There has been a threefold increase over the past decade in the number of British women having surgery to enlarge their busts, but recent concerns about an implant used in as many as 50,000 of them is a reminder that this is not a procedure to be undertaken lightly.
The controversy centres on concerns that the French manufacturer Poly Implant Prothese (PIP) switched to a non-approved silicone gel in its implants, and made changes to the outer casing which could increase the risk of leakage. It is still unclear what the implications of these changes might be for the tens of thousands of women who have had PIP implants — approved types of silicone are generally regarded as safe even in the event of leaks — but they are worrying enough for both the French and British authorities to suspend distribution, and to recall all stock.
The problem may have started as early as 2001 and, unless a woman knows for sure that she has not had a PIP implant since then, current advice is to contact her surgeon to find out. If PIP implants were used then the British Association of Aesthetic Plastic Surgeons (BAAPS) says there is no serious cause for alarm, but while further tests are being conducted into the gel, it suggests that women should have an ultrasound scan over the next six months to check for signs of weakening or rupture. If the scan reveals a problem then both implants should be removed and replaced.
Despite a number of scares over the years about the safety of silicone implants, the latest generation are much more robust with rupture rates of 1 per cent or less after six years. But rupture is only one potential complication and if my wife was considering surgery I would be more worried about other issues, such as infection, bleeding, poor cosmetic result and the need for revision.
In good hands the results of breast augmentation are generally very good. BAAPS members — just under half of all cosmetic surgeons in the UK — have some of the best results in the world. In a recent survey of more than 26,000 procedures, post-operative infection rates (0.53 per cent) were a fifth of the average across the rest of Europe, and the number with troublesome bleeding (1.2 per cent) was less than the United States’.
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The key, as with all forms of surgery, is to choose a good surgeon. You generally get what you pay for and I don’t know of a cosmetic surgeon at the top of his or her game who offers free consultations, zero interest loans, cheap ops abroad, two-for-one offers (it happens) and discount incentives for encouraging a friend to get something done.
The very best surgeons don’t necessarily charge significantly more than their peers, indeed in some cases, they are actually cheaper (expect to pay from around £4,000 upwards).
But even the best surgeons can’t halt the ravages of time and most women with implants will require some form of repeat surgery, even if they are happy with their initial result and their implants don’t rupture or develop excessive scarring. Gravity takes its toll on the breasts as women age, and what looks good on a 25-year-old can start to look a little strange on a woman in her fifties. So it pays to think of breast augmentation as a continuing process rather than a one-off operation. My last caveat concerns the reasons behind wanting a bigger bust. Good surgeons will talk a patient out of unnecessary work and/or suggest a cooling off period for her to think about surgery. If your surgeon appears more interested in your credit card, or suggests other work while you are there, you are probably in the wrong place.
Assuming that you are happy with your decision, and you choose a good surgeon, you are likely to be thrilled with the results, but if you embark on a journey for the wrong reason — such as pressure from a partner — and get second-rate surgery then you are likely to rue the day you took the plunge.
Before the op
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• Choose a surgeon who is a member of the British Association of Aesthetic Plastic Surgeons (BAAPS) and/or the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS).
• mybreast.org is widely regarded as a leader in the field. It is a nationwide network of leading surgeons (all BAAPS or BAPRAS members) with a lifetime aftercare policy.
• If you go elsewhere, make sure that your initial appointment and assessment is with the surgeon who will be doing the operation — if a clinic tries to fob you off with anyone else, vote with your feet.
• Never forget that, even in the best hands, cosmetic surgery can go wrong. In the event of complications such as infection or scarring, good follow-up is essential, so think twice before going abroad.