Breast and cosmetic implants

There are 2 main groups of breast implant procedures provided by NHS Scotland. They are performed:

• for reconstruction of a breast – for example after a mastectomy
• under the Scottish Exceptional Referral Protocol

Mastectomy reconstruction

Reconstruction of the breast may be an option after a mastectomy. Reconstruction either uses implants or your own tissue.

You and your surgeon should discuss which procedures are right for you before making a decision.

The implants used depend on the individual case. They may be:

• silicone gel
• saline filled
• a mixture of both

Exceptional Referral Protocol

You may be referred to NHS breast implant services under the Scottish Exceptional Referral Protocol. This is for women with:

• exceptionally small breasts
• a misshape of the breast that they were born with

You'll discuss the details of the proposed surgery with your surgeon if you're referred under this protocol.

Most often silicone gel implants will be used. In some cases other devices may be used.

Things to consider

There are many factors to take into account before making the decision to have silicone breast implants. You should think about these factors whether you're considering cosmetic or reconstructive surgery.

A breast implant is a manufactured device. In other words, it's artificial. It will not last forever. Further surgery is always likely to be needed for replacement. This could be many years after your initial procedure. Complications occurring after surgery can also need further procedures. But many patients benefit greatly from this type of surgery.

Before having silicone gel breast implants, you should get as much information as possible. You should find out:

• the precise nature of the procedure
• the possible complications
• what treating complications might involve

Most of this information should be discussed at your appointment with a surgeon. If you're thinking about having surgery privately, you should understand:

• what might be covered by your initial payment
• what you may have to pay more for later

Further costs of private surgery could be substantial.

You can find good background information about breast implant surgery from the:

• British Association of Plastic Reconstructive and Aesthetic Surgeons: Reconstructive Surgery
• British Association of Plastic Reconstructive and Aesthetic Surgeons: Cosmetic Surgery
• Association of Breast Surgery: Patients
• The British Association of Aesthetic Plastic Surgeons: Breast Augmentation

Costs

Procedures performed by NHS Scotland are free.

Private health insurance

Private health insurance policies may cover reconstructive surgery after breast cancer. But policies often have shortfalls or excesses to pay. You should be clear about what you'll have to pay before deciding to have private surgery.

Private procedures

Private cosmetic procedures are often provided as ‘fixed price’ deals. You need to be clear about what is involved, what is covered, and what is not.

Initial costs are likely to be around £5000 to £6000 (2021 prices). If you need further surgery for changes or replacement, it may cost around the same. Further surgery is very rarely covered by your initial payment.

What the procedure involves

Breast implant surgery usually involves a procedure under a general anaesthetic. Sometimes local anaesthesia and sedation may be possible. You may need a short stay in hospital after the procedure.

Mastectomy reconstruction usually involves placing an implant either:

• in a pocket behind the chest muscle
• directly under the skin of the breast

The details of which technique is planned and performed will be discussed with you before your surgery.

Procedures for enlarging or correcting breasts may involve placing an implant either:

• under the chest muscle
• between the chest muscle and the breast tissue

Which approach is used should be discussed with you before your surgery.

Recovery

You'll need to recover for a few weeks after surgery.

Most people find the discomfort after surgery is manageable. But the discomfort can restrict your activity, particularly in the first 2 weeks.

You should be able to return to your normal activities about 6 weeks after surgery. What you can and can't do should be discussed with you before your surgery.

Complications

All surgery can have complications. The majority of implant procedures are successful. But you should discuss possible complications before your surgery. You should check with your provider what would happen in the event of any post-operative problems. For example, find out:

• where would you be seen
• who would see you

This is especially important if you are thinking about travelling overseas for surgery.

There may be complications with:

• the anaesthesia needed for placing an implant
• things common to all surgical procedures – for example wounds and scars
• things specific to implant procedures

A full discussion with your surgeon before your surgery should cover these possibilities. You should be aware of any potential problems.

Read further information about possible complications (PDF, 1.2 MB)

The registry

The Breast and Cosmetic Implant Registry (BCIR) helps improve services for people with an implant.

Product recall

Very rarely, breast and cosmetic implant products may be recalled.

Read further information about breast and cosmetic implant product recall

Imaging and screening

Breast implants do have an impact on breast imaging – specifically mammograms. An implant makes it more difficult to see all the breast tissue on a mammogram. It's still possible to do mammograms on people who have implants. But if you have implants you need to tell the radiographer doing a mammogram than you have them. They can then take more pictures to see as much of the breast as possible.

Sometimes you might need ultrasound or MR (magnetic resonance) scans. These are not affected in the same way as mammograms. Ultrasound and MR scans can be useful to find out if implants:

• are still intact
• need any attention