Breast Implants – Potential Local Complications and Reoperations
From the U.S. Food And Drug Administration (FDA)
The most common local complications and adverse outcomes are:
- Capsular contracture (hardening of breast area around the implant)
- The need for additional surgeries
- Implant removal
- Rupture or deflation of the implant
Other local complications include implant wrinkling, asymmetry, scarring, pain and infection at the incision site. These local complications often result in reoperation or implant removal.
Potential Local Complications and Reoperations
The FDA website has a full list of local complications and adverse outcomes that occur in 1% or more of patients at any time after breast implant surgery.
But here are the most common local complications and adverse effects that occur with both silicone gel-filled and saline-filled breast implants.
Capsular contracture is the hardening of the breast area around the implant. It can occur in the tissue surrounding one or both implants. This hardening causes the tissue to tighten, which can be painful.
There are four grades of capsular contracture, known as Baker Grades:
||Breast is normally soft and looks natural
||Breast is a little firm but looks normal
||Breast is firm and looks abnormal
||Breast is hard, painful and looks abnormal
Grades III and IV capsular contracture are considered severe. They may require reoperation or implant removal. Capsular contracture, whether mild, moderate or severe, may occur more than once in the same implant.
The term "rupture" is used for silicone gel-filled and saline-filled breast implants. The term "deflation" is typically used only for saline-filled implants.
Rupture is a tear or hole in the outer shell of the breast implant. When this occurs in a saline-filled breast implant, it deflates, meaning the saltwater (saline) solution leaks from the shell.
Silicone gel is thicker than saline, so when a silicone gel-filled implant ruptures, the gel may remain in the shell or in the scar tissue that forms around the implant (intracapsular rupture).
Some breast implants rupture in the first few months after surgery and some after several years. Others may rupture after 10 or more years. Some possible causes of rupture include:
- normal aging of the implant
- damage by surgical instruments
- too much handling during surgery
- damage during procedures to the breast, such as biopsies and fluid drainage
- compression during a mammogram
- physical stresses to the breast, such as trauma or intense physical pressure
- capsular contracture
- overfilling or underfilling of saline-filled breast implants
- placement through a belly button (umbilical) incision site because it involves too much handling of the implant.
The FDA recommends removing both saline-filled and silicone gel-filled breast implants if they have ruptured. You and your doctor will need to decide whether or not your implant has ruptured and if you should have it replaced or removed without replacement.
When silicone gel-filled implants rupture, some women may notice decreased breast size, hard knots, uneven appearance of the breasts, pain or tenderness, tingling, swelling, numbness, burning or changes in sensation. However, most ruptures occur without any symptoms. These are known as "silent ruptures."
Magnetic Resonance Imaging (MRI) is the most effective way to detect silent rupture of a silicone gel-filled breast implant. The FDA and implant manufacturers recommend that women with silicone gel-filled breast implants undergo MRI screening three years after they receive a new implant and every two years after that for early detection of a silent rupture. The FDA recommends using MRI equipment that is specifically designed for imaging the breast for evaluating patients with suspected rupture or leakage of their silicone gel-filled implants.
Deflation occurs when the shell of a saline-filled breast implant tears or when the seal around the valve used to fill the implant is broken and liquid saline leaks out from the implant. When saline-filled breast implants deflate, loss of size or shape of the implant can be noticed immediately, or it may progress slowly over a period of days.
Breast implants are not lifetime devices. You may need to have one or more reoperations over the course of your life due to any one or combination of local complications. You may also need one or more reoperations to improve breast appearance if you are unsatisfied with the outcomes of the surgery aimed at correcting any local complications.
One type of reoperation involves the surgical removal of your implants, which may or may not include implant replacement. As many as 20% of women who receive breast implants for breast augmentation have to have their implant removed within 8-10 years. Over the course of your life, you may need to have your implant removed due to local complications. Many women have their implants replaced, but some women do not. Women who do not have their implants replaced may have cosmetically undesirable dimpling, puckering, or sagging of the natural breast following implant removal.
Key Points to Consider
- Breast implants are not lifetime devices; the longer you have your implants, the more likely it will be for you to have them removed.
- The longer you have breast implants, the more likely you are to experience local complications and adverse outcomes.
- The most common local complications and adverse outcomes are capsular contracture, reoperation, implant removal, and rupture or deflation of the implant. Other complications include wrinkling, asymmetry, scarring, pain, and infection at the incision site.
- You should assume that you will need to have additional surgeries (reoperations).
- If you have your implants removed but not replaced, you may experience changes to your natural breasts such as dimpling, puckering, wrinkling, breast tissue loss or other undesirable cosmetic changes.
- If you have silicone gel-filled breast implants, you will need to undergo periodic MRI examinations in order to detect ruptures of the implant that do not cause symptoms ("silent ruptures"). For early detection of silent rupture, the FDA and breast implant manufacturers recommend that women with silicone gel-filled breast implants receive MRI screenings 3 years after they receive a new implant and every 2 years after that. MRI screening for implant rupture is costly and may not be covered by your insurance.
If you have breast implants, you may have a very low but increased risk of developing a rare type of cancer called anaplastic large cell lymphoma (ALCL) in the breast tissue surrounding the implant. (ALCL is not breast cancer.) Women diagnosed with ALCL in the breast may need to be treated with surgery, chemotherapy and/or radiation therapy.