Information about BIA-ALCL for people with Breast Implants

This advice has been written by the Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG) at the request of the Medicines and Healthcare products Regulatory Agency (MHRA – UK regulator). MHRA and PRASEAG continues to monitor new BIA-ALCL evidence and related issues and updates advice as required.

PRASEAG advice - click to read

The GOV.UK also has information and advice on BIA-ALCL




Know Your Breast Augmentation Options

Mr Hassan Shaaban, consultant plastic surgeon at Aset Hospital explains the myriad of options, types of breast implants, 
and breast augmentation surgery techniques - but what are YOUR options ?
Breast Implant Shapes
Breast enlargement  -breast implant shapes

Round implants or teardrop implants?

Teardrop implants (also known as shaped or anatomic implants) have a shape to mimic the appearance of a natural breast. It has a thin upper area that slopes gently into a more full, round base. However, they carry the risk of rotating in the breast pocket which can compromise the shape and symmetry of the breast and can lead to corrective surgery. Round implants are the most common breast implant shape, they are a compressed circular sphere that is completely symmetrical and there is no fear of rotation issues.

Ergonomix implants are the latest implant which are designed to follow a woman’s movements. They have a round shape when lying down and form a natural looking sloped shape when standing as the silicone settles at the bottom of the implant when standing.

Natural Looking Breast Implants – Motiva Ergonomix® | Motiva
breast implants should you choose smooth or textured impants

Smooth or Textured implants?

Smooth implants settle faster in the body and drop a bit more creating a natural hang. However, they slide more easily and more prone to migration due to lack of friction between the implant and the surrounding tissue. They also increase the risk of capsular contracture and rippling. Textured implants minimize scarring and decrease the risk of capsular contracture, they are more likely to stay in place due to the textured surfaces increasing friction between the implant and its surroundings. However, they are associated with a type of cancer called ALCL (A type of Lymphoma).

Information on ALCL

ALCL risk from breast implants | BAPRAS 

Breast implants and Anaplastic Large Cell Lymphoma (ALCL) - GOV.UK (

Ergonomix ‘advanced smooth’ implants.  They have a uniform, controlled nanosurface which gives the benefits of textured implants in reducing the risk of capsular contracture and like smooth implants it reduces the risk of ALCL.





breast implant materials saline or silicone what are the choices



Silicone or Saline?

The silicone implant is prefilled with silicone before implantation. It gives a more natural look and feel and is less likely to show through the skin. However, if the implant ruptures the silicone must be removed. Saline implants can be prefilled or filled with saline after insertion and adjusted which allows for a smaller incision and if they rupture the saline is absorbed harmlessly by the body. However, saline has the consistency of water which makes the implants harder and they may be visible through the skin.


where does the breast implant go under or over the muscle



 Under or over the muscle? Submuscular — the implant is placed partially or totally under the pectorialis major muscle.  This is good for women with little breast tissue of their own, the implant coverage by the muscle creates a more natural look and feel.  There is less chance of visible implant rippling and slightly less chance of capsular contracture.  However, recovery may be initially more uncomfortable and slightly longer. Also, the gap between the 2 implants (the cleavage area) may be wider as natural attachment of chest muscles limit placing the implants medially. The Sub glandular — the implant is placed on top of the muscle and over the gland.  This is a slightly easier surgical procedure with less discomfort and shorter recovery time.  Larger implants can also be used.  However, not recommended for women with little breast tissue and rippling may be more visible.


fat transfer natural breast enlargement


 Fat Transfer or implant?

Augmentation using fat transfer is when fat is taken from other parts of the body and placed into the breast  to create a natural feeling and looking breast. Not only do your breasts become bigger, but the area where you remove the fat from become smaller and there is no chance of capsular contracture. However, size is limited and women who are slim are not ideal candidates. There is also a risk of lumps and nodules in the breast. It is a more expensive procedure.  Breast implants produce a more predictable change in size, and the current silicone implants are safe and more natural feeling than ever.  Additionally, no further surgery is necessary on other parts of the body.  



Hybrid Breast Augmentation combines breast implants with fat transfer to the breasts.  It allows the surgeon to sculpt the breast shape to produce a more natural shape and minimises the trauma to the skin that is caused by large implants.  By using a smaller implant and then augmenting it with fat transfer you can achieve the same result with less damage.


Implant size?

It is important to know that breast implant sizes are NOT the same as bra cup sizes.  Implants are measured in volume.  It is important to consider the following when deciding the size of your implant:


Natural body shape and size – small frame/narrow chest will limit the size of implant you can safely and comfortably wear.

Shape and size of natural breasts 

The look you are after – Natural or dramatically full

If your current breasts are drooping – sometimes a larger implant can correct some drooping.

How much natural breast tissue you have – If you have very little breast tissue a smaller implant is better so that it is covered properly.

Lifestyle and physical activities you do – if you do lots of physical exercise large implants could make this more difficult and uncomfortable.


Do I need breast uplift with my implants?

For women who are also seeking fuller or larger breasts (but have droopy breasts), the combination of uplift and breast enlargement  is also available. The two procedures together can improve the size, shape and overall appearance of the breasts.

SEE - information on Breast uplift / Mastopexy surgery at Aset Hospital

Mr Shaaban discusses combined breast uplift with implants and asks "Where is the compromise"?





Larger implants can have a higher risk of complications


Ready to learn more about a Breast  Surgery? To request your consultation, visit or call our practice at  0151 426 4777Aset Hospital is based in Liverpool, Merseyside UK and serves  national and international clients.

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