Since 2006, breast augmentation has been the top cosmetic surgical procedure in the United States, according to the American Society of Plastic Surgeons. Like all surgeries, however, its popularity does not mean that it comes without risk. That’s why it’s important to speak with a board-certified plastic surgeon about the risks of breast augmentation and your medical history to see which may be the right option for you. In today’s blog we will discuss some of the risks specifically associated with breast implants.
There are two types of breast implants approved for sale in the United States: saline-filled or silicone gel-filled. Saline implants consist of a silicone shell filled with a saltwater solution. Modern silicone implants are filled with a silicone gel while older implants were filled with liquid silicone. Both saline and silicone implants are FDA-approved. Importantly the FDA updated labeling for all implants in September 2020 to clarify that implants do not last a lifetime and should be removed or replaced every 10-12 years, depending on the specific implant.
When a breast implant is placed, it is normal for a scar to form around it. The scar is called a capsule. Occasionally the scar becomes problematic causing a capsular contracture or very tight or dense capsule. Since implants are foreign material without blood supply, the risks involved with breast implants may include infection and capsular leaks or ruptures. In this instance, the capsule may tighten and squeeze the breast implant, which can cause chronic pain or distortion in the shape of the breast, per BreastCancer.Org.
To evaluate your breast health and condition of silicone-filled breast implants for any ruptures, the FDA recommends that asymptomatic patients have an ultrasound or magnetic resonance imaging (MRI) at five to six years post surgery and every two to three years after that. With saline implants, rupture is more immediately noticeable as the breast will typically deflate visibly. Some of the other complications that the FDA reports include but are not limited to:
Expressing any concerns of complications to your plastic surgeon or doctor can help catch and resolve any problems in a timely manner to discuss any necessary treatment. If you develop pain, redness or swelling around your breast implant, you should notify your plastic surgeon immediately.
In addition to the known complications that have been associated with breast implants, the FDA recognizes “breast implant illness (BII)” to describe a group of symptoms potentially related to their implants. Symptoms include but are not limited to:
While researchers are continuing to investigate these symptoms to better understand their origins, the symptoms themselves and what causes them are poorly understood. Some patients have reported reverse symptoms of breast implant illness (BII) after removal of the implants without replacement, according to the FDA.
A separate clinical entity from breast implant-related illness (BII), breast implant-associated anaplastic large cell lymphoma or BIA-ALCL is a form of T-cell lymphoma that can develop following the placement of textured breast implants. It is a type of non-Hodgkin’s lymphoma (a cancer of the immune system), not of the breast tissue, and typically develops in the scar tissue and fluid around a breast implant, but in some cases may spread throughout the body.
Data has shown that the risk of BIA-ALCL is known to be higher for textured surface breast implants, which have a suede-like texture to help hold the implant in place tightly, versus the smooth surface commonly seen with implants. Certain textured implants have been recalled from the market and the FDA believes tissue expanders with certain textured surfaces may also be of concern and should not be used. Based on currently available data, the type of implant fill – whether it is silicone or saline – doesn’t appear to be a risk factor for BIA-ALCL.
Symptoms of BIA-ALCL may include: persistent swelling and presence of a mass or pain in the area of the breast implants. These symptoms may occur after the surgical incision is healed and often years after implant placement. If swelling is present, a doctor may obtain an ultrasound to look for fluid around the breast implant, which can be sent for study and help identify BIA-ALCL. It’s important that patients with breast implants keep and refer to the cards given to them by their surgeons at the time of original implant placement which detail implant information including: outside covering, filling, shape, manufacturer, year placed and serial number in case of a recall. While the decision of whether to remove a textured implant is complex, we encourage women to have a conversation about their options with a board certified plastic surgeon. Women who have a history of breast cancer or genetic predisposition to breast cancer who have textured implants in place should carefully discuss their options for removal or monitoring with their board certified plastic surgeon.
When it comes to your health, it’s important and necessary to be your own advocate. At our practice, we empower patients with knowledge of the most advanced options and research available, so that they can make the most-informed decisions for themselves. If you are interested in learning more about breast reconstruction and the safest, most advanced options available and suitable for your health, please contact our office. Our doctors, Dr. Elisabeth Potter and Dr. Michel Saint-Cyr are each specialized in microsurgery and breast reconstruction to offer patients the best options for them.
To learn more about BIA-ALCL, interviews with Dr. Elisabeth Potter can be viewed here.