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Augmentation - Implants

A breast implant is a balloon made of silicone, filled with either silicone gel or a saline solution comparable to body fluids. Through a four to five centimetre incision in the fold under the breast the implant is inserted. Other possible incisions are through the areola or around the nipple. According to the patients body shape and preferences, there are several options regarding the type of the prosthesis, its size and the operative technique. The operation is performed under general anaesthesia. The admission usually comes down to an overnight stay in the hospital.

Breast implants do not last forever (nor do hip or knee implants). They may have to be replaced or removed after ten to fifteen years. They may last longer, but they also might require much earlier removal.

Apart from the general problems and complications which may arise with any operation, breast implants may cause several specific problems. 

The body places an internal scar around the implant, which is called the capsule.

The number of cases of anaplastic large cell lymphoma (ALCL) is increasing. This condition is a malignant tumour of lymph cells, which develops in capsules around breast implants. The existence of this condition has not been known as long as the other complications of breast implants that are described below. At the moment of publication of this text, there is no health authority that advises to remove breast implants out of precaution. Nevertheless, this is an important point to consider before requesting breast augmentation with implants. If a sudden increase in breast volume arises due to fluid accumulation (seroma), it is necessary to investigate to exclude ALCL. 

If the capsule becomes too firm, the breast may feel harder than normal and even get an unnaturally round shape. This problem is called capsular contracture.

In case of infection around the implants, they have to be removed. 

Generally, the border of the implant can be felt somewhere with the fingertips. Even augmented breasts that feel very natural flatten out less than normal breast tissue in the recumbent position. 

When there is too little tissue to cover the implants adequately, their border, or waves on their surface may be palpable or even visible. Sometimes it is useful to combine breast augmentation with implants with lipofilling in order to obtain the desired volume as well as adequate soft tissue cover.

When a saline filled implant leaks, it loses all of its volume over a few days. A leaking silicone gel filled implant sometimes produces an abnormally soft breast first. Later on the internal scar may become very hard. It is recommended to remove any leaking implant. 

Sensation to a part of the breast, including the nipple may be lost as a consequence of augmentation, and this may be permanent. 

Mammography (radiography of the breast) is impaired by a silicone gel filled implants. 

Therefore breast augmentation is only a good option for the well-informed and motivated patient who realises that this is not a lifelong correction.

There is an excellent information page on breast implants on the website of the Royal Belgian Society for Plastic Surgery. A lot of information can be found on the website of The British Department of Health.