Management of Breast Implants

Breast implants are medical devices made of silicone or saline-filled shells surgically implanted under the breast tissue or chest muscles to increase the size, shape, and fullness of a person's natural breasts for cosmetic or reconstructive purposes. They may also improve breast symmetry, restore breast volume lost after pregnancy or weight loss, or reconstruct breasts after mastectomy or injury. Breast implants come in various sizes, shapes, and textures.

What problems can occur after the insertion of breast implants?

Surgery or surgical devices carry risk, and breast implants are no exception. From the day of insertion of their breast implants, patients are at risk of a wide range of complications. Some are not considered serious, while others require more complex interventions to treat them.

These are some of the examples of possible complications:

• Capsular contracture:
  This is secondary to forming a tight capsule around the implant which can cause pain and breast deformity.
• Device malposition:
  This occurs when the implants move from their original position. It can cause pain and discomfort for the patient and affect the cosmetic outcome.
• Implant rupture:
  Occurs when the shell of the implant breaks. In saline implants, the fluid inside the implant will be absorbed, resulting in volume loss and deflation of augmented breasts.  The problem with silicone implants is more complex and depends on the type of rupture; silicon might leave the pocket and spread into the surrounding tissue.

What surgical options are available for complications of breast implants?

• Removal of breast implants without reshaping of the breasts
  • This process is suitable for women who wish to have their breast implants removed and are not worried about their breast shape post-removal.
• Removal and replacement of breast implants
  • The purpose of this method is to solely replace outdated implants with newer ones. It is important to note that the new implants also have a limited lifespan and will require attention in the future.
• Removal of breast implants and reshaping of the breasts
  • This procedure allows women to achieve a natural enhancement of their breast shape while also being implant-free.
• Replacement of implants combined with reshaping of the breasts
  • The technique used involves both replacing and reshaping the breast implants to improve their appearance and address issues with older ones. However, it’s important to keep in mind that the newer implants will also have a limited lifespan and may require attention in the future.
• Maintaining old breast implants and reshaping the breasts
  • This option is ideal for individuals who wish to retain their previous implants while addressing sagging breast tissue above them.
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Can breast implants cause breast cancer?

Breast implants cannot cause the usual breast cancer arising from mammary ducts. However, textured breast implants can cause a rare type of cancer originating from lymphatic cells, not breast duct tissue. It is known as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare T cell non-Hodgkin lymphoma.  This is not an immediate complication of implant surgery and, on average, takes 7-10   years after inserting a textured breast implant.

What is the clinical presentation of BIA-ALCL?

BIA-AlCL presents as an ongoing fluid accumulation around the implant, causing pain and swelling. Less commonly, patients may notice a lump in the breast or armpit, fever, skin rash and weight loss.

What is the treatment of BIA-ALCL?

BIA-ALCL is a curable disease if diagnosed early and treated appropriately in a multidisciplinary setting.

It includes total capsulectomy and removal of breast implants which will be enough in the early stage of the disease. In patients with more advanced disease, chemotherapy and infrequently radiotherapy might be indicated.

Do I need to remove my textured breast implant due to the risk of BIA-ALCL?

As BIA-ALCL is quite rare disease, routine prophylactic removal of breast implants is not recommended. Patients should be aware of the small risk and make their decision about management of their breast implant in conjunction with their health practitioner.

It is highly recommended that patients conduct:

• Regular self-examinations
• 12 monthly surveillances with a health practitioner
• Regular breast screening for women aged 50-75

Please note: Previous augmentation is not a contraindication for a screening mammogram!

What is breast implant illness?

Breast implant illness is a term used to cover a broad range of symptoms in women who underwent breast implant surgery for augmentation or reconstruction regardless of the type of the implant.  Symptoms include but are not limited to chronic fatigue, joint and muscle pain, anxiety, depression and gastrointestinal problems.

The evidence for diagnosis, classification and management is limited at this stage but some women report significant improvement of their symptoms after explanation surgery. 

For patients who had breast implants surgery in the past and are complaining of non-specific symptoms; if other causes for their symptoms have been ruled out, breast implant illness should be considered. Removing of implant with total capsulectomy might help relieve their symptoms.

How can I best prepare myself for my consultation?

Your doctor will ask questions about your breast implants, ideally patients will have the following details about their implants:

• Brand
• Contents: silicone/saline
• Shape: round/anatomic
• Surface: smooth/textured
• Contact of your original surgeon if you are unsure of the details

If you have a card with details of your implant, we suggest you bring it with you for the consultation.