Written evidence from Association of Breast Surgery [BIP0004]

The Association of Breast Surgery is a member organisation and a charity. It is not a regulatory body. We do not monitor devices but when PIP implants were withdrawn from the UK in 2010, after they were found to be more prone to ruptures and silicon extravasation than any other implants (2-6 times), we advised members to recall patients who were known to have PIP implants, image the implants and discuss the pros and cons of removal.

Any patient who wished to have them out, and could not have this done through their private provider, were offered removal of the implants on the NHS. The implants would not be replaced on the NHS. As far as we are aware no patient would be denied access to removal of these PIP implants. The Breast and Cosmetic Implant registry was started in October 2016, and funding for the old implant registry was withdrawn in the early 2000s, so identifying the estimated 47,000 women was difficult. Little data was available on patients having implant surgery especially in the private sector. Explantation (removal of implants) is a surgical procedure that has a financial cost to the NHS but also impacts on capacity. It is an operation that carries a risk of an anaesthetic, bleeding, scarring, seroma (fluid in the implant cavity) formation and cosmetic dissatisfaction.

Many implants require changing or removing after 10 to 15 years because of complications. The expectation is that the vast majority of PIP implants, which have a higher risk of early failure, will already have been removed or exchanged by now.

As regards wider issues pertaining to breast implants, different types of cancers have been associated with breast implants including lymphomas (BIA-ALCL) and squamous cell carcinoma. Although the incidence is very uncommon, they are documented complications and patients should be counselled about them in the consent process. We advised surgeons to include the risks of BIA- ALCL in consenting in 2018. Information of risks for the procedure are included the ABS Guide to Breast Augmentation.

Breast implant illness syndrome (BIIS) is not recognised by WHO as a disease (due to the vague nature of the symptoms and no recognisable biochemical or pathological indicator) but there is increasing interest by patient groups. Patients may wish to discuss this with their surgeon prior to surgery. BIIS is not an indication for explantation in the NHS (https://ebi.aomrc.org.uk/interventions/breast-prosthesis-removal/)