Five Reasons Why You Need to Monitor Your Breast Implants

Thick calcified and contracted breast capsules with old ruptured dual lumen breast implants.  The saline portion likely ruptu

Breast implants don't last forever. Know the issues, get surveillance imaging for silicone gel breast implants, and keep up with evolving discussions regarding Breast Implant Illness and Breast Implant Associated - Anaplastic Large Cell Lymphoma.

#1    Breast Implants Do Not Last Forever

I have heard countless times from older women with breast implants that their original surgeons told them the implants would last a lifetime.  I didn't really believe so many were told such nonsense until I saw product literature from that era that confirmed it.  The adage "Nothing lasts forever" is true, and it includes breast implants! Saline implants have an advantage here - a hole in the implant will cause deflation, which is obvious and doesn't need fancy imaging to detect.  

#2    The FDA Recommends That You Get a Periodic MRI Scan

I could rant about all the things wrong with our regulatory agencies, including the FDA, but I think this is some good advice.  Since 2006 there has been a recommendation to get a non-contrast MRI 3 years after silicone gel breast implantation and every 2 years thereafter.  (There has been talk of changing this to first MRI at 5 years, then every 3 years, and allowing substitution of ultrasound instead).  The idea is that a hole, or tear in the shell of the silicone gel implant cannot be detected by physical exam, and mammograms aren't that great for detecting it either. Now I can hear some plastic surgeons say "A hole? So what!?', and cite a study that claimed there is no increased risk of adverse events if a known ruptured implant is left in place.  Sigh.  Flawed studies can't be made better with flawed logic and a lack of common sense.

#3    Breast Implant Associated - Anaplastic Large Cell Lymphoma (BIA-ALCL)

So far only associated with textured implants, primarily the coarsely textured Allergan Biocell implants, the incidence of this unusual cancer is rising.  Fortunately, awareness is rising as well, and when caught early as it usually is, is effectively treated with implant removal and capsulectomy.  See my page on ALCL and my blog posts on this topic here, and here.  (Some of this information has changed since originally published). BIA-ALCL often presents with swelling (seroma), which needs to be properly tested.  Any swelling, masses, or lumps (You do breast self exams, don't you?) need to be evaluated promptly.

#4    Breast Implant Illness (BII)

A controversial topic.  Sometimes called silicone implant illness. Unlike many plastic surgeons, I do think this is a real condition in some women with breast implants, both silicone gel and saline. Most epidemiologic evidence doesn't support it but these studies have many flaws.  There is scientific plausibility to explain the disorder and hopefully improved breast implant registries and better basic science research will shed more light on this in the future.  Symptoms are many, but common ones include insomnia, fatigue, brain fog, blurred vision, headache, numbness and tingling and joint aches.  Less common problems include rashes and cystitis.  Conventional evaluation often yields little objective information, so patients' complaints are often dismissed by their physicians and surgeons.  Surgeons like myself who have large BII practices see dramatic improvement in the vast majority of BII patients after implant removal and en bloc capsulectomy. Be aware of your overall health.  If you encounter slow changes to your health with no clear explanation, consider BII.

#5    Warranty and Insurance Coverage

Know your insurance policies and implant manufacturer's warranty policies.  They are all different, and they've improved over the years.  A painful capsular contracture (Grade 4) will often be covered by insurance, but not implant replacement.  Implant leakage and capsular contracture may be covered by your implant warranty but there are limits.  You don't want to neglect a worsening capsular contracture until the warranty has expired!

Douglas J. Mackenzie, MD

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