Breast implants: four things worth knowing before you decide

This is one of the commonest consultations and also one that arrives with the most loose information. These four things are, in our experience, what changes most decisions when they are explained in time.

1. An implant is not for life

This is the first thing to accept. A breast implant is a device, and devices have a working life. There is no fixed expiry date, and plenty of people carry them for decades without trouble, but the probability of needing an exchange or removal at some point is real.

That means that in deciding, you are not deciding on one operation: you are deciding to enter a long follow-up that may include another operation later. If that does not fit your life, better to know now.

2. Lifting and augmenting at once is the most demanding breast operation

It is the commonest request in the breast consultation: the breast has dropped and has also emptied at the top. A lift alone restores the shape but leaves the upper pole flat; an implant alone fills but, in a breast that has descended, worsens the drop by adding weight. The combination solves both.

And it is worth knowing why it is demanding: the two manoeuvres pull in opposite directions. The lift reduces and tightens the skin envelope while the implant expands it from inside.

That conflict is why this operation has higher reoperation rates than either of the two separately. It is not a reason not to do it; it is a reason to plan it with a moderate implant and to consider two stages when the case calls for it.

3. Size has a long-term price

A large implant weighs, and that weight acts on your skin and your tissues every day for years. The larger the implant relative to the base of your chest and the quality of your skin, the higher the risk of early descent, of thinning of the tissues covering it, and of visible rippling.

The size chosen by looking at a photograph and the size your anatomy can carry do not always coincide. When they do not, the second one wins, and that conversation is more useful before the operation than five years afterwards.

4. The specific risks, named

• Capsular contracture. The body forms a capsule around every implant; in some cases it hardens and deforms the breast. It is the characteristic late complication.
• Rupture. It can be silent with current implants, which is why imaging follow-up exists.
• Changes in nipple sensation, which can be permanent.
• Rippling or palpable edges, more likely in slim people with little cover.
• Residual asymmetry. The two breasts were never the same and will not be afterwards.
• Breast implant-associated anaplastic large cell lymphoma. A very rare entity, linked above all to textured surfaces, explained in the consultation with the current data.

The practical side

A mastopexy with implants takes three to four hours, under general anaesthesia, with one night in hospital and twelve to eighteen days back to normal life.

Two things reduce problems more than anything else: moderate implants and stopping smoking. The second is not negotiable in an operation that depends on skin healing under tension.

What is not promised

No specific result is promised and no implant for life. What is promised is a plan sized for your anatomy and not for a photograph, and that whatever may happen in ten years is said today.