Breast Augmentation Surgery – Problems and Risks

There have always been women who have suffered the agony of small, underdeveloped, or sagging breasts. Many have just accepted this as a frustrating but unchangeable situation. Some women, especially from the upper socio-economic classes, have opted for insertion of breast implants by breast augmentation surgery. However, because of the high cost, the risks and the side-effects of breast implants, today better-informed women are becoming hesitant about opting for surgical augmentation.

Increasingly such women are turning to breast enlargement options that don’t involve surgery.

The cost and risks of cosmetic surgery make this an undesirable option. The average cost of a breast enhancement surgery is between $5,000 and $6,000. Most people either don’t have this kind of money to spend on breast enlargement or prefer to keep this cash for more productive and meaningful purposes!

Nevertheless, breast augmentation is the No. 1 cosmetic surgical procedure performed in the U.S., up 756 percent since 1992, according to the American Society of Plastic Surgeons. In 1992, there were 32,600 procedures; in 2005, it skyrocketed to 279,000.

Yet, despite the popularity, the procedure has been and remains controversial because of the cost, the risks, and the problems of ruptures or leaks in the implants. Meanwhile, millions of women have been subjected to the ill effects of these modern day vanity procedures that were bought in good faith.

Types of Implants

Silicone Breast Implants

 There are two types of implants used in breast enhancement surgery – silicone gel or saline solution. Of these, silicone gel implants are considered to have a superior appearance, superior feel and look more natural compared to saline implants.

However, silicone gel implants are far more dangerous than saline implants. In case of a rupture, the silicone gel can spread into the body, with serious consequences. In fact, the FDA had banned silicone implants in 1992. However, with improved silicone implants becoming available, this ban has recently been lifted.

Saline-filled implants are safer than silicone ones. This is because, should the implant rupture, the saline solution will simply be absorbed by the body. However, saline implants tend to have a higher rate of leaking and deflation than silicone gel implants, which means more frequent surgery to replace them.

Breast Implant Risks and Side Effects

From special mammography considerations, to breastfeeding, to implant leakage, plus the inherent risks in any form of surgery, there are several issues connected with breast implant surgery that one should be aware of, in order to take an informed decision on this matter.

Breast Feeding 

Many breast implant patients do successfully breastfeed. However, breast implants may, and often do, interfere with breast feeding. If you plan to breastfeed at any time subsequent to your surgery, you must tell your plastic surgeon about this. This factor may impact the surgical technique used.

Mammography 

There is a risk that breast implants may impede breast cancer detection. During mammography, X-ray, or ultrasound, the implants can hide suspicious tumors or lesions. Treatment providers must take special care of breast-implant patients during breast exams. Additional views are required, which take additional time for imaging. If you have had breast implant surgery, you must mention this when you make a mammography appointment, so that they can schedule the extra time and special imaging needed.

The radiologist needs to use special imaging – “Eklund displacement views? should be included, in addition to the standard views, to detect lesions and tumors for women who have breast implants.

Mammography also compresses the breasts, which increases the chance of  implant rupture, which will require further surgical intervention.

Loss of Sensation 

After breast enhancement surgery, some women experience loss of sensation in the nipple and breast areas. Loss of sensation results from damage to nerve endings in the breast and nipple. This loss of sensation may be temporary, but it can also be permanent. The surgical technique used plays a role in this factor.

Leaking or Leaching of Breast Implant Material 

There have been several studies of the potential harmful effects of breast implant materials leaking or leaching into the surrounding breast tissue. The studies concluded that there is insufficient evidence of harmful effects caused by implant materials that are approved by the FDA. These FDA-approved materials are also widely used in other types of medical implants, including pacemakers, intraocular lenses, artificial joints, and other medical devices.

Breast Implant Problems 

The FDA has published a brochure to highlight the more common problems that occur with silicone gel-filled or saline-filled breast implants.

https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm259296.htm

In this brochure, the FDA has stated that the most common complications that occur with  breast implants are rupture/deflation and capsular contracture. This applies equally to both saline-filled and silicone gel implants.

Capsular Contracture

Grade IV Capsular Contracture

Capsular contracture is the term used to describe the situation where the scar tissue or capsule that has formed around the implant tightens and, thereby, squeezes the implant. This can happen in either one or both breasts. There are four grades of capsular contracture known as Baker grades.

The Baker grading is as follows

Grade Ibreast is normally soft and looks natural
Grade IIbreast is a little firm but looks normal
Grade IIIbreast is firm and looks abnormal
Grade IVbreast is hard, painful, and looks abnormal

 

Capsular contracture of Grades III and IV will usually require re-operation, and may recur again.

Rupture Deflation

Implant Rupture/Deflation

The other common problem that occurs with  breast implants is rupture or deflation. In some cases, breast implants will rupture or deflate within a few months after insertion while, in others, this may happen after several years following the surgery – sometimes going up to 10 years or more. However, rupture/deflation will take place and implants will not last a lifetime.

When silicone gel implants rupture, the consequences may include reduction in breast size, hard knots, unevenness of the breasts, pain or tenderness, tingling, swelling, numbness, burning, or changes in sensation. In some cases, an implant rupture can occur without any symptoms (silent rupture). Following a rupture, silicone gel may escape from the scar tissue capsule around the implant and migrate away from the breast, causing lumps, called granulomas, to form in the breast, chest wall, armpit, arm, or abdomen.

In case of an implant rupture, breast augmentation surgeons will generally advise removal and replacement of the implant. This is because, even when the silicone gel from the implant is still contained within the capsule of scar tissue, it can subsequently leak out and migrate into surrounding tissues.

When saline-filled breast implants deflate, the reason is leakage of the saline solution either through an unsealed/damaged valve or through a break in the implant shell. When there is a leak, deflation of the implant may be immediate or progress gradually over days, months, or years. Such deflation results in loss of size or shape of the implant. Further surgical intervention is required to remove and replace deflated implants.

Acknowledgements:

Safety of Silicone Breast Implants. Institute of Medicine National Academy Press, Washington, D.C. 2000. (IOM Report). Also available through IOM website at www.iom.edu/report.asp?id=5638

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