Management of Breast Implants
What are the indications of breast implants?
Although breast implants are used more commonly for breast augmentations, they can also be used to reconstruct the breast after mastectomy.
What problems can occur after the insertion of breast implants?
Any surgeries or surgical devices carries 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
- Removal and replacement of breast implants
- Removal of breast implants and reshaping of the breasts
- Replacement of implants combined with reshaping of the breasts
- Maintaining of old breast implants and reshaping of the breasts
Can breast implant cause breast cancer?
Breast implants cannot cause the usual type of breast cancer arising from mammary ducts. However, textured breast implants can cause a rare type of cancer originating from lymphatic cells and not breast duct tissue. It is known as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which is a rare T cell non- Hodgkin lymphoma. This is not an immediate complication of implant surgery and, on average, takes 7-10 years after the insertion of 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:
- 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.