Breast implants - Frequently asked questions

Background

Safety of PIP implants

Do my implants need to be removed early?

What’s the evidence around the safety of PIP implants?

What is a rupture?

What are the signs of rupture?

Is it safe to have a mammogram with PIP implants?

Your rights

What happens if I got a PIP implant through the NHS?

What if I got a PIP implant privately?

I want a scan – should I ask for an MRI or an ultrasound?

My original provider said they would only accept an MRI image as evidence of a rupture – what should I do?

What should I do if my local hospital only offers me ultrasound, and not MRI?

I received PIP implants as part of reconstruction surgery following breast cancer. What are my rights?

Why can't I pay for a breast implant replacement as part of a combined operation in which the NHS pays for removal of the PIP implants?

Do my implants need to be removed early?

Official government advice is that there is no medical need for PIP implants to be removed early if they are intact. But the NHS has pledged to remove PIP implants without charge whether they have ruptured or not. So, if you are worried and want your implants removed before they rupture, see your GP or surgeon.

How many women are affected?

In the UK, around 47,000 women are thought to have the implants. Private clinics fitted 95% of these for women seeking cosmetic breast augmentation. The remaining 5% were fitted on the NHS.

The NHS provides breast implants only where there is clinical need. For example, women who have a mastectomy (breast removal surgery) as part of treatment for breast cancer are often offered implants as part of reconstructive surgery.

What happens if I got a PIP implant through the NHS?

If you received a PIP implant from the NHS you should have been contacted to let you know that.

You can speak to your GP or with the surgical team that carried out the original implant for advice on the best way forward. This could include a scan to see if there is any evidence that the implant has ruptured.

The NHS will offer removal and replacement of PIP implants if a woman and her doctor decide that it is the right thing to do.

What if I got a PIP implant privately?

The following private clinics have said they will replace PIP implants free if clinically necessary:

If a private clinic that provided PIP implants no longer exists or refuses to help, then the NHS will offer you clinical advice and support, including referral to an appropriate NHS specialist.

The NHS will also cover the cost of the removal of PIP implants if you and your doctor agree. This would not include the replacement of private cosmetic implants.

How many private patients have had NHS help?

Around 7,000 women who had their PIP implants put in privately have been referred to a specialist on the NHS. So far, 4,349 scans have been done and 490 women have decided to have their implants removed on the NHS.

What should I do if my local hospital only offers me ultrasound, and not MRI?

Current advice from the Royal College of Radiologists is to start with an ultrasound examination. If this does not show any sign of a rupture or gel bleed but you are still anxious or experiencing symptoms that you think are associated with the PIP implants, then you are entitled to an MRI scan, as this is a more sensitive method.

I received PIP implants as part of reconstruction surgery following breast cancer. What are my rights?

Every woman who has had breast cancer and has PIP implants will be able to have them removed and replaced without charge.

If you originally received your implants from the NHS, then the NHS will remove and replace them if that is your choice. If you originally received your implants from a private provider, you should in the first instance see if they will remove and replace them free of charge. If not, the NHS will carry out the operation to both remove and replace them.

What’s the evidence around the safety of PIP implants?

There have been media reports of a possible link between PIP implants and a rare type of cancer called anaplastic large cell lymphoma (ALCL).

The reports arose after a French woman with PIP implants developed the cancer and died.

However, after reviewing the evidence, the British independent expert review led by Sir Bruce Keogh agreed that there was no specific link between PIP implants and cancer.

More recently, attention has focused on the rupture rate of the implants, and whether the unapproved gel filling of PIP implants could have a toxic effect.

The review has specifically looked at these issues, and found:

PIP implants do have a higher rupture rate than other breast implants.
There appears to be no risk of dangerous toxic effects in the event of a PIP implant rupture.

What is a rupture?

A rupture is a split in the implant’s casing. A rupture can happen if:

the implant’s shell gets weaker over time
the implant is damaged during the operation
there is a flaw in the implant
the breast is injured

What are the signs of rupture?

If you have any of the following signs or symptoms, you should discuss them with your GP, who will refer you to a specialist:

lumpiness of the breast
lumpiness or swelling in the area around the breast
change in shape of the breast
deflation of the breast
redness
tenderness of the breast
swelling of the breast
pain or sensitivity

I want a scan – should I ask for an MRI or an ultrasound?

The current consensus is that MRI is more sensitive than ultrasound in detecting ruptures of breast implants. This means it is less likely than ultrasound to produce a "false negative" result (i.e. suggesting that the implant hasn't ruptured when it actually has).

However, MRI is much more expensive than ultrasound and waiting times for an MRI scan are likely to be longer.

Therefore if you and your doctor feel a scan is necessary to help determine whether your implant needs removing, the Royal College of Radiologists recommend having an ultrasound first, and:

If the ultrasound is negative and you are still concerned, proceed to MRI.
If the ultrasound is positive (detects a rupture), this should be a sufficient basis for the clinical decision to remove the implant.

My original provider said they would only accept an MRI image as evidence of a rupture – what should I do?

If you've already had a positive scan and decided to use this as evidence to encourage your original (private) provider to agree to remove or replace the implants, evidence from ultrasound should be sufficient. In the light of the advice from the Royal College of Radiologists, it would be unreasonable for the provider to insist on an MRI image.

Are silicone implants banned in the US?

Although there have been reports suggesting the US has banned silicone implants, this is not accurate. Silicone implants are currently approved and readily available for women who want them, although they must be enrolled into studies to collect data about the performance and safety of their implants.

Why can't I pay for a breast implant replacement as part of a combined operation in which the NHS pays for removal of the PIP implants?

At present, this would go against the guidance issued by the Department of Health in 2009. This sets out the rules for combining NHS and private treatment and makes clear that the NHS and private components of treatment should normally be carried out at a separate time and place.

Read more about combining NHS and private treatment.

Is it safe to have a mammogram with PIP implants?

During mammography, the breast has to be squeezed fairly tightly, which could theoretically cause a breast implant to leak or rupture. Also, scarring and calcium deposits around the implant may look like cancerous tissue and make the mammogram harder to interpret.

If you have PIP breast implants and need to have a mammogram, tell the technician when you arrange the appointment. You may need more views taken than during a typical screening.