Millions of women get breast implants to improve their body image or replace breast tissue after cancer surgery. In most cases, the outcome is fine. But some patients suffer problems from ruptured devices to a newly discovered, rare cancer. Here’s what can go wrong with breast implant surgery…
Many women think that cosmetic breast implants will change their lives, and often they do – sometimes in unexpected ways.
Beth McMurray knows that all too well. The 59-year-old psychotherapist from Birmingham, Ala., ended her love affair with her movie-star breasts after she suffered bouts of breast tenderness, an infection, fluid drainings and, finally, a deflated implant that shrunk her breast size from a C-cup to its original A.
“I have a lot of discomfort. I can’t raise my arm, it’s difficult to sleep, and I wake up in pain,” McMurray says. Her post-surgery problems began a decade after she underwent cosmetic breast augmentation. “Now, I wish I’d never done it.”
After-effects of breast implant surgery may include scar tissue, leakage, infection, cosmetic flaws, loss of nipple sensation and, in rare cases, cancer. About 22,000 implants were removed because of problems in 2010, according to the American Society of Plastic Surgeons (ASPS). But that hasn’t put a crimp in women’s desire for them. That same year, there were nearly 300,000 breast augmentation procedures, up 39% from 2000. About a third, or 93,000, were reconstructions for cancer patients.
Breast augmentation is a surgical procedure to increase breast size. Reconstruction surgery rebuilds a breast’s shape after a mastectomy. The two main types are: silicone breast implants, pre-filled with silicone gel that look and feel more like human tissue, and saline implants, filled with saline at the time of surgery. “Silicone is the implant of choice,” says Kristi Funk, M.D., a Los Angeles breast cancer surgeon and founder of the Pink Lotus Breast Center. “All you have is skin, muscle and implant, whereas saline sometimes ripples under muscle.”Some women also complain saline looks less natural than silicone implants.“Before undergoing breast implant surgery, it’s important to read a lot, talk to surgeons and be informed consumers,” says Samuel Poore, M.D., Ph.D., assistant professor in the Division of Plastic and Reconstructive Surgery at the University of Wisconsin-Madison. “Know about the risks, and make good choices based on sound data.” Here are 6 complications to watch out for: 1. Capsular contracture The most common problem, capsular contracture, occurs when scar tissue, or a “capsule,” forms around an implant and becomes so tight it causes pain. Scar tissue forms whenever implants are surgically placed under breast tissue of chest muscle.
About 25%-30% of patients with saline implants get capsular contracture within three years of breast implant surgery, according to a 2000 report by breast-implant manufacturers ordered by the Food & Drug Administration (FDA). In a 2009 report by Mentor Corporation, a top manufacturer, about 8% of first-time silicone augmentation patients had severe capsular contracture up to three years after surgery, and 19% of revised-augmentation patients had it within three years. With capsular contracture, implants usually have to be removed and replaced, “particularly if the breast is hard, painful and looks abnormal,” Poore says. “Don’t panic – have it evaluated.” 2. Rupture and deflation Yes, breast implants can rupture or deflate. This can happen during implantation or puncture by surgical instruments, but also from causes such as normal aging, biopsies or fluid drainage, even compression during a mammogram, though that’s rare. Saline implants can deflate right away or over a few days, like a balloon losing air, according to the FDA. Your body absorbs the liquid and it’s harmless, unless the implant contains fungus or bacteria, which can cause infection. “You go from having a breast, to not,” Funk says.
Silicone implant ruptures aren’t always as obvious, but signs may include hard knots or lumps around the implant or in the armpit, a change in size or shape, pain, tingling, swelling, numbness, burning or hardening of the breast. If you experience any of these symptoms, immediately see your doctor. He may recommend removing and replacing the implant. 3. Infection It’s not common, but some women end up with a serious infection within a few weeks of breast implant surgery. Implants – like most foreign objects – attract bacteria. Because the devices lack their own blood supply, they can’t fight infection, says Susan Downey, M.D., associate clinical professor of plastic surgery at the University of Southern California. Watch for symptoms like a fever and heat radiating from the breasts. Infection-fighting antibiotics are deployed first for treatment. If they don’t work, you’ll need to have the implants removed and replaced after recovering completely from the infection. 4. Cancer Breast implants may be associated with anaplastic large cell lymphoma (ALCL), according to new findings announced by the FDA in January 2011.
The cause of this rare immune-system cancer is unkown. It can show up anywhere in the body, not just in the breasts, according to the FDA. It’s diagnosed in about 1 out of 500,000 women in the U.S. each year, but occurs in the breast in only 3 out of 100 million women. Because it’s so rare, doctors say women shouldn’t rush to have their implants removed. “I would worry more about dying of a snake bite or a bee sting,” Funk says.Still, plastic surgeons warn women with implants to be aware of any changes to their breasts, Poore says. In most cases, the cancer was diagnosed when women sought medical attention for pain, asymmetry, swelling, hardening of the breast area around the implant, or masses surrounding it. They typically experienced these symptoms years after the surgery, the FDA reports. One theory is that silicone, which has been found in scar tissue cells around the implant, triggers growth of infection-killing T-cells, says William Maisel, M.D., the FDA’s chief scientist.Even intact implants may “sweat” silicone, and that may “chronically irritate the capsule and stimulate the lymph system,” Funk says. That allows cells to mutate, causing cancer, she explains. To be on the safe side, see your doctor if a lot of fluid accumulates around an implant, or you experience swelling and pain.
“Some of the fluid and part of the capsule should be sent to a pathologist for analysis,” says USC’s Downey. While more cases have been found in women with silicone implants than those with saline, the FDA hasn’t determined if they’re at higher risk – or if there’s a difference between breast augmentation and breast reconstruction. 5. Changes in nipple sensation In multiple studies during the last decade, 12%-35% of women lost nipple sensation within three years of breast implant surgery, according to a federal Institute of Medicine review of the research. If a surgeon cuts around the bottom half of the areola, the procedure may occasionally damage nerves and ducts – and, rarely, cause nipple necrosis, or death, resulting in the loss of the nipple. Smoking compounds this risk. Up to 9% of women reported heightened nipple sensitivity, improving sexual pleasure. That could be a psychological response to a woman’s improved self-esteem post-surgery, Downey says.
6. Implants get old Breast implants don’t last forever. The typical shelf life is 10-20 years, according to the ASPS. Gravity also takes a toll on augmented breasts, just like natural ones. “Sometime during your lifetime, [they] will have to be changed out, due to complications or dissatisfaction with how they look,” Downey says. “They almost all get replaced.” Some women must have multiple surgeries to improve their breasts’ appearance, reposition the implant, fix scars or wounds, drain pockets of blood known as hematomas (by inserting a needle or tube through the skin), or remove a ruptured or deflated implant. About 8% of women with saline breast implants have them removed within three years, and 12%-14% within 5 years, according to a review of past and ongoing studies by the Institute of Medicine. The removal rates for reconstruction patients were 23%-27% at three years and 28%-30% at five years. About 33% of silicone-gel patients had at least one re-operation in which one or both implants were removed or replaced, at an average of 11.5 years after the original procedure. And then there’s the cost. First-time cosmetic augmentation runs $4,000-$10,000, which includes each implant, anesthesia, the facility and the surgeon’s fee. You’ll pay more to have the procedure done in expensive areas such as Beverly Hills and New York City, and it’s not covered by insurance, even if something goes awry later.
Breast reconstruction costs about $2,800 for the implants; $3,400 for tissue expanders; $5,600 for a back-flap procedure (using tissue from the back to reconstruct the breast) or $7,000 for a TRAM-flap procedure (using muscle, fat and skin from the abdomen); $600 for a nipple tattoo (which recreates the color and shape with a microneedle); and $1,200 for nipple reconstruction, according to the American Society of Plastic and Reconstructive Surgeons. Insurance covers reconstructive surgery after a mastectomy – including an additional implant for the unaffected breast to make the two appear even, doctors say.Re-operations sometimes cost more than the originals, doctors say. But some women opt not to replace implants after removal, and they may face breast dimpling, puckering or sagging. How to care for your breast implantsIf you have breast implant surgery, here are some ways to safeguard your health:
- Monitor breasts. Report any changes to your breast surgeon or primary-care physician.
- Do monthly breast self-exams and get yearly physician-administered breast exams.
- Continue routine mammography screening. Women with both saline and silicone implants should get an extra, third view in addition to the usual vertical and horizontal views, Downey says. But don’t worry unnecessarily, she adds. Implants haven’t been found to cause, or delay the detection of, breast cancer in women.
- Get MRIs. Women with silicone gel-filled implants also should get magnetic resonance imaging (MRI) three years after surgery and every two years thereafter to keep an eye on possible ruptures and to detect breast cancer.
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