Breast implants - Risks associated with breast implants

Like any type of operation, surgery to fit breast implants is associated with a number of complications.

These may be related to the operation itself, or they may occur later as a result of a problem with the implants.

In some cases, additional surgery may be needed to treat problems that develop.

General risks of surgery

All forms of surgery carry some degree of risk. Complications that can affect anyone who has surgery include:

an adverse reaction to the anaesthetic
excessive bleeding
infection
blood clots

There are also complications specifically associated with breast implant surgery. Some of these are discussed below.

Capsular contracture

After having a breast implant, your body will create a capsule of fibrous scar tissue around the implant as part of the healing process. This is a natural reaction that occurs when any foreign object is surgically implanted into the body.

Over time, the scar tissue will begin to shrink. This shrinkage is known as capsular contraction. The rate and extent at which the shrinkage occurs varies from person to person. In some people, the capsule can tighten and squeeze the implant, making the breast feel hard. You may also experience pain and discomfort.

Capsular contracture is an unavoidable complication of breast implant surgery. Everyone who has breast implants will experience capsular contracture to some degree and it is likely further surgery to resolve the problem will be needed in the future.

Rupture

A rupture is a split that occurs in the implant's casing. It can be caused if the implant's outer shell gets weaker over time, the implant is damaged during the operation, there is a flaw in the implant, or the breast is injured.

When implants were first developed, they had very thin walls and rupturing was a common problem. However, modern implants used in the UK since the 1990s rupture much less frequently.

If your implant ruptures, it is recommended you have it removed and replaced with a new one.

It is not always possible to tell if a breast implant has ruptured, but signs can include lumpiness, swelling, redness and tenderness in the breast.

If you have a saline (salt water) implant, any leakage from the implant should not cause you problems. As saline is a sterile salt-water solution, your body is able to safely absorb it.

If you have silicone implants, the silicone that leaks out of a ruptured implant may cause problems, such as siliconomas or a gel bleed.

If your implant was fitted privately, you may need to pay for any special investigations needed to confirm a suspected implant rupture.

Siliconomas

If you have a silicone breast implant that ruptures, the silicone may spread outside of the scar capsule and into your breast. This can lead to small lumps known as siliconomas developing.

Siliconomas can be tender to touch and they may need to be removed if they are causing significant pain. In rare cases, the silicone can spread to the muscles under your breast, your lymph nodes (glands) under your armpit, or around the nerves to your arm.

Gel bleed

Gel bleed occurs to some degree in all breast implants. It is where small molecules of silicone polymer separate from the surface of the implant and are taken up into the surrounding tissues or lymphatic system (the network of vessels that help the body fight infection found in several places around the body, including in the armpit).

If the silicone molecules get into the lymphatic system, they may cause your lymph nodes (glands) to become slightly swollen. This is usually a minor problem, although in some cases the enlarged lymph nodes can become uncomfortable.

Seroma

After having breast implant surgery, fluid can build up around your implant. This is known as a seroma and is fairly common. Further surgery may be needed to drain away the fluid in severe cases, but most seromas resolve without needing to be drained.

Scarring

After breast implant surgery, you will have some degree of scarring. In most cases the scarring is relatively mild.

However, in a few cases the scarring is more severe. For these women, their scars may be red, lumpy, thick or painful.

These symptoms should improve gradually and over time the scars will begin to fade. But in some cases it may take several years before there is a noticeable improvement.

Creasing and folds

Sometimes a breast implant can affect the appearance of the skin on your breast. For example, after your operation you may find your skin has creases, kinks, folds or ripples.

Creasing and folds tend to be more common in women who have very small breasts before having breast implant surgery.

Altered nipple sensation

After breast implant surgery, about one in seven women find their nipples are less sensitive or completely desensitised (have no sensation at all).

Alternatively, your nipples may be more sensitive after having breast implant surgery. Sometimes the nipples can become so sensitive they are painful. Increased sensitivity usually lasts for three to six months.

If your nipples are painful, speak to your GP or surgeon about it.

Breastfeeding problems

Having breast implants should not stop you breastfeeding, although some women will find they are not able to breastfeed after breast implants. You may also produce slightly less breast milk than you would without implants.

Your baby will not experience any side effects if you have implants and breastfeed.

Infection and bleeding

Infection and bleeding are relatively rare after breast implant surgery. However, if you are having an implant fitted for breast reconstruction after a mastectomy (breast removal), you may have a greater risk of infection and bleeding.

Most infections can be treated using antibiotics. But if your breast becomes severely infected, you may need to have the implant removed to prevent further complications developing. You should be able to have the implant reinserted after the infection has cleared up.

However, it is important the implant is not reinserted too soon, as this can increase the risk of infection. Waiting a few months after the implant was removed is usually recommended.

Some research suggests your risk of infection and bleeding may be increased if you smoke because your wounds will take longer to heal. Your surgeon may recommend not smoking before your operation to reduce the risk of developing complications.

Cancer

All types of breast implants are associated with a slightly increased risk of a very rare form of cancer called anaplastic large cell lymphoma (ALCL). However, it is not clear if the implants themselves directly cause this condition, and the overall risk is still extremely small.

In the US, figures from the National Cancer Institute state only around 1 in every 500,000 women is diagnosed with ALCL each year, and only around 3 in every 100 million are diagnosed with ALCL in the breast.

Breast cancer

There is strong scientific evidence to suggest having breast implants will not increase your risk of developing breast cancer, but it is still important for women with breast implants to attend breast screening appointments when invited.

Breast implants can affect breast screening as it may be more difficult to interpret the mammograms of women who have implants fitted. You should tell the healthcare professional taking the scan you have implants so they can ensure the best possible images are taken. Having a mammogram is unlikely to cause rupture of an implant unless it is already damaged.

If you have breast implants and develop breast cancer, your chances of making a full recovery will not be affected, but it is likely you would need to have your implants removed during the course of your treatment.

Silicone implant safety concerns

In recent years the safety of silicone breast implants has been debated. A small number of women have reported serious complications after silicone gel breast implant surgery. These complications include:

muscle spasms and pain
swollen and painful joints
rashes
changes in eye and saliva fluid
hair loss

It was thought these complications may have occurred as a result of silicone gel leakage that spread to other parts of the body.

In response to these concerns, the Department of Health set up an independent review group to investigate the safety of silicone implants. The group found no scientific evidence to support the relationship between silicone implants and illness in women.

However, in March 2010 the Medicines and Healthcare Products Regulatory Agency (MHRA) advised surgeons not to use certain implants produced by a company called Poly Implant Prothese (PIP). These implants are filled with a type of silicone gel that has not been approved.

As yet there is no evidence to suggest the gel inside them is harmful. However, speak to your GP or the clinic where the implants were fitted if you have these gel implants and have any concerns.