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The only plastic surgery clinic in the UK specialising in breast enlargement.

These days breast implants are built to last forever and all of the implants that we use here at The Staiano Clinic have a lifetime warranty (see warranty of implants).  However, there are reasons that breast implants may need to be replaced and so you should consider both the financial and physical implications of this when contemplating breast enlargement surgery.

We always advise patients to minimise the number of operations they have on their breasts because every operation will involve more scarring.

Furthermore, while we are always careful to avoid removing any breast tissue, there may be small amounts of breast tissue removed and so it gets more and more difficult to get adequate cover over implants in patients who have had multiple operations on their breasts.

For this reason, you should think carefully before having replacement of your breast implants and make sure that you are likely to gain a significant improvement which will outweigh the potential risks.

Breast Implant Replacements

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Possible Reasons For Replacement Of Your Breast Implants

Capsular contracture is probably the most common reason for requiring replacement of breast implants.

Capsular contracture is hardening of the implants and is something that happens over time.

It usually takes years for capsular contracture to develop and it does not need to be treated unless it is causing you problems.

Treatment involves removal of the capsule (capsulectomy) and replacement of the implants and it is usually best to wait as long as possible before having surgery to replace the implants because a new capsule will start to form around the new implants as soon as they are replaced.

If you would like more details about the treatment of capsular contracture and replacement of your breast implants, please contact us.

People often worry about implant rupture, but with modern implants the chances of rupturing your implant are quite low.

In the UK, breast implants are usually filled with silicone gel.  In the USA, there are still saline implants being used, and if the shell of these implants fails, then the implant will deflate with an obvious loss of volume and shape.

The silicone gel within implants is known as cohesive gel, which means that it will not run if the shell breaks (also known as form stable).

Think of it like cutting a jelly baby in two, or as the Americans would call it – a gummy bear.

This means that if the shell of the implant ruptures, you often cannot tell that it has happened because the implant may keep its shape.  This is known as a ‘silent rupture’.

Do I need a scan to check my implants?

It is very common for patients to be happy with their implants, but feel they would be even happier if they were a little bit bigger.

The majority of my patients say this but I am careful not to compensate for this by using bigger implants.

Choosing the right implants in the first place takes care and consideration.

The diameter of your breast has to be measured and an implant of the appropriate shape and projection needs to be chosen in keeping with the dimensions of you breast and your frame (you can watch my webinar for more details about this).

It is not simply about choosing the volume.

This is why I do not advocate that my patients do the ‘rice test’ at home, because all this tells you about is volume.

When patients say to me that they would like bigger implants, they are usually happy with the result of their breast augmentation and would like the same result but a bit bigger.

However, this is not possible.

If you replace your implants with bigger implants, then the bigger implants will be different in some way.

They will either have to be wider than your original implants or they will have to be a higher projection than your current implants.

This means that you will look different to your current result in some way.

You should be aware that most hospital’s aftercare policies will not cover the costs of surgery that is purely to change the size of the implants which is why you should spend time with your surgeon before the operation to make sure you are happy with the implant choice.

This is why we would always rather see you two, three or four times to go over everything before your surgery rather than having and anxieties or regrets afterwards.

If you feel like your current implants are not full enough, then it may be reasonable to replace them with higher profile implants of the same width (assuming that your implants are not already the highest profile).

However, be careful, because higher profile implants do give a different ‘look’ to your breast which you may not like as much and so you need to be comfortable that the replacement will be beneficial.

If you do not want to have more fullness, particularly in the upper part of your breast, then you can keep the same profile of implant and have a bigger, wider implant.

In my view, the width is the most important dimension of the implant and I take great care to make sure that the width of the breast implants that I use compliment the width of the breast.

I am very careful not to use a breast implant that is too wide for your frame.  If you use an implant that is too wide, then two things can happen – it will stick out too far at the sides, or it will stick out too far across the middle.

If it sticks out too far at the sides (too much side boob) then your arm may rub against your breast.  You may be happy to accept this if you want the maximum size implant that you can have, but it can be uncomfortable and you run the risk of being able to see or feel the implant in this area.

If your breast implants stick out too far across the middle, then this can obliterate your cleavage and create a condition called synmastia (or symmastia or uniboob).  This is when there is a web between the breasts and there is not a crisp demarcation between the breasts in the cleavage area.

This is unsightly and difficult to correct and so is best avoided if possible.

So be careful not to choose breast implants that are too wide for your frame.

Replacement of breast implants for smaller implants is usually for different reasons to replacement of implants for bigger implants.

Patients who want smaller implants are usually unhappy with their figure and no longer feel comfortable or in proportion.

Large breast implants will stretch the skin of the breast and so if the implants are downsized, then this can leave the breast with excess skin which can hang down and droop. For this reason, it is not uncommon to combine the downsizing of implants with a breast lift to improve the shape of the breasts.

For some people, their breast implants have served a purpose in that they have restored confidence and self-esteem for many years and they are now in a stage of their lives where they do not feel that they want them any more.

For others, there can be concerns around the implants making them feel unwell and there have been large studies looking at the medical effects of having silicone breast implants. There is no evidence that breast implants cause any medical problems despite claims that some patients developed connective tissue diseases such as SLE and rheumatoid arthritis after having implants.  There are cases of patients feeling generally unwell with tiredness and malaise, who report that they feel better after they have their implants removed.

Just because there is no medical evidence for an association at the moment does not mean that there isn’t one.

In the same way that downsizing implants can lead to excess breast skin and droopiness that may require a breast lift, so removal of implants can be combined with a breast lift to improve the shape and the cosmetic outcome.

However, if the cosmetic appearance is not particularly important, then it is perfectly reasonable to remove the breast implants and allow the skin to settle and re-drape. If the result is cosmetically unacceptable, then you can always choose to have a breast lift later.

For some people, their breast implants have served a purpose in that they have restored confidence and self-esteem for many years and they are now in a stage of their lives where they do not feel that they want them any more.

For others, there can be concerns around the implants making them feel unwell and there have been large studies looking at the medical effects of having silicone breast implants. There is no evidence that breast implants cause any medical problems despite claims that some patients developed connective tissue diseases such as SLE and rheumatoid arthritis after having implants.  There are cases of patients feeling generally unwell with tiredness and malaise, who report that they feel better after they have their implants removed.

Just because there is no medical evidence for an association at the moment does not mean that there isn’t one.

In the same way that downsizing implants can lead to excess breast skin and droopiness that may require a breast lift, so removal of implants can be combined with a breast lift to improve the shape and the cosmetic outcome.

However, if the cosmetic appearance is not particularly important, then it is perfectly reasonable to remove the breast implants and allow the skin to settle and re-drape. If the result is cosmetically unacceptable, then you can always choose to have a breast lift later.

Breast Implant Replacement

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Breast Enlargement Before & After

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The STAIANO 10 Step Process For Choosing Your Ideal Breast Implant

I developed the ’10 Step Process For Choosing Your Ideal Breast Implant’ because there is a vast array of techniques, types of implants and opinions about breast implants and I see a lot of confusion out there. While you can find plenty of information on the internet, it is not filtered or verified, so it can be hard to know what to believe.

There is no substitute for an in-person consultation with a Consultant Plastic Surgeon who can measure your frame, assess your current breast size and shape and work with you to ensure that you choose the implant that will achieve your goals.

Having specialised in breast augmentation since 2007, I have developed a pathway that will guide you through the complexities and simplify the process to ensure that you choose the ideal breast implant for you.

If you are in the research phase, then the first step is to get our guide with information about pricing and finance plans as well as frequently asked questions and tips about what you should be looking out for when choosing a plastic surgeon.

If you have any specific questions or concerns, then I do a Live Q&A every Tuesday on our Facebook, Instagram and YouTube channels, so you can either send me a question beforehand or ask me live on the night.

If you don’t feel ready to commit to coming for a full consultation, you can arrange a 15 minute call with one of our surgeons to go over all of your questions and talk about any concerns you may have.  We offer ‘virtual consultations’ that can be held by video call or phone and can be booked online.  There is a £35 charge for these calls, however, if you would prefer to go straight to a full consultation, then you can purchase a ‘clinic passport’ and get unlimited access to the clinic.

Your ‘Clinic Passport’ is a unique system that we have developed that allows you unlimited access to the clinic to go over your proposed treatment with your surgeon as often as you need.  In fact, we encourage you to come back for at least one more consultation after the initial one because it is always helpful to go over things.

You will also be able to email us or call us if you have any questions and we have a Private Facebook Group open to anyone who has been to the clinic where you can share your hopes and fears and ask a question without fear of the whole word seeing it.

In the old days patients would not really be aware whether the implant was put under or over the muscle but these days you are much more informed and likely to be involved in this decision.

As with anything in life, any time there are different ways of doing things there will always be pros and cons of each.

When talking about putting the implant under or over the muscle we are referring to the pectoralis major muscle (your pec) which is a large fan shaped muscle that has a narrow insertion up by your shoulder and then fans out across your chest to have a wide attachment along your breast bone and lower ribs.

The benefit of putting the implant on top of the muscle is that it is less painful because the muscle is not divided and it does not bleed as much so the recovery is quicker.

Also the implant sits with the breast which is preferable.

The opposite is true when the implant is placed under the muscle because when the muscle is divided, it hurts when you move and there is more risk of bleeding and so recovery is slower.

Furthermore the muscle can sometimes hold the implant high and can sometimes pull the implants wide to give an abnormally wide cleavage. There is also a risk of ‘animation deformity’ which means if you exercise your arms and your pec muscles, your breast might move as the implant moves underneath the muscle.

The benefit of putting the implant underneath the muscle is that the muscle will cover the implant in the upper part which means there is less risk that you may be able to feel the edges of the implant and less risk that you will be able to see visible rippling of the implant. You should note that even when the implants are placed under the muscle, they are not covered by muscle in the lower part or to the side and so there is still a risk of rippling or being able to feel the edge in these areas.

Another benefit of putting the implant under the muscle is that capsular contracture ,which is when the implant becomes hard, is felt later on because the muscle gives a layer of padding over the top of the implant.

We make the decision based on a balance of the risks:

Under – pros: less rippling*, less capsular contracture, less feeling the edge*

Cons – more post op discomfort, increased risk of bleeding (haematoma), implants may sit high or wide, risk of animation deformity

Over – pros: quicker recovery, implants sit with the breast and less likely to sit high or wide

Cons – more likely to feel edges and more likely to see rippling in slimmer patients, capsular contracture appears sooner

*the muscle covers the implant in the upper medial part in the cleavage area (you may still be able to feel the edge or see rippling in the lower outer part)

This is often the focus of most patients who are considering breast implants – which implant do I choose?

Over the years of putting in countless breast implants, I have developed a way to ensure that you choose the implant that will suit your frame and match your expectations.

…and one thing that I have learned is that it is not all about the size!

THE TRIDENT APPROACH allows us to help you to choose an implant based on the dimensions of your frame and the look that you are trying to achieve, rather than making you pick a volume of implant based on your best friend’s experience or someone you saw on the internet.

The Trident Approach, takes a 3 Prong strategy and involves:

PRONG 1 – the first step is for us to examine you to assess the size and shape of your current breasts, the amount of soft tissue cover you have over your chest and most importantly, the diameter of your breasts.

The base diameter of your breasts is the single most important dimension when deciding on an implant.  It is a set measurement and one that you cannot change and it will dictate the size and shape of implant that you can have that will ‘fit’ your frame.

PRONG 2 – you will try on sizers that we have in the clinic to get an idea of the sort of volume that you would like to achieve.  This is probably the most exciting part of the process and will give you a feeling of what it is like to have implants.

Many patients will spend a long time agonising of what size they would like, when in fact the decision is not only about the size and the aim of using the sizers is to get a ballpark estimate of the sort of volume that you are trying to achieve.

We always ask ‘what cup size would you like to be?’ but will then be quick to point out that we cannot guarantee any particular cup size as cup sizes are not a precise science.

The sizers will give you a better idea of what the different volumes can achieve in terms of an increase of the volume in your bra, but they will not give you that much of an idea of what sort of shape you can hope to achieve.

PRONG 3 – the final step in The Trident Approach is to look at before and after photographs of patients with the different shapes and profiles of implant to help narrow down the implant selection.

Implants come in two shapes – round and teardrop

…and in different profiles – low, moderate, high and extra high (these names vary between makes)

The before and after photos will give you an idea of what sort of ‘look’ you are trying to achieve.

It is important to remember that you have to add the implant to your current breast shape and so it is not as simple as saying that round implants give a fake look and teardrop implants give a natural look.

It depends on how much breast tissue that you have before you start and it depends on the profile of the implant that you choose.

It is possible to get a natural result with a round implant.

When you have an idea of the shape and profile of implant that you would like and we have measured the base width of your breast, then you will usually have the choice of only a handful of implants.

Using The Trident Approach, it often boils down to quite a narrow choice of implants and it is not as daunting as it may seem at first.

We encourage patients to come back for at least a second consultation and maybe even a third and fourth because it is important to be comfortable with your implant selection.

We don’t want you to feel pressured in to making a decision, which is why, once you have purchased your ‘Clinic Passport’, you will be welcome back to the clinic as often as you need so that you can be sure that you are making the right choice about the size, shape and profile of implant that is right for you.

There are a variety of different types of implants on the market and they all have their strengths and weaknesses.

Everybody wants to have the ‘best’ implant but the fact is that there are pros and cons of all of them, otherwise we would all be using one type.

Unlike many clinics, we are not tied to any particular make or manufacturer of breast implant and so we are free to use any type of implant as long as the hospital is able to get hold of it.

A breast implant is made up of a shell and contents and the different types of implants that are available are as follows:

CONTENTS:

Saline – saline implants are filled with salt water rather than silicone gel and saline implants are not commonly used in the UK.

Pros –   some patients feel that they do not want to have any silicone implanted in their body (although saline implants still have a silicone shell).
if the implant leaks it is just salt water that leaks out, which is easily absorbed by the body.
they can be inserted empty and filled during the operation allowing a smaller scar (can even be placed through a small scar in the belly button – TUBA or transumbilical breast augmentation)
Cons – more likely to ‘deflate’ over time
more likely to have visible rippling and so usually need to be placed under the muscle
not available in the teardrop shape

Silicone – the majority of breast implants that we use in the UK are filled with silicone gel.

Pros –    silicone gel is made to feel similar to the consistency of natural breast tissue and can give a better ‘feel’
the gel is called ‘cohesive gel’ and has a firm consistency known as ‘form stable’ or ‘gummy bear’, which means that it does not leak liquid silicone if the shell ruptures and will keep its shape.  It is safer in the event of implant rupture, although the implants can feel a bit firmer than the older, more liquid silicone implants

Cons –   some patients feel that having silicone in their body makes them feel ill (known as breast implant illness), although in these cases, it may be best to avoid breast implants all together.

SHELL:

The main difference between breast implants is the shell of the implant and it relates to how rough it is.  They range from a completely smooth shell (smooth implants) to a very rough shell (polyurethane foam implants) with micro and macrotextured implants in between.

Smooth Implants – this is how implants were first made back in the 1960’s and these have a glassy smooth surface.  They were found to have a risk of rippling and of going hard (capsular contracture) and it was found that by making the surface of the implant rough, it would break up the scar tissue that forms around the implant and make it less likely to contract and go hard.  However, more recently, there has been a very rare cancer associated with breast implants called Breast Implant Associated – Anaplastic Large Cell Lymphoma (BIA-ALCL) and this seems to be related to the roughness of the implants and so does not occur with smooth implants.

Pros –    less risk of BIA-ALCL

Cons –   increased risk of rippling
increased risk of capsular contracture
no teardrop shape – there is no adherence between the implant and the pocket which means that there is no teardrop shape available for smooth implants (although they do tend to settle in to a teardrop shape when in the body)

Microtextured implants – these are relatively new implants and fill the gap between traditional macrotextured silicone implants and smooth implants.  The surface is gently roughened.  In the classification of implants, they are classified as smooth but they have a slightly roughened surface in order to give some of the benefits of the textured surface while still being classified as ‘smooth’

Pros –    slight roughness to the surface may reduce the risk of capsular contracture
may be seen as a compromise between completely smooth and traditional (macro)textured implants

Cons –   relatively new on the market
no teardrop shape (although come in a less cohesive type which is more likely to settle in to a teardrop shape when in the body)

Macrotextured Implants – these have probably been the most common type of breast implant used in the UK.  They have a roughened (textured) surface which helps the implant to adhere to the surrounding breast tissue and reduces the risk of capsular contracture.  However, it is this roughened surface that has been implicated in the development of the cancer, BIA-ALCL

Pros –    textured surface offers better adherence
less chance of capsular contracture (compared with smooth or microtextured)

Cons –   increased risk of BIA-ALCL
more chance of capsular contracture (compared with polyurethane foam implants)

Polyurethane Foam Implants – these implants have been around since the 1960s but have had a controversial history.  They have the lowest rate of capsular contracture of all implants and integrate with the breast tissue securely and so are less likely to migrate or rotate.
However, a by-product of the polyurethane (2,4 TDA) was found to cause cancer in rats and so these implants were not used in the UK for a long time.  However, they continued to be used in other parts of the world and this cancer has never been found in humans.
More recently, polyurethane foam implants have been implicated in BIA-ALCL as it seems that this rare cancer which occurs in the capsule around the breast implants (it is not breast cancer) seems to more common in implicated in implants with a rougher surface and polyurethane implants have the roughest surface of them all.

Pros –    low risk of capsular contracture
low risk of migration or rotation

Cons –   increased risk of BIA-ALCL
theoretical risk of cancer caused in rats

  Rippling Capsular Contracture ALCL
Smooth Implants ++++ ++++ +
Microtextured Silicone Implants +++ +++ ++
Macrotextured Silicone Implants ++ ++ +++
Polyurethane Foam Implants + + ++++

There is a choice of the type of anaesthetic that you have for your breast augmentation.

Traditionally, it would be done under a general anaesthetic (GA) but more recently, the use of Twilight anaesthetic has become more popular.

GA

General anaesthetic involves being put to sleep. It requires the involvement of an experienced anaesthetist and the use of an anaesthetic machine.

You will not be aware of anything during your procedure and you will ‘wake up’ in the recovery room when it is all over.

During the procedure you will have a tube in your mouth that will be helping you breath and this may occasionally leave you with a sore throat.

When you wake up, you sometimes feel groggy and disorientated and you may feel nauseated. This feeling can last some hours and occasionally may last for days.

Surgery is usually done as a day case, but if you have a General Anaesthetic, you may prefer to stay in hospital overnight and go home the next day.

Twilight

Surgery can be done under local anaesthetic with sedation which is also known as Twilight Anaesthetic. This has the benefit of a quicker recovery time and less of a ‘hangover’ feeling. It means that you will be able to go home on the same day as the surgery.

The downside is that you may be more ‘aware’ of the procedure and you may feel some discomfort.

Some people think that because it says local anaesthetic, that they will be awake and responsive during the procedure, however, the sedation is such that you are usually quite drowsy and often lapse into periods of sleep.

We believe strongly in giving patients the time and the space that they need to make a decision.

You will never experience any ‘hard sell’ or pressure from us to go ahead with surgery or to make any decisions about your implants.

We realise that this is a major life decision and should not be rushed.

We offer all of our patients at least one follow up appointment before surgery to go over things and sometimes patients will come back several times just to be sure – we encourage this.

In fact, we insist on a ‘cooling off’ period of at least two weeks between your consultation and your surgery so that you can be sure that this is the right thing for you.

One of our founding values is that we will ‘do the right thing’ and this means that we will treat you like a patient, not a customer.

If you are not sure, or need more time to decide, then we will postpone your surgery until you are completely happy, no problem.

On the day of your surgery, you will be admitted to your private en suite room in one of our partner Private Hospitals.

You will have the opportunity to meet with your anaesthetist prior to your procedure and your surgeon will ‘mark you’ with surgical marker and take photographs.

We aim to bring you in to hospital 1-2 hours prior to your procedure so that you can be settled and comfortable in your room before going to theatre in a relaxed and calm way.

You will receive a complimentary ‘STAIANO’ gown and be looked after by your named nurse.

You will be given your postoperative advice sheet with the do’s and don’ts as well as what to expect in the postoperative period.  You will also have the contact details of The Clinic for any questions or concerns following your procedure as well as the 24 hour emergency contact details of the hospital for any out of hours problems.

One of the founding principles of The STAIANO Clinic and one of the main reasons that I set The Clinic up in the first place, was that I believe that your aftercare is as important as your surgery.

I will often see patients spend time and energy doing their research but they are usually researching the wrong thing.

The focus is on the surgery and all too often, it is the size of the implant, test this in itself will not have a dramatic effect on your outcome

…it is much more important to think of the shape and dimensions of the implant to make sure that it will fit and compliment your frame and your figure

…in fact, more important than that, is to research your surgeon to make sure that they are fully trained and appropriately qualified to perform your procedure.  If your implants are not placed correctly, then you are not going to be happy with your result no matter how much time and energy you have spent in choosing the size and shape.

Finally, it is the aftercare that is often neglected when patients are researching having breast implants.

All too often, I am contacted by people who have recently had surgery elsewhere and the have a problem or a query about their surgery.

My advice is always the same – you should talk to your surgeon as they will be best placed to advise you.

When performing surgery, we have a duty of care to look after you.

A significant portion of our week involves seeing our patients at every stage after their procedure to make sure that everything is on track.

Often there will be niggles, bumps, asymmetries, or scars that are a bit red and raised.  These things will almost certainly settle and the result that you get at 6 or 12 months is often unrecognisable from the result that you see at 6 or 12 days!

A large part of the service that we offer is to make you feel listened to and looked after.

This involves giving you access to the clinic for advice and support as often as you need.  Our success is built on word of mouth, which means that we pledge to,

‘do everything that we can to ensure you get the best result possible’

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What should I do if I am worried about my breast implants?

If you have any questions or concerns about your breast implants, your first port of call should be with the original surgeon or hospital where you had your surgery.

They are likely to have your medical records with details of your surgery and the implants used.

This is useful information, particularly if you are replacing your implants so that you can plan for any potential in size or shape following your surgery.

The important pieces of information to know prior to replacement of implants are:

  • The size (volume) of your implants
  • The shape of your implants – teardrop or round
  • The profile of your implants – low, moderate, high or extra high
  • The plane of your implants – above or below the muscle
  • Details of any other surgery to your breast – such as breast lift

If you are unable to see your original surgeon, then you should look for another surgeon in your area who may be able to help you.

Replacement of breast implants can be challenging surgery, so you should look for a plastic surgeon who specialises in cosmetic breast surgery. You can get a copy of my book ‘Never Accept A Lift From Strangers’ – how to choose the best plastic surgeon for your cosmetic breast surgery’ for advice and information about how to go about finding the most appropriate surgeon.

If there have been changes in your breast and you are unsure whether it is due to your implants or your breast tissue, then you could visit your GP as he or she will be the best person to advise whether you would need to see a breast surgeon if there are any concerns about breast lumps or breast cancer (you can read in my book the difference between a breast surgeon and a plastic surgeon who performs cosmetic breast surgery).

Our Breast Implant Replacement Work

Some words from our patients

“Thank you so much for my surgery, very happy with the results. On my consultation after the first two minutes of meeting you, I was sure that you were the surgeon I wanted and would not need to look anywhere else. You were caring and supportive, very professional. I would recommend you to anyone at any time. Thank you very much.”

Words by KM
Procedure: Implant Replacements

“I never imagined my breast surgery would go so smoothly, even the recovery has been amazing. Jonathan is exceptional and has helped me to achieve just what I wanted with minimal fuss. Fabulous surgeon. Would absolutely recommend anyone to go to the Staiano Clinic if they are considering surgery.”

Words by LM
Procedure: Implant Replacements