Risks Of Breast Implant Replacement Surgery
Breast implants are generally safe, but they do come with some risk. Breast augmentation and breast lift surgery is performed to correct sagging breasts and improve the overall shape of the chest. In this guide, we review the Risks Of Breast Implant Replacement Surgery, long-term effects of breast implants, side effects of breast implants leaking, and symptoms of your body rejecting breast implants.
In this guide, we review the Risks Of Breast Implant Replacement Surgery, long term effects of breast implants, side effects of breast implants leaking, and symptoms of your body rejecting breast implants.
Risks Of Breast Implant Replacement Surgery
Breast implant replacement surgery is a common procedure, but it’s also one that can cause serious problems if not done right. If you’re considering a breast implant replacement, make sure to ask your doctor about the risks and complications that are associated with this surgery.
Nerve damage to the chest
Nerve damage to the chest is another risk for breast implant replacement surgery. Nerves can be damaged during breast implant replacement surgery, which can cause numbness or pain in your chest area. Symptoms may include:
- Pain when you touch your breasts or nipples
- Feeling like something is touching your skin but there is nothing there (paraesthesia)
- Temperature sensitivity of your skin on one side of your body (hemi-hypersensitivity)
If you experience any of these symptoms after having a breast augmentation procedure, it’s important that you tell your doctor immediately so they can diagnose what’s going on and treat it appropriately. To avoid nerve damage during breast implant replacement surgery, make sure that all equipment used by both surgeons is sterile before use and only use sterile materials when dressing wounds afterward. If possible, use an antibiotic cream such as bacitracin or Neosporin over open wounds until they heal completely; this will help prevent infection from developing under any bandages used during recovery time periods as well as reduce chances of developing infections later down road due to having open sores still exposed underneath dressings/bandages applied after initial procedures were completed
Chest muscle weakness
If you are considering breast implant replacement surgery, it’s important to know that there are some risks involved. One of these risks is chest muscle weakness.
Chest muscle weakness can be caused by nerve damage that results from the surgery itself or from other health issues related to aging or previous surgeries. This can result in a loss of strength in your chest wall and elasticity, as well as stability–all things that help keep your breasts up where they belong!
Pain after breast implant replacement surgery
You may experience pain after breast implant replacement surgery. This is normal and can be managed with painkillers. If you do not have access to painkillers, physical therapy can help you control the pain and reduce it by increasing blood flow in your chest area.
Pain reduction exercises include:
- Massage therapy
- Exercise
Asymmetry in the shape of your breasts
Asymmetrical breasts are a common complaint among women. The cause of this can be attributed to many factors, including weight gain or loss, pregnancy and breastfeeding. It’s important to remember that asymmetry can also be caused by breast implants that have shifted over time.
To determine if your asymmetry is due to the breast implants or the breast tissue itself:
- Look at yourself in front of the mirror with both arms raised above your head (like you’re stretching). Then look at yourself from behind while leaning forward slightly so that gravity pulls down on each side of your chest equally. If one side appears larger than another when viewed from these angles then it may be an implant problem rather than a breast tissue issue.*
Chest tissue loss
The first thing to know is that breast implant replacement surgery can cause tissue damage. This can lead to a loss of sensation in the breast, which means you may not feel pain when something is wrong. For example, if you have an infection or tumor developing under your implants, it may not be obvious because there’s no sensation that would tell you that something is wrong.
If this happens after only one surgery (and many women have had multiple surgeries), then it’s likely due to poor surgical technique or materials used during reconstruction by your doctor or surgeon. On the other hand, if this happens after several procedures–and especially if they were performed by different doctors–then there could be other factors involved such as scarring from previous surgeries and/or possibly even pre-existing conditions like diabetes mellitus type 2 (DM2).
Breast implant replacement surgery requires having a supportive doctor and taking time to heal.
The importance of finding a surgeon you trust
When you are looking for a surgeon, it is important to find one who will listen to your needs and concerns, as well as answer any questions that come up along the way. Ask your doctor about how many breast implant replacement surgeries they have done in their career, as well as how many times they have performed each specific procedure. This information can help give you peace of mind during this process and ensure that your surgeon has experience with what he or she is doing.
The right kind of doctor should also be able to explain exactly what type and size implants would be best suited for each patient’s body type and desired look after surgery is complete. It’s important not only for them but also for patients themselves so that there aren’t any surprises down the road when things don’t turn out exactly like expected!
long term effects of breast implants
The final guidance, Breast Implants – Certain Labeling Recommendations to Improve Patient Communication, provides recommendations concerning the content and format for certain labeling information for saline and silicone gel-filled breast implants, including:
The recommendations in this guidance supplement the recommendations in the FDA’s Saline, Silicone Gel, and Alternative Breast Implants guidance, issued September 29 , 2020 superseding the prior version dated November 17, 2006.
Some of the complications and adverse outcomes of breast implants include:
The following is a list of local complications and adverse outcomes that occur in at least 1 percent of breast implant patients at any time. You may need non-surgical treatments or additional surgeries to treat any of these, and you should discuss any complication and necessary treatment with your doctor. These complications are listed alphabetically, not in order of how often they occur.
A complete list of complications, as well as information on rates for those complications can be found in the patient labeling for the approved breast implants, Labeling for Approved Breast Implants.
Breast Implants are not considered lifetime devices. The longer people have them, the greater the chances are that they will develop complications, some of which will require more surgery. There is no guarantee that you will have a satisfactory cosmetic outcome from any reoperation.
The type of surgical procedure performed during a reoperation depends on the complication involved. You may need to have one or more reoperations over the course of your life due to one complication or a combination of local complications. More than one procedure may be performed in a single reoperation. Types of surgical procedures that may be performed in a reoperation include:
If you elect to have your breast implants removed, or if it is medically indicated, there are two primary methods for implant removal. Your plastic surgeon may choose to remove your implant alone and leave the scar tissue that surrounds your implant in your body, also called the scar capsule. This option requires less surgical dissection and may pose less risk of local complications such as bleeding. Alternatively, your surgeon may also surgically remove the scar capsule when your breast implant is removed. This is called “en-bloc resection”. You should discuss with your surgeon which method is best for your situation.
If you experience any symptoms of BIA-ALCL, such as persistent swelling or pain, or other changes in the area around your breast implant, talk to your surgeon or health care provider about the need for further evaluation. Evaluation for BIA-ALCL typically involves a physical exam, imaging, and/or assessment of the fluid or tissue around the breast implant. It is important to have an evaluation to diagnose BIA-ALCL because a confirmed BIA-ALCL diagnosis may change the type of operation that should be performed. Generally, patients with confirmed BIA-ALCL should undergo implant removal and removal of the surrounding scar capsule, which is a more extensive operation than implant removal alone. Talk to your surgeon about the method of removal most appropriate for you.
Removal of a breast implant, with or without replacement, is one type of reoperation. The life of breast implants varies by person and can’t be predicted. You may need to have your implant removed at some time over the course of your life because of one or more local complications.
After removal, some women do not choose to replace their implants. These women may have cosmetically undesirable dimpling, chest wall concavity, puckering, or sagging of their natural breasts.
The photograph below shows a 29-year-old woman 1 year after having her silicone gel-filled breast implants removed, but not replaced. Women with large breast implants, especially those inserted on top of the chest muscles (subglandularly), may have major cosmetic deformity if they choose not to replace them or to undergo additional reconstructive surgery.
Photo courtesy of Walter Peters, Ph.D., M.D., F.R.C.S.C., University of Toronto.
Some insurance companies do not cover implant removal or implant replacement, even if there are complications and even if the first implant surgery was covered.
Capsular contracture is the hardening of the breast around the implant. It can occur in the tissue surrounding one or both implants. This hardening causes the tissue to tighten, which can be painful.
Capsular contracture may be more common following infection, hematoma and seroma. However, the cause of capsular contracture is not known.
There are four grades of capsular contracture, known as Baker grades.
Grades III and IV capsular contracture are considered severe and may require reoperation. The surgical procedure usually involves removal of the implant with or without replacement of the implant. There is a possibility that capsular contracture could occur again after surgery to correct it.
The FDA has not cleared or approved any devices to treat or reduce the incidence of capsular contracture.
The picture below shows a Grade IV capsular contracture in the right breast of a 29-year-old woman 7 years after placement of silicone gel-filled breast implants.
Photo courtesy of Walter Peters, Ph.D., M.D., F.R.C.S.C., University of Toronto.
Rupture is a tear or hole in the outer shell of the breast implant.
Some possible causes of rupture of breast implants include:
The term rupture is used for all types of breast implants, but the term deflation is only used for saline-filled implants. You and/or your doctor will be able to tell if your saline-filled implant ruptures because the saline solution leaks into your body immediately or over several days and deflates the implant. You will notice that your implant loses its original size or shape.
The following surgical procedures are not recommended for FDA-approved saline-filled breast implants because they are known to cause rupture and deflation:
The photograph below shows a 30-year-old woman whose left saline-filled breast implant deflated. The implant is thought to have deflated due to a particular design, which is no longer used by the manufacturer.
Photo courtesy of Walter Peters, Ph.D., M.D., F.R.C.S.C., University of Toronto.
Silicone breast implants can rupture at any time after your implant surgery, but the longer an implant is in place, the greater the possibility an implant may rupture.
If a silicone gel-filled breast implant ruptures, it is not likely that you or your doctor will immediately notice because most silicone implant ruptures are without symptoms, “silent ruptures”. A silent rupture doesn’t change the way an implant looks or feels, and your surgeon or health care provider may not be able to detect a silent rupture by a physical examination alone. Magnetic resonance imaging (MRI) is the most effective method for detecting silent rupture of silicone gel-filled breast implants.
However, occasionally when a silicone gel-filled implant ruptures, a woman may notice a decrease in breast size, change in breast implant shape, hard lumps over the implant or chest area, an uneven appearance of the breasts, pain or tenderness, tingling, swelling, numbness, burning, or changes in sensation.
Generally, when silicone gel-filled implants rupture, the silicone gel escapes through a tear or hole in the implant shell but remains confined within the scar tissue capsule around the implant, called an intra-capsular rupture. If the gel migrates beyond the scar tissue around the breast implant, it is called an extracapsular rupture. Sometimes, after a rupture, the gel may move to other distant areas around the body, which is called extracapsular rupture with gel migration. It may be difficult to remove silicone gel after a rupture.
Connective Tissue Disease, Breast Cancer, and Reproductive Problems
The FDA has not detected any association between silicone gel-filled breast implants and connective tissue disease, breast cancer, or reproductive problems. However, the FDA has received reports of systemic symptoms (see below) by some patients with both saline and silicone gel-filled breast implants. In order to fully understand these complications, studies would need to be larger and longer than those conducted so far.
Symptoms such as fatigue, memory loss, rash, “brain fog,” and joint pain may be associated with breast implants. Some patients may use the term “breast implant illness” (BII) to describe these symptoms. Researchers are investigating these symptoms to better understand their origins. These symptoms and what causes them are poorly understood. In some cases, removal of the breast implants without replacement is reported to reverse symptoms of breast implant illness.
We encourage patients to report any injury, adverse event, or symptom related to a medical device, including the symptoms listed above, to the FDA by phone at 1-800-FDA-1088 or online at MedWatch, the FDA Safety Information and Adverse Event Reporting program. Please include the following information:
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a T-cell lymphoma that can develop following breast implants. For additional information, see: Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).
Understanding Patients’ Preferences
Patients’ voices, preferences and perspectives are critical to understanding the impact medical devices have on their conditions and their quality of life. The FDA’s Center for Devices and Radiological Health (CDRH) announced plans to study how patients weigh the benefits and risks associated with smooth and textured breast implants including the risk of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), which appears more often in patients with textured breast implants.
In September 2020, CDRH contracted with Research Triangle Institute (RTI) International to conduct this study. To ensure the study prioritized the needs and experiences of patients, CDRH and RTI designed the survey tool based on input from focus groups made up of patients considering, or having had, breast reconstruction or augmentation using breast implants, as well as input from health care providers.
CDRH expects the survey results will help assess whether patients’ perception of risks of BIA-ALCL associated with textured breast implants are influenced by information about potential benefits of textured breast implants.
The insights gained through this patient-centered approach will help incorporate patient preferences in CDRH’s regulatory decision-making. CDRH is working to publish the results of this study in a peer-reviewed publication. We will continue to update the public when more information is available.
Some women who undergo breast augmentation can successfully breastfeed and some cannot. Women who undergo mastectomies and then have breast implant reconstruction surgeries may not be able to breastfeed on the affected side due to loss of breast tissue and the glands that produce milk.
At this time, it is not known if a small amount of silicone may pass through from the breast implant silicone shell into breast milk during breastfeeding. Although there are currently no established methods for accurately detecting silicone levels in breast milk, a study measuring silicon (one component in silicone) levels did not indicate higher levels in breast milk from women with silicone gel-filled implants when compared to women without implants.
In addition, concerns have been raised regarding potential damaging effects on children born to mothers with implants. Two studies in humans have found no increased risk of birth defects in children born to mothers who have had breast implant surgery. Although low birth weight was reported in a third study, other factors (for example, lower pre-pregnancy weight) may explain this finding.
side effects of breast implants leaking
Breast implants are one of most common cosmetic surgeries performed every year. They can make a huge difference in a person’s self-confidence and satisfaction with their looks. However, these procedures carry risks, and anyone interested should take time to consider the possible consequences.
Breast implant ruptures do happen and are serious, but the good news is that they can usually be detected and addressed before they cause any serious complications. If you have questions about what happens when a breast implant ruptures, a board certified plastic surgeon such as Dr. Steele can help guide you through your options.
Why do Breast Implants Rupture?
The implants used for breast augmentation are not designed to last forever. Dr. Steele advises his patients that most women will require a secondary breast implant surgery within 10-20 years after placement of their implants. The FDA recommends periodic screening with MRI to detect silent or occult implant rupture. While uncommon, breast implants may rupture after suffering severe physical trauma like a car accident. The most common reason for implant rupture is a breakdown of the outer silicone shell over time.
Signs of Breast Insert Failure
Saline implants have a silicone outer shell that can puncture and a valve that could fail or cause leakage. It is usually evident when a saline breast implant ruptures because the body quickly absorbs the saltwater. When this happens, the breast will rapidly deflate and become noticeably smaller.
Silicone breast implant ruptures are often harder to detect. Modern silicone implants like gummy bear inserts are highly cohesive and rarely ever breach the scar capsule that surrounds the implant. Symptoms of a ruptured silicone implant develop gradually over time. Examples of common side effects include pain, swelling, or changes in breast shape that may indicate a capsular contracture.
However, some silicone ruptures are referred to as “silent” because they show no symptoms. For this reason, the Federal Drug Administration (FDA) recommends that people with silicone implants get regularly tested by MRI to screen for occult implant rupture. If a prospective patient wants more information about common signs of breast implant rupture, Dr. Steele can help provide reassurance and answers.
Risks from Implant Breakage
There are no systemic risks with a breast implant rupture. With a saline implant, the body simply absorbs the saline, and the silicone shell stays inside the scar capsule that naturally forms around any foreign device. With a silicone implant rupture, the highly cohesive silicone almost always stays within the capsule. This may cause tightening of the scar capsule which is known as capsular contracture. Typical symptoms include pain, malposition of the implant, firmness of the breast, and a change in breast shape. While rare, extracapsular spread of silicone into the breast tissue may cause palpable nodules in the breast with the possibility of swollen lymph nodes in the axilla/arm pit. It is recommended that the implant and scar capsule be removed (through capsulectomy) with the possibility of placing new implants.
Learn More about what to do when a Breast Implant Ruptures
If you are worried about what happens when a breast implant ruptures, the best thing you can do is talk to a plastic surgeon who has experience dealing with these issues. In most situations, a surgeon will remove the scar capsule and rupture implants, while replacing them with new silicone gel filled implants.
symptoms of your body rejecting breast implants
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.
A breakthrough in breast reconstruction at UTSW
When Renee Mallonee found out she was BRCA2 positive and her lifetime risk of breast cancer was high, she took the news very seriously. After 15 years of screenings and tests every six months, in 2020 she turned to UT Southwestern and became the first patient in the United States to receive a single port robotic nipple-sparing mastectomy.