Myths answered on breast implants and enlargement

There are many myths around breast enlargement surgery - our cosmetic surgeon clears up the common misconceptions.

There are many myths around breast enlargement surgery - how do you know which ones are true or false?

We spoke to Mr Venkat Ramakrishnan, consultant plastic and cosmetic surgeon at Spire Wellesley Hospital in Southend, Essex, to clear up the myths around breast implants and augmentation surgery.

Myth: "Teardrop implants always look more natural than round implants"
There is a notion that teardrop-shaped implants are more natural looking. This is not true.

There are a few points to be considered. The round implants are softer and have a more natural feel to them. When the patient is upright they assume a teardrop-like shape and when the person is lying down it behaves more like a normal breast would. This is because the gel is more mobile.

In order to retain a shape, the teardrop implants have a more dense gel and they feel firmer. In selected patients the teardrop implants are useful. A round implant does not mean that there is a round appearance after augmentation - if the size is large any type will give a round appearance in the upper cleavage area.

Myth: "Implants under the muscle always look better than over the muscle"
Not so in most patients. The normal breast is not under the muscle. The under-the-muscle approach is good only in patients who are very thin, without any fatty tissue and limited skin laxity. In fact when there is loose skin, an implant under the muscle may lead to a double bubble deformity and will not allow the implant to fill the envelope naturally.

Myth: "Armpit approach to place the implant is better than under the breast"
The scar under the breast is the most commonly used technique. This is because it allows the surgeon best access to the pocket (the space in which the implant sits) and allows us to secure the bleeding points. The scar is a fine one in the majority of Caucasian skin types. It is preferable to use this approach with gel implants as there is less fracturing of the gel when placing the implants.

Myth: "Implants with a lifetime warranty are better"
Some companies state that there is a lifetime warranty on the implants; these vary. If there is capsular contracture (scar around the implants), some companies say that they will cover it. It is most often a free implant.

If there is a manufacturing defect some companies provide implants with a small sum to cover the costs of replacement. In my experience, the compensation is only a fraction of the cost of the whole procedure - it is important to select a very good quality implant in the first instance rather than rely on any warranty.

Myth: "Implants can cause breast cancer"
Implants do not increase or decrease the risk of breast cancer. The implants are placed behind the breast tissue and all the breast tissue is in front of the implant. Hence, the standard methods of breast self-examination are possible and are required after an augmentation, as it is in all women.

It may be difficult to have a mammogram in patients with implants as the positioning of the breasts in the machine may prove difficult depending on the size of the implant. It is recommended to use ultrasound in cases following augmentation if any checks need to be made to look for changes in the breast tissue or the implants.

More recently, there has been some evidence that there could be a type of cancer that can appear in the capsule tissue or the scar tissue around the implants called the Anaplastic Large Cell Lymphoma (ALCL). We know little about this at the present stage, except that it has some association with the implants and is very rare.

This problem has presented in the very rare occasion, as sudden swelling around the implant and in such cases, the breast must be scanned and implant removed with the scar tissue and testing done. Although it is extremely rare, anyone seeking implant surgery must be made aware of this.

Myth: "Silicone implants are dangerous"
Insertion of any foreign body will have an effect on the body. Effects such as increasing the bust size and pertness of the breast are welcome benefits of the procedure; on the other hand, it will have some not so welcome effects as well.

The implants stretch the skin and thin the breast tissue. One can have stretch marks, loss of sensation or increasing droopiness due to having large implants. Due to thinning of the tissue, rippling of the implant may pose a problem in some people. If the implant ruptures, the silicone can create nodularity in the breast due to reaction, but this problem is associated with older silicone oil-filled implants and cheaper implants with poor integrity of the silicone bag in which the gel sits.

High quality manufacturers have overcome this problem by limiting seeping of the silicone through the bag and also using high medical grade silicone gel. The stories about exploding implants, especially during air travel, or leaking of silicone through the nipple are false.

Myth: "Breast implants need to be regularly replaced"
There is normally no expiry date on implants and they do not need regular replacement. However, anyone seeking augmentation must be told that there is a possibility that they may require two to four further operations to maintain the implants during their lifetime, depending on what age they seek the first augmentation operation.

The usual reasons for removal and replacement are: the hardening of the implant over the years due to scar tissue around the implant; breakdown of cheaper implants; recall of defective implants (as we saw in the PIP implants’ case); fluid build-up around the implant; desire to have larger or smaller implants; or sagging of the breast over time.

Each operation will incur more expense and time off work. Although a small percentage of woman who have implants undergo replacement, one cannot tell if that person is going to be you. It is important to make allowance for further operations if you are going to have implants, and only have the highest quality implants - after all the cost of implants is only a small fraction of the total cost of the operation and it is important that poor quality implants are avoided in an effort to save money.

Call 01702 447 926 for an appointment with Mr Ramakrishnan or to book on to the next available free cosmetic surgery event at Spire Wellesley Hospital.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.

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Mr Venkat Ramakrishnan

Mr Venkat Ramakrishnan, cosmetic surgeon at Spire Wellesley Hospital

Mr Venkat Ramakrishnan is a consultant plastic surgeon at Spire Wellesley Hospital in Essex.

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