The decision to have a breast augmentation or breast reconstruction with implants is an extremely personal decision. We recommend you carefully consider the following when you make your decision.
A breast implant is a device used in plastic surgery to improve the aesthetics or the look of a patient through changing the size and shape of the breasts. When a plastic surgeon implants this medical device to enlarge the breast, this is called Breast Augmentation or augmentation mammoplasty
Reconstruction happens when the implants are used as a response to deformity or a breast mastectomy due to breast cancer, accident, or disease. Breast implant surgery procedures may also be used to give a patient with underdeveloped breasts a confidence boost through enhancing the shape and size of her breasts.
Two main types of implants are legally used in the US. They are silicone gel filled breast implants and saline filled implants. Please refer to our blog article here for more details on breast implants.
Breast implants are not lifetime devices. The implants themselves can have issues, and the appearance of the breasts after the initial augmentation will also change over time. Some associated risks of breast implant use in surgery include pain, rupture, capsular contracture, or even a very rare type of cancer (anaplastic large cell lymphoma (BIA-ALCL). And we will discuss these issues here.
A rupture happens when the implant's shell (silicone outer covering of the implant) suffers a tear. Ruptures occur for a number of reasons, and can occur with saline filled and silicone gel filled implants. The more usual reasons for a tear or hole in the outer silicone include:
Saline filled implants are typically easier to detect a rupture because they will simply deflate as the salt water is absorbed by the body. Deflated saline implants are noticeable since the implant will usually show a visible decrease in mass and size.
Ways to reduce the likelihood of your saline implants suffering a deflation:
● Use of any other material in the implant besides recommended injectable sterile saline.
● Placing more than one implant in any one breast pocket.
● Closed capsulotomy, which is a method to deal with capsular contracture, involves squeezing the implant very firmly with the aim of fracturing the scar tissue around the implant (the capsule).
For silicone gel filled implants (particularly of the newest generation), the patient won't know there has been a rupture as the majority of the silicone gel will stay in the implant pocket and the implant may not look or feel different. This is because when a rupture occurs in a silicone implant, the exiting liquid is usually trapped in the scar tissue that has formed about the implant. This is called a “silent rupture.” If gel is able to move past the scar tissue around the implant, this is called an extra capsular rupture. This may prove difficult, if not impossible to extract surgically.
A magnetic resonance imaging test is the most reliable way to check if there is a rupture in a silicone gel filled breast and is still the gold standard recommended by the FDA. This is because there will usually be no visible reduction or change in size, shape or firmness of a silicone gel filled implant if it ruptures. The FDA recommendation obtaining an MRI 3 years after implant placement and every 2 years after that, to check for silent implant rupture. However, this recommendation is currently being re-evaluated by the FDA and may switch to annual ultrasounds (which are less expensive than an MRI, likely in an effort to increase compliance with imaging).
Textured implants are implants that have a rough surface on the outside. One of the alleged benefits of the textured surface was that it elicited a more robust inflammatory response with more scar tissue formation and incorporation around the implant. This meant that the tissue gripped the implant well and would keep the implant in place better. This was especially important for "shaped", "anatomic" or "teardrop" implants in order to prevent them from rotating into an unnatural orientation. There is mounting evidence that having a textured surface to the implant may increase the risk of developing a rare type of cancer called anaplastic large cell lymphoma (BIA-ALCL). Allergan (one of the main implant manufacturers in the USA) have removed their implants from Europe and North America. As of this writing, Mentor and Sientra still offer a textured surface device.
Scar tissue usually will form around an implant, and this is called the capsule. Having some scar tissue around the implant is a good thing, in that it will help resist implant displacement. However, if the scar tissue hardens abnormally, and begins to squeeze the implant, this is called Capsular Contracture. This is thought to be caused by chronic inflammation around the implant with the most likely mechanism being bacteria contaminating the surface of the implant. The condition is generally classed into four grades, known as Baker grades. These are:
● Grade I: The breast appears to be soft, normal, and natural.
● Grade II: The breast appears to be normal still, but feels more firm.
● Grade III: The breast is hard and abnormal looking. The implant will ball-up and may contract higher on the chest wall.
● Grade IV: The breast is hard, abnormal in shape/appearance, and is now painful.
Out of these four, the last two, meaning grades 3 through four are the most bothersome, and is when patients will typically notice that something is not right. Surgery is still the best option for this condition, although there is still a risk for capsular contracture to come back even with a new implant.
As mentioned earlier, breast implants have a limited life span. This means that, even if no complications occur, patients may still desire surgery to correct cosmetic issues that occur over time. The exact procedure that needs to be done will depend on the nature of the problem. In some cases, more than a single procedure may be necessary to correct a problem. The most common implant revision surgeries are:
● Removal of the implant. This may or may not be subsequently replaced.
● Removal or release of the scar tissue around the implant (capsulotomy / capsulectomy).
● Changing the implant volume / shape.
● Changing the breast tissue over top of the implants (breast lift or breast reduction).
● Reinforcing implant position with mesh.
