A “boob job” is the number-one cosmetic procedure in the UK and far more is now on offer, as Joani Walsh reports
It has been more than 20 years since Pamela Anderson’s surgically enhanced embonpoint bounced across our television screens in Baywatch, introducing a global peak-time audience to the potential allure of globe-like peaks.
These were so unnaturally round and perky that they may as well have had the price tag still hanging from the nipples.
But while Pammy’s mammaries signalled a boom in busts – breast augmentation is the most popular cosmetic procedure performed in the UK – British women have roundly rejected obviously augmented orbs in favour of a more natural look.
The teardrop or “anatomical” implant that reflects the curve of the natural breast, with more volume below the nipple than above, is the bestselling shape in Britain for Silimed, the world’s third largest producer, and makes up half of sales and rising for Mentor, the second biggest supplier in the UK.
And a conical shape is now also available that is particularly suited to women whose natural breasts may no longer be as robust as they once were. “It helps lift as well as fill out the breast and may therefore save the need for mastopexy or breast uplift surgery,’ says consultant plastic surgeon Jonathan Staiano. “I only started using it a year ago, yet it already makes up 10 per cent of procedures.”
It’s not just the shape of implants that have improved, there is now such an enormous selection of sizes, materials, textures, and levels of pertness and “squidginess” that it is possible to create a designer decollete or build your own boob job as women take control of their bodies.
It is a trend being marketed by at least one manufacturer, GC Aesthetics, with factories in the UK and France producing 600 combinations of implant which, it claims, offers women a “couture” approach to breast enhancement. For the first time, along with Mentor and its 750-strong range, GC’s marketing is also being directly targeted towards women instead of just their surgeons.
“While not decrying the anguish caused to so many women, the furore over PIP ultimately did the industry a favour,” says Mr Staiano of the 2012 scandal in which French manufacturer Poly Implant Prosthese was found to have used industrial, rather than medical-grade, silicone with twice the rupture rate of approved devices, affecting potentially 300,000 women worldwide.
It is possible to create a designer decollete or build your own boob job as women take control of their bodies
“Not only has it lead to improvements in safety procedures, it has also meant women have become more rigorous in their research and far more involved in their procedures.” Breast augmentation subsequently increased by 13 per cent last year after a 1.6 per cent dip in the immediate aftermath, according to figures from the British Association of Aesthetic Plastic Surgeons (BAAPS).
“And it’s no longer just about the surgeon,” Mr Staiano continues. “I’ve had patients come to their consultation with not only the name of the manufacturer, but the style of their desired implant. Even just five years ago, a surgeon would simply ask a patient what size they wanted to be. It’s now far more about the shape.
“My patients are split into two groups: those who’ve had children or lost weight, and those who have always had smaller breasts and want to look in proportion. The woman who just wants to be big breasted is, in my experience, rare. It’s more important for her to look natural.”
Peter Cranstone, managing director of Eurosurgical, the British distributor for Brazilian Silimed, agrees. “There’s a new perception regarding breast enhancement surgery because of a demographic trend that’s towards restoration rather than augmentation – mothers in the post-35 age group, for instance, who just want back what they originally had,” he says.
That new or restored shape will generally now be determined by the projection: how far the breast will stand out from the chest wall, with some implants available in five projections from low to ultra-high.
The most popular in the UK, according to GC Aesthetics, are high, with more fullness towards the top of the breast, while Swedes like them low, which look more like a natural breast. The French head for middle ground, while 51 per cent of Brazilians, and 95 per cent of Columbians and Vietnamese aim extra high, although it may be partly because that shape has the additional benefit of filling out an “empty” breast particularly well, says Mr Cranstone.
Then there’s viscosity: the squidginess factor. All implants now used in the UK are “cohesive”, meaning the silicone gel inside remains “form stable” and doesn’t run if the shell ruptures and are therefore safer than previous models.
They’re consequently firmer, but with different consistencies of gel available and with the possibility of under-filling the shell for a softer feel, although this has to be balanced against increased risk of visible rippling of the shell beneath the skin and possible rupture.
The shells themselves are made from silicone, but some surgeons prefer a polyurethane layer on top which, although it makes implants slightly more difficult to insert and remove, carries less risk of capsular contracture whereby scar tissue forms around the implant and causes hardening. But this has to be weighed against a study that showed polyurethane appeared to increase incidence of cancer in rats.
Contracture occurs in 4.5 per cent of cases within ten years, according to BAAPS, although the US Food and Drug Administration records it as 20 per cent. Contracture is the primary reason for implants needing to be replaced. It is also why the UK’s National Institute for Health and Care Excellence (NICE) recommends that all implants are routinely removed at ten years.
“But I tell my patients they don’t have to have their implants removed unless and until there is a problem, such as contracture, or the breast has naturally started to drop with age or after pregnancy,” says plastic surgeon Jacqueline Lewis, pointing out the weight of implants may actually increase the impact of gravity.
“If they want to wait, they should have an ultrasound at regular periods to ensure the implants are intact because a silent rupture can occur without presenting any signs or necessarily any problems as the gel is now less likely to migrate,” she says. “But I’ve seen patients whose implants are still in place 25 years after insertion.”
The positioning of the implant is also important in achieving a natural-looking result. Placing it between breast tissue and the muscle means it sits more naturally. However, thinner women without much subcutaneous tissue can also benefit from the extra layer of cover when the implant goes behind the muscle. “The procedure is likely to hurt and bleed more, though,” Mr Staiano warns.
And pain is not to be underestimated. Nearly all those questioned in an international survey undertaken by Mentor of women who’d had breast implants commented on the “extreme” pain of their procedures.
“It’s why women becoming more involved in their procedures is such a positive move,” says Mr Staiano. “Because those who end up most pleased with the results are generally those with the most realistic expectations and who know what to expect. Breast augmentation may seem like an instant solution to what, for some women, may have been a life-long problem. But it carries risk. So I cannot emphasise enough – do your research.”