Stephen McCulley, Reconstructive and Aesthetic Surgeon. MBChb, FCS(SA)Plast, FRCS(plast)

Frequently Asked Questions

Cosmetic Breast Surgery FAQs

Breast Enlargements (Augmentation)

What should I do if I have PIP implants?

PIP implants were made by a French company with silicone that have not been passed for medical implant use. This means it may have more impurities in it. If you do have PIP implants they appear more likely to rupture over time. Negative or bad effects of the silicone are not proven with no evidence to support it is unsafe. However, the higher rupture rate and this uncertainty has led to differing advice. All patients should have a scan to see if the implant is intact. If the scan shows an intact implant they could choose to change the implant at some point over the next number of years. If it is ruptured then they should definitely be changed but this is not an emergency so do not panic. Arrange for removal or exchange over the next few months. If the implants are intact but you want to get on and exchange them then this is also a reasonable decision.

What would happen if the implants did rupture?

If the implant has ruptured you will probably not even know about it. You can present with lumps around the implant or occasionally in the arm-pit area. After confirming with a scan the implant can be safely removed and a new implant usually replaced if that is the preference.

How are implants held in place?

Modern implants have a rough surface called texturing. This texturing interacts with your own tissue to sometimes adhere to it. For all implants the body forms a layer of scar tissue called a capsule. This surrounds the implant holding it in place. Occasionally the implant will rotate in this capsule. If round this makes no difference but can be a problem in an anatomical implant in 1% of cases.

What is the difference in the shapes of implants?

Implants can be round or tear shaped (also called anatomical). The tear shaped implants have a sloping upper surface and give a softer or more natural appearance to the top of the breast. By contrast round implants give more roundness to the top part of the breast. In reality both can give good outcomes and other factors are the volume and the projection or ‘pertness’ of the implant. The differing options can be discussed depending upon what look you are after.

What are the chances of the implants leaking?

About 1 in 10 implants have been shown to rupture after 10-15 years. However, these figures are only available on older generation technology. Therefore modern implants are likely to be much better and closer to 1%. Indeed most good manufacturers guarantee against rupture for 10 years.

How long after breast-feeding can I have surgery?

It is better to wait until you have finished breastfeeding for a minimum of 6 months although we would recommend that you wait until after 12 months.

Are silicone implants safe?

Silicone is the best-tested product within the human body with over 40 years of surgical use. It is used in many medical products with very good safety records. Breast implants are safe with no evidence of connections to cancer or autoimmune or fatigue syndromes. However, it can create ‘problems’ such as infections, hardening or rupture with some spread of silicone. These problems are not shown to be dangerous in them selves but may need further surgery.

Can I fly after breast implants?

Yes you can. This tale of exploding implants is simply a load of rubbish!

How do implants affect mammograms?

Implants look like a white blob on a mammagram so obscuring the breast tissue. You will start mammagrams from the age of 50. Therefore implants do affect the mammagram. However, additional views can sometimes be performed to get around this. Despite this there is no evidence that woman with breast implants have a delayed diagnosis for breast cancer.

Why do woman choose to have implants under the muscles?

The main reason to place an implant under the muscle is to increase the ‘padding’ on top of the implant and so reduce the chances of seeing the edge as seen with some celebrities! It is mostly used with slender patients or those with very small breasts. If you have reasonable amounts of breast tissue then the implant can be placed under the breast alone with good results. Going directly under the breast is slightly better at filling up any droop in the breast.

When should implants be changed?

When they are either ruptured or causing a lot of physical symptoms because they have become encapsulated or hardened over time. There is no set time to exchange an implant as good quality modern implants may last many decades. It is worth getting your implants checked after 10 years with an examination and either ultrasound or MRI scan. You should then repeat that every 3-5 years after 10 years. If the scan is fine and you are happy with the shape the implants can be left alone.

Mastopexy and Breast Reduction

What will happen to the sensation of my breasts?

Sensation is usually fully retained after a breast lift but has a 20% chance of being lost in a breast reduction. If you have any concerns please discuss these with us in your initial consultation.

Why can I not just have an implant?

Implants do create some lift in a breast. However, if the laxity or droop is of such a degree an implant will not be able to create the lift. Also you may need an implant that is much too big to try and achieve the lift. So, implants are good for small amounts of droop only.

What scars will I have?

The scars for breast reduction and mastopexy are often the same. They can be the full scars of around the nipple, down from the nipple and under the breast crease. These are the ‘anchor’ or Wise scar pattern. With some breast reduction and more commonly in breast lift the scar in not needed in the breast crease, therefore just a scar around the nipple and down, sometimes called the short scar techniques.

How much fullness will I achieve with a breast lift?

The main effects of a breast lift are to tighten the breast skin and lift the nipple. This will achieve more fullness in the upper part of the breast, especially in a bra. However, there can still be some reduced fullness out of a bra in the upper part of your breast, if the skin is very stretched as it cannot ‘hold’ the breast tissue in position. In some cases an implant in addition to a breast lift gives that extra fullness.

Do I get a breast lift with a breast reduction?

Mostly definitely! A breast reduction works by lifting the nipple and reducing skin and breast tissue. Leaving the breast smaller and up-lifted.

How much smaller will I become?

Breast reduction makes the breast smaller and uplifted. A mastopexy simply lifts the breast but keeps all the breast tissue so leaving the breast as the same overall volume. How much smaller a breast reduction will make you is variable as this comes down to partly patient preference and partly what is safe. As a general rule the breast can be safely reduced at least 50% of the original volume. If you want to be really small then this may require different techniques but is still feasible.

Can I have breast implants alongside a mastoplaxy procedure?

Yes, both procedures can be safely carried out to enhance both the size and appearance of the breasts. For patients who want to achieve a fuller effect, a mastoplaxy alone may not deliver the desired result, whereas implants will help fill out the breast to give a firmer shape. It may even be the case that the breast needs less skin tightening once an implant is in place.

My breasts are already quite small – can I still have a breast uplift procedure?

Yes, a breast uplift is still possible, even on smaller breasts. Many women successfully achieve perkier breasts through an uplift, and it is a particularly popular procedure after pregnancy and breastfeeding which can cause the breasts to lose their shape in some cases.

How much swelling can I expect after a breast uplift or reduction?

As with all surgery, it is normal to expect some temporary swelling and bruising. These side effects will generally settle down within four weeks.

Answers provided by Mr Stephen McCulley and his expert team. You can see further helpful information in our Resource Centre or in our Ask Our Specialist Nurse section.

Stephen McCulley offers a wide range of cosmetic breast surgery procedures including breast enlargement, breast reduction, inverted nipple surgery, correcting impact problems and more!

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