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How safe are breast implants?

There has been a threefold increase over the past decade in the number of Irish women having surgery to enlarge their busts, but recent concerns about an implant used in many of them is a reminder that this is not a procedure to be undertaken lightly.

The controversy centres on concerns that the French manufacturer Poly Implant Prothese (PIP) switched to a non-approved silicone gel in its implants, and made changes to the outer casing which could increase the risk of leakage.

It is still unclear what the implications of these changes might be for the tens of thousands of women who have had PIP implants -- approved types of silicone are generally regarded as safe even in the event of leaks -- but they are worrying enough for authorities to suspend distribution, and to recall all stock.

The problem may have started as early as 2001 and, unless a woman knows for sure that she has not had a PIP implant since then, current advice is to contact her surgeon to find out.

If PIP implants were used then experts say there is no serious cause for alarm, but while further tests are being conducted into the gel, it suggests that women should have an ultrasound scan over the next six months to check for signs of weakening or rupture. If the scan reveals a problem then implants should be removed.

Despite a number of scares over the years about the safety of silicone implants, the latest generation are much more robust with rupture rates of 1pc or less after six years. But rupture is only one potential complication, and if my wife was considering surgery I would be more worried about other issues, such as infection, bleeding, poor cosmetic result and the need for revision.

In good hands the results of breast augmentation are generally very good. The key, as with all forms of surgery, is to choose a good surgeon. You generally get what you pay for and I don't know of a cosmetic surgeon at the top of his or her game who offers free consultations, zero interest loans, cheap operations abroad, two-for-one offers (it happens) and discount incentives for encouraging a friend to get something done.

The very best surgeons don't necessarily charge significantly more than their peers, indeed in some cases, they are actually cheaper.

But even the best surgeons can't halt the ravages of time and most women with implants will require some form of repeat surgery, even if they are happy with their initial result and their implants don't rupture or develop excessive scarring.

Gravity takes its toll on the breasts as women age, and what looks good on a 25-year-old woman can start to look a little strange on one in her 50s. So it pays to think of breast augmentation as a continuing process rather than a one-off operation.

My last caveat concerns the reasons behind wanting a bigger bust. Good surgeons will talk a patient out of unnecessary work and/or suggest a cooling off period for her to think about surgery. If your surgeon appears more interested in your credit card, or suggests other work while you are there, you are probably in the wrong place.

Assuming that you are happy with your decision, and you choose a good surgeon, you are likely to be thrilled with the results, but if you embark on a journey for the wrong reason -- such as pressure from a partner -- and get second-rate surgery, then you are likely to rue the day you took the plunge.