Infection
Infection after a breast augmentation procedure is rare (less than 1%), but if infection develops around an implant it is difficult to treat with antibiotics alone, and sometimes the implant needs to be removed for the infection to settle. This can be very upsetting, it may require additional surgery, and it may be several months before the implant can be replaced. If infection were to occur, I would see you through this problem, and usually the hospital waives additional treatment costs as part of your package price.
Adverse Capsular Contracture
The normal healing response of the body after breast augmentation is to form a fibrous capsule around the implants. Over time, this capsule very gradually shrinks, which can cause the tissue around the implants to feel firm, and you may notice the breast implants change shape or that one breast might start to look different from the other. This is known as capsular contracture and it’s a normal process. Usually it is 10, 15, 20 years or even longer before this occurs, and this is often the reason for having the implants replaced at that stage.
However, in up to 10% of women this can occur earlier than 10 years. Some women therefore may require their implants replacing earlier than is normal, with release of the tight capsule. Plastic surgeons cannot accurately predict to whom this might happen, but recent developments in implant technology have reduced the chances of this problem developing.
Implant Rupture
A rupture is a split that occurs in the implant’s casing. Many years ago rupture of a breast implants was a common problem, because when implants were first developed they had very thin walls. The implant’s outer shell got weaker over time and thus rupture typically occurred 11-20 years after the original breast augmentation procedure.
Rupture is much less common nowadays because modern implants used in the UK since the 1990s are extremely robust, and some implants come with a guarantee against such a development. These modern implants have a firm gel consistency (similar to a set jelly) so even if an implant’s casing splits, the silicone gel inside tends not to leak out. The silicone is usually is contained within the normal fibrous capsule around the implant, so the silicone does not spread around the body in significant amounts. In the unlikely event that your implant ruptures it is recommended, but not mandatory, that you have it removed and replaced with a new one.
Silicone Safety
In the 1990s there were concerns raised by patients and doctors as to whether silicone was harmful to tissue. Some studies had suggested links between breast implants and certain health conditions – particularly in relation to autoimmune disease such as Rheumatoid arthritis. In 1998 a UK Independent Review Group analysed all these studies and did not find any adverse effects. Scientific studies have not convincingly demonstrated that breast implants are connected with any serious disease, and we therefore consider silicone implants to be safe to use in the body.
The alternative to silicone implants are saline (salt water) filled implants, but women and plastic surgeons prefer the look and feel of silicone implants. Silicone breast implants are generally considered to be more like real breast tissue. Saline implants are more prone to causing rippling of the skin and if the shell ruptures they deflate immediately. Therefore nearly all Plastic Surgeons in the UK recommend the use of silicone implants. The Department of Health continues to monitor all new research into the subject.
PIP Implants and Silimed Implants
PIP implants were a French manufactured implant that were withdrawn from the UK market in 2010 after they were found to not to be of the quality and standard we demand for medical products in the UK. They are not dangerous but used a sub-standard grade of silicone gel and they were prone to rupture.
I have never used PIP breast implants, but can offer advice and assistance if you have PIP implants and wish them removed and replaced. Research hasn’t found any evidence to suggest that PIP implants pose a serious health risk, and the implants don’t necessarily need to be removed unless they’ve ruptured, but naturally you may be anxious about leaving them in.
Silimed is a Brazilian manufacturer of implants, and in October 2015 products made by Silimed were suspended from use in Europe after particles were found on the surface of some implants (not breast implants) during a factory inspection. Concerns have therefore been raised about the current integrity of the manufacturing process, but there are no reports of any problems with Silimed implants that have previously been used.
I have never used Silimed implants but can advise you if you have any concerns. I only use the highest quality implants from leading breast implant manufacturers with long established safety and reliability profile.
Pregnancy and Breastfeeding
Breastfeeding is usually still possible after breast augmentation and there is no evidence to date that silicone is transferred into the breast milk.
Pregnancy does affect the size and appearance of breasts. After pregnancy, the skin may stretch and implants may not create the same appearance as before the pregnancy.
Breast Cancer
Breast implants do not cause breast cancer. There is no increase in risk of breast cancer in women who have implants. In fact, women who have breast implants actually tend to have lower risk of breast cancer, but this may just be a reflection that these women tend to have a smaller size bust and thus less breast tissue present.
Breast implants can however affect screening for breast cancer. In particular they may interfere with medical imaging (mammography) of the breast during screening for breast cancer. Implants can obscure the image of the breast in a mammogram, so special mammogram techniques and extra views are required to image the whole breast. In some cases other tests such as ultrasound or MRI may be required. Concerns have therefore been expressed that theoretically implants may interfere with the detection of breast cancer and could delay diagnosis. It is uncertain whether this has any real effect on breast cancer treatment or prognosis.
Anaplastic Large Cell Lymphoma (ALCL)
ALCL is an extremely rare form of blood cell cancer (T-call lymphoma, not breast cancer) occurring in the fibrous capsule around a breast implant. The best current evidence indicates there may be between 1 in 1000, to 1 in 30,000 risk of ALCL with breast implants. To date, there have been just 28 reported cases of ALCL in the UK, and 410 cases worldwide amongst the 5-10 million women who have received breast implants for cosmetic or reconstructive reasons.
The British Association of Plastic and Reconstructive Surgeons (BAPRAS) provides reassurance that ALCL is extremely rare and treatable (http://www.bapras.org.uk/professionals/clinical-guidance/alcl-risk-from-breast-implants). Treatment involves removal of the implant and the fibrous capsule, although some women may require additional treatment. ALCL in the capsule around an implant does not seem to be as serious as ALCL occurring elsewhere in the body and most patients with breast implant-associated ALCL have achieved complete remission.
The most recent scientific studies have not been able to confirm with any certainty whether any particular type of implant can create a higher or lower risk than another of developing the disease. All manufacturers of textured implants are represented. There have been no cases of ALCL with smooth (as opposed to textured) implants, but traditionally smooth implants were though to cause more capsular contracture. Therefore the UK Government’s Medicines and Healthcare products Regulatory Agency (MHRA) advises no change to current practice and that patients should be advised that ALCL is a very rare condition.
If a woman develops spontaneous swelling of one breast more than one year after the original breast augmentation procedure, and is found to have an accumulation of fluid around the breast implant (late seroma), a plastic surgeon will consider whether this is due to ALCL and investigate this accordingly. It is important to remember however that ALCL is extremely rare, most seromas are not ALCL and seroma is a normal finding in the first few weeks or months after breast augmentation.