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Complications of breast implants

NHS Choices Medical Reference

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After having breast implant surgery, about one in three women will require further surgery within 10 years of their initial operation.

Additional surgery may be needed as a result of complications such as capsular contracture (hardening of the scar capsule around the implant, see below), age-related changes to the breast (sagging) or the shell of the implant rupturing (splitting).

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
  • risk of infection
  • developing blood clots (where the blood thickens to form solid lumps)

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. The 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 will be needed in the future.

There are three methods of reducing the tightness caused by capsular contracture. These are:

  • closed capsulotomy
  • open capsulotomy
  • open capsulectomy

Closed capsulotomy

In a closed capsulotomy, the surgeon will try to tear the layer of scar tissue by squeezing the capsule. If successful, the tightness around the implant will be relieved and the implant will feel soft.

However, sometimes the scar tissue is so tough it cannot be torn, and there is also a risk of the implant rupturing (splitting). If the implant ruptures, further surgery will be required to replace it. A closed capsulotomy can also cause bleeding and bruising.

Due to the risk of further complications, a closed capsulotomy is not the preferred method of treatment for capsular contracture.

Open capsulotomy

The aim of an open capsulotomy is to relieve the tightness caused by capsular contracture and give the implant more room to move inside the breast pocket.

The procedure will be carried out under general anaesthetic and involves the surgeon making an incision (cut) into the breast pocket to remove the implant. They will then make a series of cuts in the scar tissue inside the breast to help relieve the tightness around the implant. The implant will then be re-inserted and the incision closed.

Open capsulectomy

An open capsulectomy is the most successful treatment for capsular contracture. As with an open capsulotomy, it is carried out under general anaesthetic and involves the surgeon removing the scar capsule completely. This allows the body to form a new capsule around the implant.

Rupture

A rupture is a split that occurs in the implant's casing. A rupture can be caused if:

  • the implant's shell (which holds the silicone or saline) gets weaker over time
  • the implant is damaged during the operation
  • there is a flaw in the implant
  • the breast is injured

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

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

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. However, if you have silicone implants, the silicone that leaks out of a ruptured implant may cause problems, such as siliconomas or a gel bleed (see below). You may be expected 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 developing that are known as siliconomas.

Siliconomas can be tender to touch and if they are causing significant pain they may need to be removed. 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, and has recently been a problem with PIP 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 and are 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.

Scarring

After breast implant surgery, you will have some degree of scarring. In most cases, the scarring is relatively mild. However, in approximately 1 in 20 women, the scarring is more severe. For these women, their scars may be:

  • red, or highly coloured
  • lumpy
  • thick 
  • painful

The symptoms of severe scarring should improve gradually, and over time the scars will begin to fade. However, 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 that your skin has:

  • creases
  • kinks 
  • folds
  • ripples

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

Nipple sensation

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

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

If your nipples are painful, speak to your GP or surgeon who will advise how to deal with it.

Infection and bleeding

Following breast implant surgery, infection and bleeding are relatively rare, occurring in less than 1% of cases. Internal bleeding is also unusual.

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

Most infections can be treated using antibiotics. However, 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 re-inserted after the infection has cleared up.

However, it is important that the implant is not re-inserted too soon, as this can increase the risk of infection. Waiting a minimum of three 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. The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) recommend you do not smoke before your operation in order to reduce the risk of developing complications.

Seroma

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

Silicone implant safety

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

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

It was thought these complications 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). The implants are filled with a type of silicone gel that has not been approved.

The non-approved silicone gel implants were manufactured between 2001 and 2009 and have the following model numbers:

  • IMGHC-TX
  • IMGHC-MX
  • IMGHC-LS

Tests are currently being carried out to determine whether there are any patient safety issues associated with these unauthorised implants. As yet there is no evidence to suggest the gel inside them is harmful. However, speak to your GP or surgeon if you have these gel implants and you are concerned.

See the MHRA's press release for more information regarding PIP's silicone breast implants.

Medical Review: July 01, 2012

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