Addressing the safety concerns behind breast implants

Breast implants are an increasingly common surgical option chosen by patients around the world, and while the reasons for choosing breast implants varies from patient to patient, the importance of researching and understanding the procedure is vital in every case.

 

Today we’ll look at the types of breast implants available to New Zealand patients, and discuss some of the potential risks of these devices which every patient should be aware of.

 

What are breast implants made from?

There are two types of breast implant approved for use in New Zealand: saline and silicone.

Saline and silicone breast implants both have an outer silicone shell, however they differ in the filler material and subsequent consistency:

• Saline breast implants

Saline implants are filled with sterile salt water. These are actually uncommonly used in New Zealand

• Silicone breast implants

Silicone implants are filled with a thick, viscous silicone gel to closely mimic the feel of human fat. Silicone implants are most popular with women as patients believe the consistency of the implant creates a more natural look and feel to the breast tissue.

Implants also come with different surface textures, smooth or textured, which lend them different properties. Finally, they can have different shapes; round or tear-drop(Anatomical).

 

What problems can occur after placement of an implant?

 

Rupture:

The shells of breast implants have a relatively small failure rate, however if an implant ruptures – i.e. bursts there is general agreement the implant should be replaced

 

How to identify a ruptured saline implant

 If a saline breast implant ruptures, the saline filler within the implant will leak, causing the implant to deflate and the affected breast to shrink changing in both size and shape.

While this rare occurrence can be a worrying time for patients, most people will absorb the leaking saline solution without health risks.

 

How to identify a ruptured silicone implant

A silicone breast implant rupture may be much harder to detect. A silent rupture can occur in silicone implants, where the filler remains contained within the fibrous tissue (capsule) that forms around the implant. Any changes in feel or shape can be very subtle.

Although leaking silicone gel isn’t thought to cause serious health problems, a ruptured breast implant can cause breast pain, thickening or hardening of the scar tissue around the implant, or changes to the contour or shape of the area.

If silicon manages to leak outside of the capsule, there is more likelihood of signs or symptoms such as:

• Softening or hardening of the breast.
• Pain, swelling, numbness or redness in the affected breast.
• Knots or hard lumps surrounding the implant.
• Change in size or shape of the breast.
• Inflamed armpit lymph nodes

Should you experience the above symptoms following your procedure, it’s recommended that you contact your surgeon immediately to discuss your concerns.

 

Capsular Contracture:

 Capsular contracture is a thickening and tightening of scar tissue that normally forms around the implant. As the scar tissue tightens, it can squeeze the implant and cause pain and hardening of the breast. This may correspond with a change in shape of the breast. Textured surface implants have been shown to have a lower risk of developing capsular contracture, hence their increased popularity over smooth implants in recent times. If capsular contracture is significant the only solution is revision surgery with removal of the capsule.

 

Rotation or Displacement:

Rotation or spinning of an implant can occur within the surgical pocket it is placed in. This is not an issue with a round implant which is the same shape in all directions. Anatomical implants however have a correct orientation and can distort the breast shape if they rotate. This is another reason implants have textured surfaces as these tend to “stick” more in position especially when a stable capsule has formed.

 

Infection:

 A breast implant is a foreign material inside living tissue. If an infection occurs and bacteria lodge themselves on or coat an implant it can be virtually impossible to eradicate with antibiotics as they wont cross from the well vascularized tissues to the inert foreign material. Because of this many precautions are taken during implant surgery to minimize the risks of infection. The risks are low (around 2%) however if infection becomes established the implant often needs to be removed. Any signs of infection need to be reported to your plastic surgeon immediately.

 

Breast Implant Associated Anaplastic Large Cell Lymphoma BIA-ALCL:

This is a rare condition but has been increasingly reported over the last few years and has had media coverage worldwide. Lymphoma is a malignancy of the white blood cells and this particular type has been identified occurring in the capsule around breast implants. BIA-ALCL has been identified in patients having had both cosmetic implant surgery and brest reconstruction after mastectomy. To this point it has only been found in patients who have at some point had a textured implant but been reported in many different types of texturing. As alluded to above there are sound reasons for the use of textured implants in certain settings. Because it is difficult to identify everybody who has actually received breast implants and because the disease tends to occur after a many year delay it is hard to put an exact incidence on to the rate of BIA-ALCL. Even scientific estimates vary from 1in 3000 to 1in 60,000. (To put it into perspective the lifetime risk of breast cancer is 1 in 9).

 

How does BIA-ALCL present?

• Most often patients may notice a sudden swelling of the breast with fluid (seroma) around the implant many years (7-14) after it was placed
• Less commonly a lump close to the implant or in the armpit could develop
• This can be associated with hardness or lumpiness of the tissue around the implant

 

As with everything regarding breast implant surgery an open and frank discussion with your plastic surgeon is vital to understand risks as they pertain to you and your choice of breast implants.

More information is available

• https://plasticsurgery.org.nz/consumer-information/issues/breast-implant-associated-anaplastic-large-cell-lymphoma-alcl-faqs/
• https://www.tga.gov.au/breast-implant-associated-cancer-or-bia-alcl

 

At Bisson Plastic Surgery, we strive to educate and inform all patients on their chosen procedure before undergoing surgery. If you are considering breast implants and would like to know more about the options available and discuss your expectations with our plastic surgeon, contact Bisson Plastic Surgery today.