Dr. Nerina Wilkinson: Plastic Surgeon
Meet Sandy one of my patients who had a breast augmentation procedure 12 years ago: She firstly didn’t know that implants don’t last a lifetime, she has a capsular leak (how did that happen?), she has no money for this (would medical aid cover this?) And what alternative procedures could she undergo that she could afford
Since the first breast augmentation in the early 1960’s – breast augmentation surgery remains one of the most common surgical procedures performed today .Patients are having breast augmentation surgery at a much younger age, often in their 20”s. Many patients therefore , are after 10 -15 years of “wearing” these implants faced with the decision on what next… either due to definite signs of breast implant rupture or concern over whether their implants may rupture in the future.
How long do breast implants last?
The reality is that silicone breast implants are not forever and most patients never considered this fact when they initially decided to have the breast augmentation surgery. The longer you have had a breast implant , the higher the chance that the implant could rupture . I often explain to my patients when they are considering breast implants that they would need to change the implants after 10 – 15 years even though many companies would like us to believe that the implant should last a life time. I simplify the scenario by comparing the breast implants to a pair of shoes. We would definitely not be wearing the same pair of shoes , every day, for 15 years. The wear and tear on the shoes would make them prone to failure and one would not want to wait for the day that the heal or stap breaks off . Besides the imminent failure we would possibly also want the newer technology / brand/ style of shoe of the time.
Therefore my advice to patients is to rather replace the implants before they actually start to leak. When the implant is intact the implant replacement if often a simple procedure with a fast recovery as the original space can be used for the new implant. If however the implant has ruptured then the surgery becomes more complicated.
What if my breast implant ruptures?
In the past rupture (where there may be a hole in the shell of the implant) was a common problem seen by many plastic surgeons.
However modern implants are much less likely to do this as the quality of the outer shell of the implants has improved and the inner gel is more cohesive (i.e. silicone particles stick to each other like a set jelly).
In the unfortunate situation of a silicone implant rupture: the majority of cases we find that the silicone gel will remain within the capsule (or fibrous tissue) that the body forms around the prosthesis over time. In some patients this capsule may thicken and tighten around the implant to cause “capsular contracture”. In severe cases this can cause pain and hardening of the breasts
Often patients may undergo routine breast cancer screening and we may find that the implants have ruptured but that patients are totally asymptomatic.
Occasionally silicone gel may spread outside the capsule into the surrounding tissues and lymph nodes where it can create lumps that patients can palpate under their arms.
It is however important to remember that even in the event of silicone leakage: an Independent review by MHRA has concluded that medical grade silicone is totally safe. It is important to remember that silicone is frequently used in the body in many other ways such as wrapping silicone around cardiac pacemakers. Therefore if you are having any symptoms of implant leakage, no need to panic. You have time to make a decision on how you would like to proceed.
Breast augmentation surgery is a cosmetic surgery procedure and therefore most medical aids would not cover a ruptured breast implants. Patients need to therefore at the time of their primary breast augmentation surgery realize that they will possibly encounter later costs when planning on replacement in the future.
Many implant companies have “implant replacement policies”. However first one needs to prove that the implant ruptured due to a definitive implant defect, and often 20 years later that specific implant company may not be trading anymore.
What are the surgical options if my breast implants have ruptured?
A defective implant needs to be removed with the complete capsule that the body formed around the implant.
There are then 3 options: for replacement:
- after removal of the implant do nothing. This is often the case in older patients who are post-menopausal. They would often have naturally increased their own breast size and are happy to have smaller breasts during this period.
- Replace the implant with a new implant. If however the patient developed a high grade of capsular contracture i.e. hardening of the surrounding breast tissues, the new implant should be relocated to a new position i.e. in front or behind the muscle to prevent the possibly of a recurrence of the capsular contracture.
- Fat transfer. In patients who do not want to replace their silicone implants but who still would like to retain some volume, then fat transfer would be the procedure of choice. Your own body fat can be harvested from one area of the body and injected into the breast to improve the shape. The advantage of Autogenous fat grafts over breast implants is the lack of complications associated with the implantation of a foreign material.
Women who desire a large, firm or round breast may not be appropriate candidate for autogenous fat transplant as fat grafts result in a more natural looking appearance. Similarly, fat grafts to the breasts are not a viable option for women lacking significant sources of donor fat for liposuction i.e., very thin, as the volume required is very high.
Lipofilling can realistically only achieve a natural, small 100cc volume breast augmentation.
Be sure of your implant history:
If you have had breast augmentation surgery it is important to have the implant history for you and your surgeon to make educated decisions on your breast implant health and future planning.
I find many patients in my practice walking into my rooms on Jimmy Choo shoes clutching a Gucci bag.
However, whenever I ask these patients, what implants they are “wearing” very few are able to give me this information!
Your surgeon should have provided you with documentation and your implant ID card after your breast augmentation surgery. This card will supply you with details of the make, size, surgery date and batch number. It is important to always keep this card in a safe place for future references. If you no longer have this information, contact your surgeon who should be able to provide you with these details.
How should I monitor my breast implants to prevent problems?
I suggest to all my patients that it is sufficient that they see their plastic surgeon once a year. Self-examination is highly recommended and an immediate consultation is necessary if their breasts change in size or shape or develop lumps.
The longer a woman has breast implants, the more likely she is to experience local complications or adverse reactions. Woman need to monitor their breasts for the rest of their lives.
Conclusion
Beautifully shaped and size breasts definitely make a women look and feel womanly, sensual and confident. For this reason breast augmentation surgery has been one of the fastest growing procedures and extensive research and advances have been made to continuously improve the quality of the implants As doctors and patients we should therefore continuously stay up to date on the newest technology . Think about it: was there anything wrong with your last cellular phone? Possibly not, but you still chose to upgrade to the next version…
