Safer Breast Implant Surgery


Breast implant surgery for either breast augmentation or reconstruction is serious surgery and there are potential risks in the short and longer term. With enough time, everyone will require reoperation. Fortunately most people will have their breast implants for longer than 10 years.
While we understand more about the use of implants and they are made better than they have been in the past, time will unfortunately take its toll. It is an unfortunate fact that breast implants are not lifetime devices.
In the first instance implants are placed into the breast and the symmetry and outcome will depend upon the procedures selected, their individual characteristics of the breast prior to surgery and technical performance. Over time the body’s own characteristics and the integrity of the implant will play an increasing role in the longer term outcome.
There are general risks of all operations:
There are short-term risks such as haematoma and infection.
Scarring is an inevitable consequence of surgery and is usually more than acceptable but there are a number of elements including genetics that play a role in scarring so it will be different from person to person especially if there is a requirement for a breast lift or prior surgery for breast cancer in addition to the breast implant.
There are more specific risks that relate to breast implants:
It is usual that breast implants can be felt at different locations on the breast particularly in the lower part of the breast both in the middle of the body, in the fold beneath the breast and along the side near the armpit. Larger implants and for women with very little subcutaneous fat and breast volume the implants will be more evident.
Although it is not usual for cosmetic breast surgery, nipple sensation is frequently reduced in the short term and recovers to normal over time. It is uncommonly reduced on a permanent basis or even absence but this is far more common for breast cancer reconstruction rather than cosmetic breast surgery.
Some of the complications that are encountered relate to bacteria from the skin or breast tissue contaminating the surface of the implant and increasing in number. When a threshold number is reached the body can respond to this causing capsular contracture. Capsular contracture has historically been one of the commonest reasons for reoperation on breast implants but the rates of this problem have dramatically reduced with time.
Over time we have developed a greater understanding about how to minimise this problem and reduce the degree of bacterial association with implants. This has been demonstrated to dramatically reduce the incidence of problems such as capsular contracture. This is called the 14 point plan which is an integral part to best breast implant practice to give the safest and most enduring outcomes. This is a routine part of Dr Magnusson’s practice and he is a concept champion for the 14 point plan. More information on this can be found on the safer breast implants website. http://saferbreastimplants.org/ 
As the rate of hardening around implants reduces and the body’s response to implants becomes softer and less perceptible the incidence of implant pocket instability becomes a little higher and is different from one person to the next according to the characteristics of their breast tissues at the start.
For example, patients with loose tissues that have stretched in response to weight fluctuations or pregnancy will tend to stretch again at a later time especially under the stress of expansion by an implant. As a consequence the implant pocket may become less stable over time. In contrast, a woman who has not had children, has firm skin and no tendency towards droop may tend to have a more stable implant position although the risk is not entirely removed. Implant migration or movement is another cause for reoperation on breast implants in the medium to long-term.
The final outcome from breast implant surgery will develop over 6 to 9 months as the body’s tissues respond to the presence of the implant. There will always be a degree of asymmetry/difference and breasts should be considered more like sisters than twins although obviously the goal is to have them as close as possible to the same.
Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) is a rare association with breast implant surgery. The commonest presentation of this problem is a painless swelling of one breast from 2 to 12 years (average seven years) after breast implant surgery. As long as the diagnosis is considered it is readily diagnosed by examining the fluid that has collected around the implant under ultrasound control. It is also readily treatable when detected early usually with surgery alone that removes the implant and the capsule of the body has developed around this.
BIA-ALCL is a rare disease and there may only be around 300 women in the world who have had this problem even though breast implants have been used now for over 50 years. Our current concept is that there is a combination of breast implants, bacterial colonisation and a response from the body that in genetically susceptible people may lead to a lymphoma. This adds further importance to the 14 point plan. The incidence of this disease is possibly one in 5 to 1 in 10,000 for textured implants. The rate of bacteria related complications of breast implants have been reduced using the 14 point plan leading to a reduction in the incidence of capsular contracture from as high as 15 to 20% and down to as little as 1 to 2%. It is possible that these same technical steps at surgery will also reduce further the incidence of BIA-ALCL.
There are different rates of these various problems that arise with different implant types. Consequently there are reasons for choosing a specific implant type for any one individual taking into account the amount of breast tissue already present, the degree of activity is normally undertaken, the patient’s goal and the nature of the breast that is already present which can be soft and droopy or quite firm and tight. This choice may not be the same choice that is best for the next lady, your friend or even your relative.
Smooth implants have historically had a higher rate of capsular contracture and implant migration which are the commonest reasons for reoperation.
Textured implants of different types will have the potential for other concerns such as double capsule formation, greater degrees of breast animation, delayed seroma and BIA-ALCL.
With good surgical technique and use of the 14 point plan the capsular contracture rate for smooth implants has dropped and may now be very close or the same as textured implants. Implant stability remains less reliable with smooth implants. In contrast, there have been no patients develop BIA-ALCL who have only ever had smooth implants alone. The rate of combined rate of reoperation for capsular contracture and implant migration may be one in 20 or more patients for smooth implants. By comparison the risk for developing BIA-ALCL in textured implants may be one in 5000, may be reduced by the 14 point plan and different types of textured implants appear to have different rates of risk some of which may be as low as one in 30,000.
The perfect implant does not yet exist and everybody does not respond the same however implant surgery is safe, results are more reliable now than they have ever been and a treatment plan needs to be created for the individual and not come from a cookie cutter approach.
Training, meticulous technique and adherence to recommended guidelines are going to give you the safest and most enduring outcome from breast implant surgery.

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