Bubbles In Breast Implant Years After Surgery
There are symptoms and signs that may indicate problems associated with breast implants. However, one must always remember that majority of implant ruptures are picked up incidentally on ultrasounds and mammograms. On the other hand, some of the symptoms and signs mentioned below may not be due to the breast implant, but rather possible disease within the breast tissue itself.
Breast pain, breast discomfort, nipple sensitivity and soreness are not uncommon presenting complaints from patients with breast implants. Many attribute it directly to the implants but one must remember, idiopathic (unknown medical cause) breast and nipple pain is actually a very common phenomenon in women in general. If the discomfort is not associated with hardening, shifting or changes in the implant shape, a simple ultrasound or MRI can provide reassurance that the implant is intact, and may also allow detection of any abnormal breast tissue overlying the implant.
Breast lumps are often a concerning feature in patients with or without breast implants. In patients with old liquid silicone implants, pockets of silicones which has seeped into the breast tissue can form hard lumps. These can be detected and differentiated from breast cancer lumps via imaging techniques such as ultrasound, mammogram and MRI.
Change in breast shape or progressive asymmetry between the two breasts. Breast implants can move on the chest wall, or capsular contracture can push an implant upwards. This often occurs slowly overtime, thus can be difficult for some to notice. However, if you find that your bra sits crooked because your breasts are not at the same level, or if it doesn’t fit because one is sitting a little further into the armpit, then it may be time to see your doctor or a plastic surgeon. Don’t forget, sometimes pre-existing natural breast asymmetry can become more obvious after weight changes or even hormonal fluctuations such as pregnancies or menopause. This means, you may need a change in the size of your implants to correct the difference between the two sides.
Breast swelling is very rarely associated with breast implants. This can be associated with trauma to the chest wall (you may have bled around the implant), or it may be spontaneously with no precipitating event. The former requires urgent surgery, the latter requires further investigations into the cause of the swelling. Swelling can be due to fluid around the implant or infection. Swelling can sometimes be associated with abnormality in the breast tissue and need to be thoroughly assessed.
Breast skin or nipple discharge need to be taken seriously. If there are any discharge from an open sore on the breast or the nipple, please see your doctor. This could be implant-related or associated with diseases of the breast tissue or nipple, which may not necessarily be cancer.
Bubbles In Breast Implant Years After Surgery
Rippling is one of the potential complications of breast augmentation surgery. This side effect is called rippling because folds in breast implants become visible or can be felt to the touch. Therefore, looking or feeling like ripples beneath the skin.
What Causes Breast Implant Rippling?
It is estimated that rippling may affect up to 10% of individuals who undergo breast augmentation with implants. Not all cases are deemed severe enough to necessitate breast implant revision.
During breast implant surgery Dr. Shah inserts a saline or silicone shape beneath the skin, and usually also beneath muscle tissue. Common factors in the development of ripples include:
Insufficient Coverage From Soft Tissue
There are a few instances in which soft tissue coverage may be insufficient to adequately accommodate the selected implant. For example:
Rippling due to soft tissue coverage may not occur immediately. If a patient loses a substantial amount of weight, rippling may occur years after the initial implant placement. Pregnancy and breastfeeding may also prompt changes to soft tissue and, as a result, rippling.
Asymmetry Of Tethering
Breast implants somewhat integrate into the pocket where Dr. Shah places them. Regardless of the consistency of technique across numerous cases, the fact remains that all patients heal differently. In some instances, tissue can contract around the implant slightly as healing occurs, causing a tethering effect that pulls on superficial tissue in an unexpected manner.
The Matter Of Fill
Saline implants hold the potential for rippling in between the core and the outer shell. Silicone implants are not likely to do this because they are filled prior to insertion. Dr. Shah fills saline implants after inserting them into the pocket. This technique is performed as carefully as possible, yet there is still a degree of unpredictability that could lead to overfilling or underfilling, either of which can cause rippling.
The Solution To Rippling Is Revision
There are two standard approaches to correct breast implant rippling. In some cases, it may make sense to add volume around the implant. This may mean that Dr. Shah will have to remove and replace the existing implant with a smaller size, or different position beneath the pectoral muscle.
Rippling associated with over or underfilling of saline implants may be corrected by removing or adding content. Dr. Shah can typically perform this in the office under local anesthetic. Sometimes, patients with saline implants prefer to switch to a silicone structure.
breast surgery type
Breast surgery encompasses a wide array of procedures for the breasts. From enhancing the size to male breast reduction, these procedures are tailored to your individual needs and cosmetic goals. Our board-certified plastic surgeon offers the whole spectrum of breast surgery and can help you identify the best way to reach your desired results.
1. Breast Augmentation
Breast augmentation is the most popular plastic surgery in the United States. Hundreds of thousands of patients undergo this procedure each year, which is designed to increase the size of your breasts using breast implants. Dr. Bogue offers silicone, saline, and “gummy bear” implants and can help you determine which implant type will look most natural as well as size, placement, and incision site.
Dr. Bogue also provides breast implant revision for those who want to change the type of breast implant or alter the size and shape of their results. Breast explant, or breast implant removal, is another option for women who are unhappy with their results or have experienced complications such as pain, firmness, or implant rupture.
2. Breast Lift
Breast sagging has varying degrees and is based on nipple placement in relation to the crease beneath the breasts, as well as the direction of the nipple. A breast lift restores a perky, youthful bust by tightening excess skin, reshaping the breast gland, and repositioning the nipple. A breast lift can also address large areolas and may be combined with breast augmentation with implants.
3. Breast Reduction
Overly large breasts cause a host of issues ranging from chronic back, neck, and shoulder pain to skin irritation and an inability to perform specific exercises. A breast reduction alleviates these concerns by eliminating excess breast tissue and improving the size, shape, and position of the breasts. If you have asymmetrical breasts, a breast reduction can provide an even bust—this can also be achieved with breast augmentation.
4. Breast Reconstruction
Many breast cancer survivors struggle with their sense of femininity after a single or double mastectomy or a lumpectomy. Breast reconstruction is commonly performed to restore the breasts and a womanly figure. Women have several options for breast reconstruction, some of which can be done at the time of the mastectomy or lumpectomy—Implant-based breast reconstruction, autologous tissue breast reconstruction, and lumpectomy defect correction.
5. Male Breast Reduction for Gynecomastia
Men of all ages struggle with a condition known as gynecomastia, or enlarged male breasts. Gynecomastia is often caused by a hormonal imbalance of testosterone and estrogen. The overproduction of estrogen causes male breasts to swell. Enlarged breast tissue can be painful and embarrassing, but the condition typically goes away in young men and male children as they grow into adulthood. However, your genetics, medications, substance abuse, and weight gain can all play a part in gynecomastia. Dr. Bogue offers male breast reduction, which continues to grow in popularity as the stigma of plastic surgery decreases.
Breast Implant Through Nipple
An incredibly common question and concern among women who plan to undergo a breast enhancement surgery, determining which incision is right for you is nearly just as big of a decision as the procedure itself. The incision can affect everything from scarring and recovery to long-term results and even future breastfeeding opportunities.
To help you get a better understanding of each incision, as well as the procedure itself, we have put together a comprehensive guide on choosing the right incision for your breast augmentation surgery.
What is Breast Augmentation?
Firstly, what is breast augmentation? And what are its benefits? Breast augmentation is a plastic surgery procedure that uses breast implants (either silicone, or saline, or a combination of both) to increase a woman’s breast size, fullness, and elevation while artistically shaping the breast into a natural-looking, beautiful contour.
With the ability to help women achieve the breast size, shape, and contour they have always dreamed of, breast augmentation can help a woman feel more self-confident and secure in her own body.
Types of Breast Implants
Deciding on the type of breast implant you will receive is just as important as deciding the location of your breast augmentation incision. Why? Because the type of implant you choose directly influences the location of the incision.
Not to mention, implant type and shape affect the results you will see after surgery, which is why Dr. Sanders encourages you to learn as much as you can about breast implants. Below, he shares a quick overview on implants that should be helpful as you begin your research into the ideal breast augmentation incision for you, implant options, and more.
Silicone Breast Implants
Silicone implants are pre-filled with a silicone solution, which is meant to mimic the texture and feel of natural breasts. Many women prefer silicone implants because they offer a more realistic feel and appearance.
However, it is important to note silicone implants often require a slightly larger incision compared to saline implants and are only available to patients 22 and older.
Saline Breast Implants
Compared to silicone implants, saline implants offer the advantage of a smaller incision, as they are inserted into the breast and filled with a saline solution through a small tube.
Additionally, saline implants are available in several different sizes (width) and projections (the amount the implant pushes the breast forward), which makes it easy for a plastic surgeon to customize the implant to your unique needs and goals.
The “Ideal Implant”
In the September 2012 edition of the Aesthetic Surgery Journal, a new implant called the “IDEAL IMPLANT” was featured and quickly received lots of buzz. A unique type of implant, the Ideal Implants are structured saline implants designed to resist folding, wrinkling, sloshing, and collapsing when upright (which is a common flaw associated with traditional saline implants).
Like other saline implants, the Ideal Implant is filled with saltwater and housed in silicone. So what makes it different from traditional saline or silicone implants?
That would be the internal structure that compartmentalizes the saline, reducing folding and wrinkling and giving the breasts a more natural look and feel. Similar to saline implants, the Ideal Implant requires a smaller incision compared to silicone implants, as these implants are filled with a saline solution when inserted.
Breast Augmentation Incision Options
When planning your breast augmentation procedure, there are a number of important decisions to make, including incision location and which is ideal for your unique aesthetic goals.
Currently, there are 4 different breast augmentation incisions surgeons use to insert implants: inframammary incision (under the breast), transaxillary incision (through the armpit), periareolar incision (around the nipple), and trans-umbilical incision (through the belly button).
In the sections below, we will discuss the advantages and disadvantages of each incision, what factors to consider when making your incision decision, how each incision works for implant insertion, and the risks of each incision.
This information will better help you determine which breast augmentation incision is right for your specific anatomy and goals. Let us dive in and look at each incision type individually.
Under the Breast (Inframammary Incision)
The inframammary incision, otherwise known as the breast fold incision, is the most common (and likely the most popular) breast augmentation incision technique used in the United States. In fact, it was the original incision used for breast enhancement procedures and continues to be used as a go-to technique among many plastic surgeons.
Positioned under the breast where the lower part of the breast meets the chest wall, an inframammary incision makes it easy for an experienced plastic surgeon to insert either saline or silicone implants below or above the muscle, as well as find optimal placement for the most natural appearance.
signs of breast implant problems
Breast augmentation remains one of the most common and popular plastic surgery procedures performed in the U.S., and it has a low risk of complications – the most common being breast pain, changes in nipple and breast sensation, scar tissue formation, and rupture and deflation.
However, a small number of women experience a compilation of symptoms that has come to be known as breast implant illness, or BII. Though we are still learning about BII, and it is not a formal diagnosis, several new studies are investigating potential causes for the symptoms, which are wide-ranging and very real.
More than 100 symptoms have been associated with BII. Some of the most common include:
Breast implant illness has become more widely known in the last couple decades as patients have increasingly shared their stories on social media. In April 2022, retired race car driver Danica Patrick posted on Instagram about her struggles with BII and her decision to have her breast implants removed.
While it can be comforting to find a community of people with similar symptoms as you, unfortunately, sometimes these channels help spread misinformation or unnecessary fear.
Many patients with BII symptoms can find relief without having to remove their breast implants. In some cases, the cause of symptoms is an underlying condition that affects the immune system or hormone production.
If you develop unexplained symptoms that you suspect may stem from your breast implants, talk with a board certified plastic surgeon. We will listen to you and try to determine what the cause of your symptoms are and connect you with specialists if need be.
Determining the cause of your symptoms
Symptoms can occur with any type of breast implants and can start immediately after implantation or years later.
Because so many BII symptoms are associated with other conditions, it’s important to rule out causes unrelated to the breast implants. For example, many similar symptoms are associated with autoimmune conditions such as lupus, rheumatoid arthritis, scleroderma, and Lyme disease. Hypothyroidism, menopause, and fibromyalgia also can cause symptoms similar to those of BII.
Our goals in diagnosis are to determine the cause of your symptoms and to make a plan to resolve those issues at the source. In some women, the implants themselves prove to be the issue, such as if the implant or tissues surrounding it stiffen, or if the implant ruptures. For many more, an underlying condition is the culprit.
Diagnosis starts with a conversation about what triggers your symptoms and the extent to which they interfere with your quality of life. From there, we may refer you to a specialist in areas such as:
If the specialists find an underlying condition, unrelated to your breast implants, treatment for that condition should relieve or eliminate your symptoms. If no underlying conditions are found, we’ll discuss potential next steps, such as removing your implants.
Deciding whether to remove your breast implants
Choosing to remove your breast implants is just as big a decision as it was to get them, and yet more women made that decision in 2021 than in previous years. According to statistics from The Aesthetic Society, 148,000 women had implants removed and replaced (up 32% from 2020), and 71,000 had their implants removed and not replaced (up 47%), though it’s unclear what role if any BII played in the increase.
If you’re unhappy with the size or shape of your implants, or if you’ve developed a complication such as capsular contracture – the formation of hard, stiff scar tissue around the implant – the decision to remove them may reduce your symptoms.
But if you are satisfied with your appearance and your symptoms are systemic, rather than directly associated with the breasts, the decision can be more difficult. Even if BII symptoms resolve after implant removal, adjusting to changes in your appearance can be challenging.
Your plastic surgeon will discuss all options with you to help you make the best decision.
Clearing up common myths related to BII
There are many websites and social media groups dedicated to breast implant illness. And it’s not unusual for patients to tell us they read or saw something that worries them in one of these communities. We’d like to address a couple of the more common concerns.
Sagging skin after implant removal: There are a lot of people who post photos of themselves after having their implants removed. These photos are usually of women who had very large – 400cc or 500cc – implants removed, leaving excessive, sagging skin behind. Images like these can cause unnecessary anxiety.
Transferring fat to the breast from elsewhere in the body can help restore some volume after implant removal. Though your breasts likely will not be as full as they were with implants, this process can provide a pleasing appearance and a less dramatic transition.
“Only one right” way to remove implants: There are several methods to safely remove breast implants:
However, many social communities say that only specific procedures – notably en-bloc capsulectomy – will eliminate BII symptoms. This is untrue, and there are situations in which that procedure could cause more problems. For example, if the capsule is stuck to the chest wall, taking it all out could cause a pneumothorax, or air to leak into the space between the lungs and chest wall. In this case, we can take out most of the capsule and cauterize the patch that’s against the ribcage.
Additionally, removing the capsule and implant together (en-block) may require a longer incision, especially for women who have only had an augmentation and not a breast lift plus augmentation.
Current research and action related to BII
Research is under way to determine the degree to which certain symptoms are directly caused by breast implants and what effect, if any, removal has on those symptoms.
A study published in December 2021 found that the type of breast implant removal performed did not affect the reduction of breast implant illness symptoms.
Part two of this study investigated concerns, expressed on some BII websites, that the presence of heavy metals in silicone and saline breast implant capsules are a primary cause of systemic symptoms and health problems. More than 20 heavy metals were studied and some participants with BII symptoms had statistically higher levels of arsenic and zinc in their breast implant capsules compared with participants who didn’t exhibit BII symptoms. But the measured levels were all below what is considered acceptable exposure levels by regulatory agencies.
Also, the research confirmed that fewer heavy metals were detected in breast implant capsules than in breast tissue from patients who never had implants. Among participants with BII symptoms, there was a higher number of current or former smokers using tobacco and marijuana and a greater number of women with gluten allergies, suggesting that environmental exposure and personal choices related to cigarette smoking, marijuana use, tattoo pigments, and dietary sources may be the source of a BII patient’s exposure to heavy metals.
Based on this research, heavy metal toxicity should not sway a patient’s decision to remove her breast implants.
Finally, it’s important to note that a BII task force has been established within The Aesthetic Society to conduct research and follow new breast implant patients for more than 10 years in hopes of establishing more definitive data and finding more answers for patients and providers.
We understand it can be extremely frustrating to feel unwell without a specific diagnosis – especially after you’ve been through one or more major breast surgeries. Our breast plastic surgery and specialist teams work together, dedicated to providing you with evidence-based care that will get you to the ultimate goal of feeling better.
If you experience symptoms or complications that you suspect may be related to breast implants, call 214-645-8300 or request an appointment online.