Potential Breast Implant Complications
Author: Dave Stringham
Breast implants deflate when the saline solution leaks either through an unsealed or damaged valve or through a break in the implant shell. Implant deflation can occur immediately or slowly over a period of days and is noticed by loss of size or shape of your breast. Some breast implants deflate (or rupture) in the first few months after being implanted and some deflate after several years.
Causes of deflation include damage by surgical instruments during surgery, overfilling or underfilling of the breast implant with saline solution, capsular contracture, closed capsulotomy, stresses such as trauma or intense physical manipulation, excessive compression during mammographic imaging, umbilical incision placement, and unknown/unexplained reasons. You should also be aware that the breast implant may wear out over time and deflate/rupture. Deflated breast implants require additional surgery to remove and to possibly replace the breast implant.
The scar tissue or capsule that normally forms around the breast implant may tighten and squeeze the breast implant and is called capsular contracture. Capsular contracture may be more common following infection, hematoma, and seroma. It is also more common with subglandular placement (behind the mammary gland and on top of the chest). Symptoms range from mild firmness and mild discomfort to severe pain, distorted shape, palpability of the breast implant, and/or movement of the breast implant. Additional surgery is needed in cases where pain and/or firmness is severe.
This surgery ranges from removal of the breast implant capsule tissue to removal and possibly replacement of the breast implant itself. Capsular contracture may happen again after these additional surgeries.
Pain of varying intensity and duration may occur and persist following breast implant surgery. In addition, improper size, placement, surgical technique, or capsular contracture may result in pain associated with nerve entrapment or interference with muscle motion. You should tell your surgeon about severe pain.
You should know that there is a high chance that you will need to have additional surgery at some point to replace or remove the breast implant. Also, problems such as deflation, capsular contracture, infection, shifting, and calcium deposits can require removal of the breast implants. Many women decide to have the breast implants replaced, but some women do not. If you choose not to, you may have cosmetically unacceptable dimpling and/or puckering of the breast following removal of the breast implant.
Dissatisfaction with Cosmetic Results
Dissatisfying results such as wrinkling, asymmetry, implant displacement (shifting), incorrect size, unanticipated shape, implant palpability, scar deformity, hypertrophic (irregular, raised scar) scarring, and/or sloshing may occur. Careful surgical planning and technique can minimize but not always prevent such results.
Infection can occur with any surgery. Most infections resulting from surgery appear within a few days to weeks after the operation. However, infection is possible at any time after surgery. Infections with a breast implant present are harder to treat than infections in normal body tissues.
If an infection does not respond to antibiotics, the breast implant may have to be removed, and another breast implant may be placed after the infection is resolved. In rare instances, Toxic Shock Syndrome has been noted in women after breast implant surgery, and it is a life-threatening condition. Symptoms include sudden fever, vomiting, diarrhea, fainting, dizziness, and/or sunburn-like rash. A surgeon should be seen immediately for diagnosis and treatment for this condition.
Hematoma is a collection of blood inside a body cavity, and a seroma is a collection of the watery portion of the blood (in this case, around the breast implant or around the incision). Postoperative hematoma and seroma may contribute to infection and/or capsular contracture. Swelling, pain, and bruising may result.
If a hematoma occurs, it will usually be soon after surgery, however this can also occur at any time after injury to the breast. While the body absorbs small hematomas and seromas, large ones will require the placement of surgical drains for proper healing. A small scar can result from surgical draining. Implant deflation/rupture can occur from surgical draining if damage to the breast implant occurs during the draining procedure.
Changes in Nipple and Breast Sensation
Feeling in the nipple and breast can increase or decrease after breast implant surgery. The range of changes varies from intense sensitivity to no feeling in the nipple or breast following surgery. Changes in feeling can be temporary or permanent and may affect your sexual response or your ability to nurse a baby.
At this time it is not known if a small amount of silicone may diffuse (pass through) from the saline-filled breast implant silicone shell and may find its way into breast milk. If this occurs, it is not known what effect it may have on the nursing infant. Although there are no current methods for 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-filled gel breast implants when compared to women without breast implants.
With respect to the ability to successfully breast feed after breast implantation, one study reported up to 64% of women with breast implants who were unable to breast feed compared to 7% without breast implants. The periareolar incision site may significantly reduce the ability to successfully breast feed.
Calcium Deposits in the Tissue Around the Breast Implant
Deposits of calcium can be seen on mammograms and can be mistaken for possible cancer, resulting in additional surgery for biopsy and/or removal of the implant to distinguish the calcium deposits from cancer.
Delayed Wound Healing
In some cases, the incision site takes longer to heal than normally.
Unstable or compromised tissue covering and/or interruption of wound healing may result in extrusion, which is when the breast implant comes through the skin.
Necrosis is the formation of dead tissue around the breast implant. This may prevent wound healing and require surgical correction and/or breast implant removal. Permanent scar deformity may occur following necrosis. Factors associated with increased necrosis include infection, use of steroids in the surgical pocket, smoking, chemotherapy/radiation, and excessive heat or cold therapy.
Breast Tissue Atrophy/Chest Wall Deformity
The pressure of the breast implant may cause the breast tissue to thin and shrink. This can occur while breast implants are still in place or following breast implant removal without replacement. In addition to these complications, there have been concerns with certain systemic diseases, of which you should be aware.
Connective Tissue Disease
Concern over the association of breast implants to the development of autoimmune or connective tissue diseases, such as lupus, scleroderma, or rheumatoid arthritis, was raised because of cases reported in the literature with small numbers of women with implants. A review of several large epidemiological studies of women with and without implants indicates that these diseases are no more common in women with implants than those in women without implants. However, a lot of women with breast implants believe that their implants caused a connective tissue disease.
Published studies indicate that breast cancer is no more common in women with breast implants than those without breast implants.
Second Generation Effects
There have been concerns raised regarding potential damaging effects on children born of mothers with breast implants. A review of the published literature on this issue suggests that the information is insufficient to draw definitive conclusions.