Receiving breast implants following a mastectomy is a popular breast reconstruction option that works for a variety of body types and women. However, it is not without its risks. Recent studies have reported that around one in three women experience post-surgical complications after having breast implants following a mastectomy, and that one in five women require surgery again after the initial procedure. Additional studies have found that close to 50 percent of women who received silicone gel implants for breast reconstruction must undergo another surgery within around two to three years.
For these reasons, it is important for you to make an educated choice on the best reconstructive procedure for your body type. We aim to provide you with additional information so that you can go forth with the procedure of your choice with as much information as possible.
General Surgery Risks
Since breast implants are a surgical procedure, there are a few common risks associated with all surgeries and all types of surgical reconstruction. These risks include blood clots, infections, and excessive bleeding. Additionally, there is some risk that the body will have an adverse reaction to anaesthesia. As stated, these risks, while rare and generally carefully prepared for and controlled by modern medicine, are associated with all types of surgery and are not exclusively limited to breast implant procedures.
Local Implant Complications
There are additionally a handful of risks and complications associated with breast implants specifically. Many of these occur within around three to six months after the implants are in place. Such complications include breast pain, asymmetry, hematoma, extrusion, and lymphedema. However, the most common complications are capsular contracture, rupture, and deflation.
Many believe that the capsular contracture is a more common complication among breast implant patients than hematoma and infection. Capsular contracture affects the tissue surrounding the implants, causing it to become hard and painful. This may occur in one or both implants.
The specific cause of capsular contracture is unknown, meaning there is no way of preventing it at this time, though certain types of implants, such as the “gummy bear” implants have been shown to have a lower rate of capsular contraction. The process starts when the body builds up scar tissue around the implant as a part of its natural reaction to a foreign object. Over time, the scar tissue thickens. Some women experience this thickening faster and in larger amounts than others, resulting in the hardened feel of the implant.
Currently, the severity of capsular contracture is split into four grades. With Grade I capsular contracture, the breast still appears normal and has a normal softness to it. Grade II finds the breast slightly firmer, but the natural look continues to stay. Surgery is not normally needed for Grade I or II capsular contracture. However, Grade III and Grade IV are considered to be more severe complications and reoperation is often needed to correct the issue. Breasts in Grade III look abnormal and are firm, while those in Grade IV appear abnormal and are painful and hard to touch.
Rupture and Deflation
With both saline and silicone implants, there is a risk that the implant will rupture. This occurs when the outer shell of the implant is torn. Several things can cause this to happen, including damage from surgical instruments, capsular contracture, mammogram compression, and overfilling of the implant. Ruptures may also occur over time. Some women experience ruptures within a few months, while others do not have implant rupture even after several years. Regardless of the implant type, a ruptured implant should be removed to avoid any sort of physical complications resulting from the leak.
Deflation is most often seen with saline implants because the saline solution used to fill them is thinner than silicone and can move out of the opening easier. Changes in the shape and size of a ruptured saline implant is visible within a few days, making it easier to spot a rupture. Because saline is a natural substance found within the body, the body will likewise simply reabsorb any leaked saline.
Silicone implants, on the other hand, are filled with a thicker silicone gel making them less likely to rapidly deflate. However, when silicone leaks from ruptured implants, it can travel to other parts of the body, resulting in small lumps, also called siliconomas. When a silicone implant breaks, women may experience tenderness, swelling, or numbness in the affected breast, along with decreased size and an uneven appearance. Due to the less obvious nature of silicone ruptures, and their increased likelihood of causing other complications, many women undergo regular MRIs to detect any problems early on.
Beyond the main complications of ruptures and capsular contracture, there are several other complications that women may experience.
- For some women, breast implants change the look of the skin on the breast and create various ripples, creasing, and folds. This problem is most often seen among women with small breast sizes.
- Although scarring is normal following breast implant surgery, there have been some cases where women experience severe scarring around the breasts. Thankfully, these scars often disappear over time.
- Roughly one in seven women experience a decrease in sensation in their nipples following breast implant surgery. Some women may also experience an increase in sensitivity or even pain, though this often subsides after around three to six months.
All types of breast implants will likely require a reoperation at some point. Local complications may result in reoperation being more regular for some women than others, but most women will need to have another surgery at least once or twice during their lifetimes.
There are several different procedures that may require reoperation, including surgically removing scar tissue, repositioning an implant, draining a hematoma, or completing a biopsy. Often times reoperation is not needed until some time after the initial procedure, but women who are unhappy with the cosmetic results of the first procedure may opt for reoperation sooner to get the look they want.
Removal and Replacement
Removal is required in roughly 20 percent of women with breast implants within the first 10 years of having the implants. It is normally needed when women experience some sort of local complication, but women can also opt to have their implants removed later on if they want them to be.
When removing an implant due to complications, women can decide whether they want the implant replaced or left out. Leaving implants out may cause the breast to appear saggy or dimpled. The cosmetic changes resulted from removing an implant vary depending on the size of the breasts and where the implants were placed.
Anaplastic Large Cell Lymphoma (ALCL)
Recently, there have been several reports connecting breast implants to anaplastic large cell lymphoma, or ALCL. This is a rare type of lymphoma and only around 60 cases have been reported to the FDA. Among women who have implants and ALCL, the lymphoma is discovered within the fibrous capsule formed by the body when the implant was inserted and it is normally diagnosed after the women already received medical treatment for such implant-related symptoms as swelling and pain. Most cases are treated through the surgical removal of the scar tissue and the implants. Currently, the indicated risk of women with breast implants developing ALCL is relatively low; however, it is still a point of consideration.
Opting for breast implants for reconstruction is not an inherently dangerous decision, but it is important that you consider the possible complications, along with your own personal expectations and desires, during the decision process.
Although many women do not experience a large number of implant-related complications, the longer you have breast implants, the greater the risk of developing certain problems like capsular contracture is. Thankfully, many of these complications can be corrected through surgery.