Risks of Breast Implants

• Risks of Breast Implants
• Implant Complications
• Additional Surgeries
• Removal
• Capsular Contracture
• Rupture/Deflation
  • Saline-Filled Implants
  • Silicone Gel-Filled Implants
• Connective Tissue Disease
• Breastfeeding
  • Effects on Children
• Things to Consider Before Getting Breast Implants (Available in text and PDF)

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Risks of Breast Implants

Some of the complications and adverse outcomes of breast implants include:

• Additional surgeries, with or without removal of the device
• Capsular contracture, scar tissue that forms around the implant and squeezes the implant
• Breast pain
• Changes in nipple and breast sensation
• Rupture with deflation of saline-filled implants
• Rupture with or without symptoms (silent rupture) of silicone gel-filled implants

 

Implant Complications

The following is a list of local complications and adverse outcomes that occur in at least 1 percent of breast implant patients at any time. You may need non-surgical treatments or additional surgeries to treat any of these, and you should discuss any complication and necessary treatment with your doctor. These complications are listed alphabetically, not in order of how often they occur. 

 

Complication	Description
Asymmetry	The breasts are uneven in appearance in terms of size, shape or breast level.
Breast Pain	Pain in the nipple or breast area
Breast Tissue Atrophy	Thinning and shrinking of the skin
Calcification/Calcium Deposits	Hard lumps under the skin around the implant.  These can be mistaken for cancer during mammography, resulting in additional surgery.
Capsular Contracture	Tightening of the tissue capsule around an implant, resulting in firmness or hardening of the breast and squeezing of the implant if severe.
Chest Wall Deformity	Chest wall or underlying rib cage appears deformed.
Deflation	Leakage of the saltwater (saline) solution from a saline-filled breast implant, often due to a valve leak or a tear or cut in the implant shell (rupture), with partial or complete collapse of the implant.
Delayed Wound Healing	Incision site fails to heal normally or takes longer to heal.
Extrusion	The skin breaks down and the implant appears through the skin.
Hematoma	Collection of blood near the surgical site.   May cause swelling, bruising and pain.  Hematomas usually occur soon after surgery, but can occur any time there is injury to the breast.  The body may absorb small hematomas, but large ones may require medical intervention, such as surgical draining.
Iatrogenic Injury/Damage	Injury or damage to tissue or implant as a result of implant surgery
Infection, including Toxic Shock Syndrome	Occurs when wounds are contaminated with microorganisms, such as bacteria or fungi.  Most infections resulting from surgery appear within a few days to a week, but infection is possible any time after surgery.  If an infection does not respond to antibiotics, the implant may need to be removed
Inflammation/Irritation	Response by the body to an infection or injury.  Demonstrated by redness, swelling, warmth, pain and or/loss of function.
Lymphedema or Lymphadenopathy	Swollen or enlarged lymph nodes
Malposition/Displacement	The implant is not in the correct position in the breast.  This can happen during surgery or afterwards if the implant moves or shifts from its original location.  Shifting can be caused by factors such as gravity, trauma or capsular contracture.
Necrosis	Dead skin or tissue around the breast.  Necrosis can be caused by infection, use of steroids in the surgical breast pocket, smoking, chemotherapy/radiation, and excessive heat or cold therapy.
Nipple/Breast Sensation Changes	An increase or decrease in the feeling in the nipple and/or breast.  Can vary in degree and may be temporary or permanent.  May affect sexual response or breast feeding.
Palpability	The implant can be felt through the skin.
Ptosis	Breast sagging that is usually the result of normal aging, pregnancy or weight loss.
Redness/Bruising	Bleeding at the time of surgery can cause the skin to change color. This is an expected symptom due to surgery, and is likely temporary.
Rupture	A tear or hole in the implant’s outer shell.
Seroma	Collection of fluid around the implant.  May cause swelling, pain and bruising.  The body may absorb small seromas.  Large ones will require a surgical drain.
Skin Rash	A rash on or around the breast.
Unsatisfactory Style/Size	Patient or doctor is not satisfied with the overall look based on the style or size of the implant used.
Visibility	The implant can be seen through the skin.
Wrinkling/Rippling	Wrinkling of the implant that can be felt or seen through the skin.

A complete list of complications, as well as information on rates for those complications can be found in the patient labeling for the approved breast implants, Labeling for Approved Breast Implants.

 

Additional Surgeries

Breast implants are not lifetime devices. The longer you have breast implants, the more likely it is that complications will occur and you will need to have them removed. There is no guarantee that you will have a satisfactory cosmetic outcome from any reoperation.

The type of surgical procedure performed during a reoperation depends on the complication involved. You may need to have one or more reoperations over the course of your life due to one complication or a combination of local complications. More than one procedure may be performed in a single reoperation. Types of surgical procedures that may be performed in a reoperation include:

• Implant removal, with or without replacement
• Capsule removal or surgical release of the scar tissue around the breast implant
• Scar or wound revision, such as surgical removal of excess scar tissue
• Drainage of a hematoma by inserting a needle or tube through the skin to drain the collection of blood
• Repositioning of the implant by surgically opening the incision and moving the implant
• Biopsy/cyst removal by inserting a needle through the skin or cutting through the skin to remove a lump.

 

Removal

Removal of the implant(s), with or without replacement, is one type of reoperation. As many as 20 percent of women who receive breast implants for augmentation have to have their implants removed within 8 to 10 years. You may need to have your implant removed at some time over the course of your life because of one or more local complications.

After removal, some women do not choose to replace their implants. These women may have cosmetically undesirable dimpling, puckering, or sagging of their natural breasts.

The photograph below shows a 29-year-old woman 1 year after having her silicone gel-filled breast implants removed, but not replaced. Women with large breast implants, especially those inserted under and within the breast glands but not on top of the chest muscles (subglandularly), may have major cosmetic deformity if they choose not to replace them or to undergo additional reconstructive surgery.
 

Photo courtesy of Walter Peters, Ph.D., M.D., F.R.C.S.C., University of Toronto.

Some insurance companies do not cover implant removal or implant replacement, even if the first implant surgery was covered.

 

Capsular Contracture

Capsular contracture is the hardening of the breast 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.

Capsular contracture may be more common following infection, hematoma and seroma. However, the cause of capsular contracture is not known.

There are four grades of capsular contracture, known as Baker grades.

 

Baker Grading Scale

Grade I	Breast is normally soft and looks natural
Grade II	Breast is a little firm but looks normal
Grade III	Breast is firm and looks abnormal
Grade IV	Breast is hard, painful, and looks abnormal

 

 

Grades III and IV capsular contracture are considered severe, and may require reoperation. The surgical procedure usually involves removal of the implant with or without replacement of the implant. There is a possibility that capsular contracture could occur again after surgery to correct it.

The picture below shows a Grade IV capsular contracture in the right breast of a 29-year- old woman 7 years after placement of silicone gel-filled breast implants.

 

Photo courtesy of Walter Peters, Ph.D., M.D., F.R.C.S.C., University of Toronto.

 

Rupture

Rupture is a tear or hole in the outer shell of the breast implant. When this occurs in a saline 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). The longer you have a breast implant, the greater the chance of implant rupture.

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.

Some possible causes of rupture of breast implants include:

• Capsular contracture
• Compression during a mammogram
• Damage by surgical instruments
• Damage during procedures to the breast, such as biopsies and fluid drainage
• Normal aging of the implant
• Overfilling or underfilling of saline-filled breast implants
• Physical stresses such as trauma or intense physical pressure
• Placement through a non-FDA approved incision site, for example the belly button
• Too much handling during surgery

 

Rupture and Deflation in Saline-Filled Breast Implants

The term rupture is used for all types of breast implants, but the term deflation is only used for saline-filled implants. You and/or your doctor will be able to tell if your saline-filled implant ruptures because the saline solution leaks into your body immediately or over several days. You will notice that your implant loses its original size or shape.

The following surgical procedures are not recommended for FDA-approved saline-filled breast implants because they are known to cause rupture and deflation:

• Closed capsulotomy - a technique used to relieve capsular contracture involving manually squeezing the breast to break the hard capsule
• Placement of drugs or other substances inside the implant other than sterile saline
• Any contact of the implant with Betadine, a povidone-iodine topical antiseptic made by Purdue Frederick Company
• Injection through the implant shell
• Alteration of the implant
• Stacking of the implants (more than one implant per breast pocket).

The photograph below shows a 30-year-old woman whose left saline-filled breast implant deflated. The implant is thought to have deflated due to a particular design, which is no longer used by the manufacturer.

 

Photo courtesy of Walter Peters, Ph.D., M.D., F.R.C.S.C., University of Toronto.

 

Rupture in Silicone Gel-Filled Implants

If your silicone gel-filled breast implant ruptures, it is not likely that you or your doctor will immediately notice. 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).

When a silicone gel-filled implant ruptures, a woman may notice a decrease in breast size, change in breast implant shape, hard lumps over the implant or chest area, an uneven appearance of the breasts, pain or tenderness, tingling, swelling, numbness, burning, or changes in sensation. Ruptures that show symptoms usually happen outside of the capsule. However, some ruptures are called “silent ruptures.”

A “silent rupture” doesn’t change the way an implant looks or feels to a woman because the rupture occurs within the capsule. Silent ruptures are not usually evident by a physical examination by a doctor. Magnetic resonance imaging (MRI) is the most effective method for detecting silent rupture of silicone gel-filled breast implants. The FDA recommends MRI at 3 years after implantation and every 2 years after that to screen for rupture.

Silicone gel that leaks outside the capsule surrounding the implant may travel (migrate) away from the breast. The leaked silicone gel may cause lumps to form in the breast or in other tissue, most often the chest wall, armpit or arm. It may be difficult or impossible to remove silicone gel that has traveled to other parts of the body.

 

Connective Tissue Disease

The FDA has not detected any association between silicone gel-filled breast implants and connective tissue disease, breast cancer, or reproductive problems. In order to rule out these and other rare complications, studies would need to be larger and longer than these conducted so far.

 

Breastfeeding

Some women who undergo breast augmentation can successfully breastfeed and some cannot. Women who undergo mastectomies and then have breast implant reconstruction surgeries may not be able to breastfeed on the affected side due to loss of breast tissue and the glands that produce milk.

 

Effects on Children

At this time, it is not known if a small amount of silicone may pass through from the breast implant silicone shell into breast milk during breastfeeding. Although there are currently no established methods for accurately detecting silicone levels in breast milk, a study measuring silicon (one component in silicone) levels did not indicate higher levels in breast milk from women with silicone gel-filled implants when compared to women without implants.

In addition, concerns have been raised regarding potential damaging effects on children born to mothers with implants. Two studies in humans have found no increased risk of birth defects in children born to mothers who have had breast implant surgery. Although low birth weight, was reported in a third study, other factors (for example, lower pre-pregnancy weight) may explain this finding.

 

Things to Consider Before Getting Breast Implants

There are several important things to consider before deciding to undergo breast implant surgery, including understanding your own expectations and reasons for having the surgery. Below are some things the FDA thinks you should consider before undergoing breast augmentation, reconstruction or revision surgery.

• 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 and implant removal. Other complications include rupture or deflation, wrinkling, asymmetry, scarring, pain, and infection at the incision site.
• You should assume that you will need to have additional surgeries (reoperations).
• Many of the changes to your breast following implantation may be cosmetically undesirable and irreversible.
• 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 breast implants, you will need to monitor your breasts for the rest of your life. If you notice any abnormal changes in your breasts, you will need to see a doctor promptly.
• If you have silicone gel-filled breast implants, you will need to undergo periodic MRI examinations in order to detect ruptures that do not cause symptoms (“silent ruptures”). For early detection of silent rupture, the FDA recommends 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.