General risks from breast implants and breast
augmentation
Leak or Rupture
The incidence of a leak in the implant or a rupture, either of which
would cause the implant to "deflate" and leave you with a flat breast, is also
significant. The implant itself is typically guaranteed for life by the
manufacturer. That means that in covered situations, the implants will be replaced
at no charge by the manufacturer. Keep in mind that you will still be responsible
for surgeon's and hospital fees as well as anesthesia. Each manufacturer has a
different policy but will typically contribute approx. $1,200.00 or $1,500.00 toward these
costs.
I have basically accepted the fact that my implants will have to be
replaced one or more times in my lifetime. I am 31 years old and it would be folly to
assume that they will last for 20, 30 or 40 years. Many of the horror stories that you
have read or will read on the Internet and elsewhere about leakage and rupture of implants
actually refer to older silicone implants. In any event, be prepared for the
possibility that a rupture could occur. Even if you have saline implants, which
makes the rupture less dramatic in its consequences, you must ask yourself if you are
ready for a second or third surgery?
According to the FDA, 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. Other
women may unknowingly experience a rupture without any symptoms (i.e., “silent
rupture”). Magnetic resonance imaging (MRI) with equipment specifically designed for
imaging the breast may be used for evaluating patients with suspected rupture or leakage
of their silicone gel-filled implant. Silicone gel may escape from the fibrotic capsule
around the implant, may migrate away from the breast, and may cause lumps called
granulomas to form in the breast, chest wall, armpit, arm, or abdomen. Plastic surgeons
usually recommend removal of the implant if it has ruptured, even if the silicone is still
enclosed within the scar tissue capsule, because the silicone gel may eventually leak into
surrounding tissues.
When saline-filled breast implants deflate, the saline solution
leaks either through an unsealed or damaged valve or through a break in the implant shell.
Implant deflation can occur immediately or progressively over a period of days, months, or
years and is noticed by loss of size or shape of the implant. Additional surgery is needed
to remove deflated implants.
Additional Surgery and
Removal Without Replacement
Women with breast implants may need additional surgery at some point
to replace or remove implant(s) due to problems such as deflation, capsular contracture,
infection, shifting, and calcium deposits. Women who do not have their implants replaced
may have cosmetically undesirable dimpling, puckering of the breast following removal of
the implant, or other unsatisfactory cosmetic outcomes.
The photographs above shows a woman one year after removal of
silicone gel-filled breast implants without replacement (from the FDA website).
The photographs above show another, more favorable implant
removal result.
Patients with large implants, particularly those inserted
subglandularly (on top of the muscle and under the breast glands), may have a major
cosmetic deformity if they choose not to replace them or to undergo additional
reconstructive surgery.
There are no reliable statistics on how likely it is that you will
lose sensation or experience changed (even increased) sensation, in your breasts or
nipples. Most of the studies concern mastectomy or reconstruction patients
where levels of trauma to the breast tissue are quite high. Nevertheless, every
doctor should tell you that the risk of diminished sensation, numbness or even extra
sensitivity is a risk.
According to my surgeon, placement below the muscle diminishes this
risk significantly because there is less chance of interfering with the tissue nearest the
skin, which causes sensation. After having my implants for about 9 months, I had
completely normal sensation. I experienced frequent nipple erection during the first few
months due to greater than usual sensitivity but, other than that, my sensation has been
unchanged. My nipples tend to be a little overactive to begin with. My cousins also have
said they had no sensation problems. You will note when you obtain your doctor's list of
risks and/or the manufacturer's insert, this is a listed risk. You can also expect a
change in sensation at least temporarily if you have a periaeriolar (nipple) incision.
Saline and silicone implants obscure the effective mammography of
breast tissue. If breast tissue with cancerous or potentially cancerous growth or tissue
change cannot be adequately detected due to the presence of an implant, this is obviously
a problem. Placement of implants below the muscle can reduce the amount of obscurity
caused by the implant.
Most plastic surgeons I have consulted on this issue don't find that
it is a significant problem. However, if you have or get saline or silicone implants, you
will, at a minimum, need to have special attention during mammography. A soy bean
oil implant was recently tested due to it not obstructing mammography. The soy
implant trials were discontinued when the risks created by the oil outweighed the
benefits. It does not appear that soy implants will be used in the near future here
or abroad.
