haul it is best to wait 3 weeks. You are allowed to drive from about 1 week provided the seat belt is comfortable over your chest.

As with any operation, normal risks of surgery and anaesthesia can occur with breast augmentation. These include infection, haematoma, and skin necrosis. Infection can occur despite our normal routine of administering antibiotics at the time of surgery as well as post-operatively. In Mr. Karidis’s experience, this happens in about 1 in 500 breast implants placed. Signs such as pain, redness, swelling, or fever, following augmentation should be reported immediately to the hospital. Infection not reported could easily compromise the success of any surgery. If infection was to be serious and fail to respond to antibiotics, removal of the implants would be required and replacement would not be effected until such time as the infection had cleared. Bleeding, as a result of a leak in a blood vessel will give rise to swelling and bruising of the breast. If this is slight then your body will be able to absorb it in time. If it is significant (termed haematoma, and in Mr. Karidis’s hands, occurs in about 1 in 500 breast implants) then it may be necessary to drain this. Mr. Karidis will be able to assess this. Late onset seromas(fluid build up) may also develop in about 1%. This may require drainage if significant.

This in fact is the most common complication of breast implants. A capsule or capsule formation is a layer of scar tissue that normally forms around any artificial material placed in the body. It is important to realise that this is the natural response of the body to foreign material. Most times this capsule is so soft that it is virtually undetectable and therefore does not affect the implant in any way. Capsular contracture or hardening occurs when this layer of scar tissue shrinks around the implant, squeezing it so that it starts to feel firm, or in some cases, quite hard. Most capsular contractures experienced today stem from the smooth shell silicone implants placed some years ago. The capsule contracture rate in the past was 30-35%. With the onset of textured shell implants, and better operative technique, the problem of capsular contracture has been significantly reduced. In Mr. Karidis’s hands and in his personal experience this occurs about 1-2% of the time.

The cause of capsular contracture is not totally clear, but seems to be multifactorial. The prevailing theory is that this is due to a “Biofilm”. A Biofilm is a thin layer of a mucus like substance which adheres to a solid surface and contains a community of bacteria and other microorganisms. As a result of these microorganisms the body responds through a reaction of scar thickening and tightening. It is important to realise that there are degrees of contracture and that the majority of women, who do develop this hardening, develop it only to a mild extent. In the minority however, it may be severe enough to be bothersome, even painful and may cause distortion of the breast. The condition may occur in one or both breasts and to a different degree either side.

Capsular contracture may develop any time, even years later although it is most likely to happen in the first 3 years after surgery.

Traditionally there have been two ways to reduce or relieve the firmness of a contracture. These are the closed and open capsulotomy. In the closed capsulotomy, the firm implant is manually squeezed tightly from the outside, in an attempt to disrupt or tear the scar envelope. This is very rarely used today and is not advised either. The other method, which is much more controlled and thus the preferred method, is the open capsulotomy, performed under general anaesthesia. In this procedure the old incision is reopened and the thickened capsule is removed or loosened. The implant is then reinserted again into the breast pocket. Unfortunately, even after a successful capsulectomy, there is again the possibility of recurrent hardening in about 5% of patients.

Unfortunately at this time there is no effective way to prevent capsular contracture if it is going to occur. However as mentioned previously, encapsulation is no longer the problem that it was. It is also important to remember that capsular contracture is not in itself a health risk other than its possible interference with mammography.

Perhaps the most significant concern over breast implants is the possibility of delayed detection of breast cancer with silicone and saline filled breast implants. Both of these types of implants are radiopaque, meaning the implants obstruct the breast tissue viewing to varying degrees on mammogram. Mammography techniques however have improved over the last few years enabling the radiographer to minimise the amount of breast that is hidden by the implant. It is important however to also realise that 10-20% of breast cancers are invisible to x-ray, and therefore most breast cancers are still being discovered by self or physical examinations. In this respect, some clinicians feel that the implant can actually increase the ease of palpation. Furthermore in the presence of implants, many clinicians also request other types of scans, i.e. ultrasound and magnetic resonance scans (MRI) in addition to mammograms where appropriate to further visualise the breast tissue further.A woman with breast implants should be on the same schedule of routine mammography as all other women. The radiographer should be informed that she has implants and therefore special displacement (Eklund) views will be required for proper radiological evaluation. In conclusion, implants make the job of the radiologist more difficult but they do not prevent him/her from carrying it out.

Breast implants do not interfere with breast feeding as the implants are placed behind the breast tissue and milk ducts. Therefore lactation (breast feeding) can proceed without any problems. Of course if pregnancy should occur, particular care should be taken to support the breasts during this period in order to maintain the best possible shape. This is achieved by wearing a supportive bra day and night continuously during pregnancy and also whilst breast feeding. If you can limit breast feeding to three months or less this will probably reduce the stretching of your breasts and therefore preserve your shape. Ultimately however, pregnancy and breast feeding with all of its associated hormonal changes, will lead to some changes within the breast and therefore is likely to affect the shape to some degree. Of course this is not something that can be predicted.

Changes in nipple and breast sensation (feeling) can occur. Some patients may lose sensation entirely, others report only a slight decrease, and some even report heightened sensation. In the majority of cases where sensation changes occurs, these are only temporary and soon recover. The recovery period can sometimes take up to 18 months to complete. In a small minority of patients, however, permanent loss of sensation may occur.

Feeling the edge of the implants, or palpation as it is termed, may occur in thinner women following breast augmentation. In these situations the implants are more likely to be felt at the lower part of the breast near the fold as well as the sides. Again this has no medical implications, although women who do not bear this in mind may suddenly become worried about feeling a ‘lump’ in their breast. In any instance of uncertainty it is always best to contact your surgeon to have this examined.

Rippling or wrinkling of the skin over the implant may occur in women who have little or no breast tissue or ones that have recently lost weight. This is basically the natural slight folding of the implant that occurs with all implants and which if you are thin enough, with very little overlying tissue, then you will be able to either feel this on the skin surface or see it as a slight waviness or rippling effect. This has no medical implications in itself but can be cosmetically undesirable. This can occur in any location of the breast. In order to minimise this effect and if deemed appropriate at the time of the consultation, you may be advised that the best placement of the implant should be in the submuscular position as previously described. It is important to understand however that rippling or wrinkling can still occur even when the implant is placed behind the muscle. Should this then occur it might be difficult or impossible to eradicate this, particularly in a very thin individual.

There is no chance of the implant exploding or bursting whilst travelling in an aeroplane, swimming, diving etc.

In accordance with the National Healthcare commission guidelines, according to the last five years of annual audit figures submitted to the Hospital of St. John and St. Elizabeth in London, Mr. Karidis inserted on average 300 breast implants per year. In the last 10 years alone he has inserted over 3000 breast implants.

We look forward to seeing you at the clinic at about 14 days after your surgery to check all is healing well. This is usually extremely exciting as it will be the first proper glimpse at your new breasts! Providing all is well, you will usually see Mr. Karidis at around 6 weeks post operation for a routine check up. Further appointments will of course be made as necessary in order to follow you up until everything settles completely.

In a word no. There are a number of pills and creams that have appeared over the years, purporting to enhance, enlarge, or fill out the breasts. The simplest of these is the herbal supplements. They are for the most part natural. Unfortunately the results derived from these are subtle and too often, none at all. How you respond to herbal supplements depends entirely on your body chemistry. For women seeking a substantial increase in the size of their breasts, herbal supplements are not going to do the job. Breast firming creams have also been created. These creams usually contain a plant extract called Pueraria Mirifica and which has a high concentrate of phytoestrogens. These are not hormones but supposedly they provide the same benefits as the female hormones called oestrogens. Oestrogen is what increases breast size during ovulation along with the birth control pill and doctor prescribed hormone supplements. However, there is little documented evidence to show that these creams really do much of anything at all. So firming creams are probably more hype than anything else.

Injectable fillers to enhance the breast were in vogue about 10 years ago. Plastic surgeons of course have been using injectable fillers for many years to fill out lines, creases, and irregularities or depressions on the skin. Although these are largely safe in themselves for use in smaller areas such as wrinkles and lines, there was always a question mark as to how effective they would be in larger volumes such as required in a breast enlargement. The filler used for this was called Macrolane and was made up of a stabilized hyaluronic acid- basically a sugar and salt water gel. Although these fillers are certainly much safer than the silicone injections that were used many years ago with some disastrous results, they did give rise to lumpiness and distortion in a large number of women. Furthermore it is important to remember that these fillers are not permanent and therefore require “regular” top ups to maintain the volume. More recently fat injections taken from another part of your body have been used to fill out breasts. However there is still uncertainty and unpredictability with this form of treatment and trials are currently still taking place so it is yet to be determined whether or not fat injections will have a definite place in our armamentarium.

Brava is a breast shaping systems devised by a Florida Plastic surgeon. It’s a clinically proven device used as a non-surgical alternative for breast enhancement. It consists of 2 plastic semi rigid domes with silicone gel rims containing a small microprocessor. The system is applied over the breasts and applies a gentle sustained pull to the breast area resulting in growth of new breast tissue. It is based on the principle that all types of body tissue will grow and generate new, normal tissue when gentle sustained uniform tension is applied(i.e. skin and muscle over abdominal area during pregnancy). The system is held in place with a sports bra and must be worn for at least 11 hours a day for 15 weeks. It can result in an increase of up to 1 cup size. Although initial studies have shown that this effect has been maintained for more than one year even after discontinued use, some patients require further treatments. The disadvantages are that it is very cumbersome and unwieldy to use, and doesn’t always give the patient the size that they desire.

A surgeon fee, anesthetist fee and hospital fee will be required. You will be given a breakdown of these costs on the day of your consultation.

The chances are excellent that you’ll be happy with your surgery. Most patients understand the advantages and benefits of this type of surgery. However, despite assurances by competent British Plastic Surgeons and the UK’s Department of Health, many women are still concerned about the safety aspect of silicone and implants in general. If you decide to undergo breast augmentation surgery it is important that you choose an implant that you feel assured about. A surgeon can only inform and advise what implant he feels is best however ultimately the decision is yours. Unfortunately, the perfect implant has yet to be made and there are some positives and drawbacks associated with all implants. It is important that any potential patient weigh up the benefits and risks prior to undergoing any surgery and allow themselves not to be swayed by any form of media hype or scaremongering.