Breast implants

Introduction

Breast implants can be used for two purposes:

  • reconstructive – to reconstruct the breast mound following a mastectomy (the surgical removal of the breast)
  • cosmetic – to enhance the size and shape of the breast

Breast implants

Breast implants are prosthetic (artificial) implants. In the UK, two types of breast implants are commonly used:

  • silicone gel implants
  • saline (sterile salt water) implants

Most breast implants are made out of silicone rubber and each type has associated advantages and disadvantages. See Breast implants – Considerations for more information about the different types of implants available.

Silicone is a durable material that is available as a liquid, a gel or a solid form similar to plastic.

How common are breast implants?

In the UK, breast implant surgery is the most common cosmetic procedure to be carried out on women. Each year, an estimated 8,000 women have breast implant surgery, either to make their breasts larger or for reconstructive purposes.

Important decision

Having breast implant surgery is not something to be taken lightly. Your decision to have breast implants should be an informed one that takes into account the potential risks and side effects.

You should also have realistic expectations about the results of breast implant surgery so that you are not disappointed with the results. Find out about the procedure, the recovery period and any possible complications. Ask your GP or surgeon if you are unsure about anything.

Last updated: 05 January 2012

Complications of breast implants

After having breast implant surgery, about 30% of 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 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 a number of complications that are 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 will vary 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 that further surgery will be needed in the future.

There are three methods of reducing the tightness that is 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 that 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 that is caused by capsular contracture and to 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 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 (that 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 any problems. As saline is a sterile, salt water solution, your body is able to safely absorb it. However, if you have silicone implants, silicone that leaks out of a ruptured implant may cause problems, such as siliconomas or a gel bleed (see below).

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 armpit or around the nerves to your arm.

Gel bleed

A gel bleed is where tiny particles of silicone are released from the surface of a silicone breast implant. This can occur when the breast implant ruptures, or sometimes it can happen when there is no rupture.

If the silicone particles get into the lymphatic system (the network of vessels that help the body to fight infection), they can be transported to nearby lymph nodes (glands), such as those in the armpit. This may cause the lymph nodes to become slightly swollen. This is usually a minor problem, although in some cases the enlarged lymph nodes may become uncomfortable.

Scarring

After having 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 that 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 that they are painful. Increased sensitivity usually lasts for between three to six months.

If your nipples are very painful, speak to your GP or surgeon who will be able to give you advice about 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. But 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 once the infection has cleared up.

Some research suggests that 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 that 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 it is fairly common. In severe cases, further surgery may be needed in order 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 that 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 that the gel inside them is harmful. However, speak to your GP or surgeon if you have these gel implants and you are concerned.

For further information on PIP's silicone breast implants please see:

Last updated: 28 February 2013