Breast implants have some special risks that do not exist with most other plastic surgery procedures. This is because breast implants are “foreign objects” placed into the body, and the way a body reacts to an implant is not entirely predictable. Much of your body’s response to an implant depends on your individual healing characteristics and the quality of the surrounding tissue.
Treating implant complications is much more difficult than inserting implants for either augmentation or reconstruction. If you develop a problem with a breast implant, the cosmetic surgeon you choose makes all the difference.
The problems described below will be discussed in more detail during consultation with your surgeon.
Implant Failure
Like all manufactured products, breast implants will not last forever. Failure of an implant is the most serious complication associated with breast implant procedures. Women who choose breast augmentation or reconstruction must be willing to accept the risk that they will likely need to have an implant removed at some point in their lives because of rupture or deflation. When this happens, most women (but not all) choose to have the failed implant replaced with a new one.
Deflation of a saline implant is easy to notice because the breast becomes visibly smaller as the saline filler leaves the shell, to be harmlessly absorbed by the body within a day or two. Failure of a silicone gel implant is harder to detect because silicone gel is much thicker than saline and does not flow out of the implant shell as saline does. If the implant shell breaks, the silicone gel is more likely to gradually ooze out of the shell and into the capsule of tissue that surrounds all implants. There may be no noticeable change of breast size or contour at all, or the change may not be evident for years. Women with silicone gel breast implants must be extremely vigilant about seeing their plastic surgeon once a year to have their implants checked.
Implant Removal
Removal of a breast implant is called explantation. Explantation of ruptured silicone gel implants can be more complicated than removal of deflated saline implants because it is very important to look for and remove any free gel that may be in the breast area. In the vast majority of cases, explantation and re-insertion of a new implant are done in a single surgery that should not take more than 2 hours.
Explantation without getting a new implant can leave a breast deformity, and your breasts will probably not look as they did before you got implants. Your surgeon will describe the options available for treating the deformity.
Capsular Contracture
The most common complication with breast implants is capsular contracture. Every implanted device develops a capsule around it as part of the natural healing process. This capsule is essentially scar tissue that keeps the implant separated from the surrounding tissue. In some women, the capsule around a breast implant begins to tighten or contract, and what was originally a soft implant begins to feel hard and adopt an unnaturally rounded appearance. Severe capsular contracture causes some degree of breast deformity but can be treated in several ways. However, most treatments involve another surgery.
Infection or Extrusion
Occasionally an infection may affect the implant pocket, in which case the implant needs to be removed so the infection can be treated. A new implant can be inserted after a few months. The same is true if a breast implant extrudes, or passes through the skin. This very rare complication is more likely to occur in women who have very little breast tissue to begin with or receive very large implants.
Implant Displacement
Sometimes a breast implant may shift its position or become displaced, though this is rare. The type of implant and the quality of the tissue surrounding it influence whether an implant will shift. Some women are willing to live with this complication while others want it corrected surgically.
Breast Asymmetry
Another reason for needing additional surgery is asymmetry of implant size or position. No woman has perfectly symmetrical breasts, but few notice the asymmetry. When your breasts are enlarged, any pre-existing asymmetry may seem magnified. Your surgeon will explain your particular pre-existing asymmetry during your consultation so you will know in advance what to expect after surgery.
Change in Breast Sensation
A potential complication of breast implants that cannot be treated is a change in nipple sensation. The nipples may be oversensitive, undersensitive, or even numb. Small patches of numbness near the incisions may also occur. These symptoms usually disappear with time, but may be permanent in a small percentage of patients.
The Importance of Mammography
There is no evidence that breast implants will affect fertility, pregnancy, or the ability to nurse. They do, however, affect mammography because a breast implant makes it more difficult to see the tissue and therefore detect breast cancer. All women with breast implants should have their mammograms done at a facility with technicians who are experienced in the special techniques required to get a reliable x-ray of a breast with an implant.
Ultrasound examinations may be of benefit in some women with implants to evaluate an implant or breast lumps. The most reliable way to identify rupture of a silicone gel implant is magnetic resonance imaging, or MRI, and your surgeon may request an MRI if he suspects a rupture.
