Breast implants - Complications 

Complications of breast implants 

After having breast implant surgery, about one in three women will require further surgery within 10 years of their initial operation.

Additional surgery may be needed as a result of complications such as capsular contracture (hardening of the scar capsule around the implant, see below), age-related changes to the breast (sagging) or the shell of the implant rupturing (splitting).

All forms of surgery carry some degree of risk. Complications that can affect anyone who has surgery include:

  • an adverse reaction to the anaesthetic
  • excessive bleeding
  • risk of infection
  • developing blood clots (where the blood thickens to form solid lumps)

There are also complications specifically associated with breast implant surgery. Some of these are discussed below.

Capsular contracture

After having a breast implant, your body will create a capsule of fibrous scar tissue around the implant as part of the healing process. This is a natural reaction that occurs when any foreign object is surgically implanted into the body.

Over time, the scar tissue will begin to shrink. The shrinkage is known as capsular contraction. The rate and extent at which the shrinkage occurs varies from person to person. In some people, the capsule can tighten and squeeze the implant, making the breast feel hard. You may also experience pain and discomfort.

Capsular contracture is an unavoidable complication of breast implant surgery. Everyone who has breast implants will experience capsular contracture to some degree and it is likely further surgery will be needed in the future.

There are three methods of reducing the tightness caused by capsular contracture. These are:

  • closed capsulotomy
  • open capsulotomy
  • open capsulectomy

Closed capsulotomy

In a closed capsulotomy, the surgeon will try to tear the layer of scar tissue by squeezing the capsule. If successful, the tightness around the implant will be relieved and the implant will feel soft.

However, sometimes the scar tissue is so tough it cannot be torn, and there is also a risk of the implant rupturing (splitting). If the implant ruptures, further surgery will be required to replace it. A closed capsulotomy can also cause bleeding and bruising.

Due to the risk of further complications, a closed capsulotomy is not the preferred method of treatment for capsular contracture.

Open capsulotomy

The aim of an open capsulotomy is to relieve the tightness caused by capsular contracture and give the implant more room to move inside the breast pocket.

The procedure will be carried out under general anaesthetic and involves the surgeon making an incision (cut) into the breast pocket to remove the implant. They will then make a series of cuts in the scar tissue inside the breast to help relieve the tightness around the implant. The implant will then be re-inserted and the incision closed.

Open capsulectomy

An open capsulectomy is the most successful treatment for capsular contracture. As with an open capsulotomy, it is carried out under general anaesthetic and involves the surgeon removing the scar capsule completely. This allows the body to form a new capsule around the implant.

Rupture

A rupture is a split that occurs in the implant’s casing. A rupture can be caused if:

  • the implant’s shell (which holds the silicone or saline) gets weaker over time
  • the implant is damaged during the operation
  • there is a flaw in the implant
  • the breast is injured

When implants were first developed, they had very thin walls and rupturing was a common problem. However, modern implants that have been used in the UK since the 1990s rupture much less frequently.

If your implant ruptures, it is recommended that you should have it removed and replaced with a new one.

If you have a saline (salt water) implant, any leakage from the implant should not cause you problems. As saline is a sterile, salt water solution, your body is able to safely absorb it. However, if you have silicone implants, the silicone that leaks out of a ruptured implant may cause problems, such as siliconomas or a gel bleed (see below). You may be expected to pay for any special investigations needed to confirm a suspected implant rupture.

Siliconomas

If you have a silicone breast implant that ruptures, the silicone may spread outside of the scar capsule and into your breast. This can lead to small lumps developing that are known as siliconomas.

Siliconomas can be tender to touch and if they are causing significant pain they may need to be removed. In rare cases, the silicone can spread to the muscles under your breast, your lymph nodes (glands) under your armpit or around the nerves to your arm.

Gel bleed

Gel bleed occurs to some degree in all breast implants, and has recently been a problem with PIP breast implants.

It is where small molecules of silicone polymer separate from the surface of the implant and are taken up into the surrounding tissues or lymphatic system (the network of vessels that help the body fight infection and are found in several places around the body, including in the armpit).

If the silicone molecules get into the lymphatic system, they may cause your lymph nodes (glands) to become slightly swollen. This is usually a minor problem, although in some cases the enlarged lymph nodes can become uncomfortable.

Scarring

After breast implant surgery, you will have some degree of scarring. In most cases, the scarring is relatively mild. However, in approximately 1 in 20 women, the scarring is more severe. For these women, their scars may be:

  • red, or highly coloured
  • lumpy
  • thick 
  • painful

The symptoms of severe scarring should improve gradually, and over time the scars will begin to fade. However, in some cases it may take several years before there is a noticeable improvement.

Creasing and folds

Sometimes, a breast implant can affect the appearance of the skin on your breast. For example, after your operation you may find that your skin has:

  • creases
  • kinks 
  • folds
  • ripples

Creasing and folds tend to be more common in women who have very small breasts before having breast implant surgery.

Nipple sensation

Following breast implant surgery, about one in seven women find their nipples are less sensitive or completely desensitised (have no sensation at all).

Alternatively, after having breast implant surgery your nipples may be more sensitive. Sometimes, the nipples can become so sensitive they are painful. Increased sensitivity usually lasts for between three to six months.

If your nipples are painful, speak to your GP or surgeon who will advise how to deal with it.

Infection and bleeding

Following breast implant surgery, infection and bleeding are relatively rare, occurring in less than 1% of cases. Internal bleeding is also unusual.

However, if you are having an implant fitted for breast reconstruction following a mastectomy (breast removal) you may have a greater risk of infection and bleeding.

Most infections can be treated using antibiotics. However, if your breast becomes severely infected, you may need to have the implant removed to prevent further complications developing. You should be able to have the implant re-inserted after the infection has cleared up.

However, it is important that the implant is not re-inserted too soon, as this can increase the risk of infection. Waiting a minimum of three months after the implant was removed is usually recommended.

Some research suggests your risk of infection and bleeding may be increased if you smoke, because your wounds will take longer to heal. The British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) recommend you do not smoke before your operation in order to reduce the risk of developing complications.

Seroma

After having breast implant surgery, fluid can build up around your implant. This is known as a seroma and is fairly common. In severe cases, further surgery may be needed to drain away the fluid. However, seromas usually resolve without needing to be drained.

Silicone implant safety

In recent years, the safety of silicone breast implants has been debated. A small number of women have reported serious complications following silicone gel breast implant surgery. These complications include:

  • muscle spasm and pain
  • swollen and painful joints
  • rashes
  • changes in eye and saliva fluid
  • hair loss

It was thought these complications occurred as a result of silicone gel leakage that spread to other parts of the body.

In response to these concerns, the Department of Health set up an independent review group to investigate the safety of silicone implants. The group found no scientific evidence to support the relationship between silicone implants and illness in women.

However, in March 2010 the Medicines and Healthcare products Regulatory Agency (MHRA) advised surgeons not to use certain implants produced by a company called Poly Implant Prothese (PIP). The implants are filled with a type of silicone gel that has not been approved.

The non-approved silicone gel implants were manufactured between 2001 and 2009 and have the following model numbers:

  • IMGHC-TX
  • IMGHC-MX
  • IMGHC-LS

Tests are currently being carried out to determine whether there are any patient safety issues associated with these unauthorised implants. As yet there is no evidence to suggest the gel inside them is harmful. However, speak to your GP or surgeon if you have these gel implants and you are concerned.

See the MHRA’s press release for more information regarding PIP’s silicone breast implants.


Page last reviewed: 03/07/2012

Next review due: 03/07/2014

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Comments

The 14 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Cassendra Gill said on 12 September 2013

The procedure of breast enlargement surgery is very simple as the surgeon implant behind the natural breast tissue as it helps in increasing the size of the breast. The surgery only takes 2-3 hours and general anesthesia have been used before performing surgery. After having surgery patient has to suffer some swelling and soreness for some days but most of the patients recover within 4-5 days. It is instructed to wear a support bra the stitches will also be removed within a week. Most of the people think that breast enlargement surgery increases the risk of breast cancer, and it also affects your ability to breast feed but no scientific evidence has yet proven this. Breast enlargement surgery helps in adding volume and contours the breast that lacks fullness and shape. Breast enlargement surgery is performed by plastic surgeons but it is very important that you may select and experienced, well trained and professional surgeon.

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marper said on 04 February 2013

I had implants fitted by harley medical nearly 4 years ago . Last year I found out they were pip ones and both ruptured !! It took me 6 mnths of hassle , chasing surgeon round the country and endless waiting on the phone . I finally had them replaced july 2012 . The operation was free but they didnt pay ANY expenses . I also paid £300 for STRONGER ones . Ive never been happy with shape of left one and now it is mishapen and hard . I rang harley , had to then ring pip helpline (they are NOT pip ones now ) .They said surgeon does not practice anywhere near me and Id have to go to harley st London to see him . Further surgery would not be free . I was pleased with the first implants if they hadnt fitted sub standard ones I would not have had to have them replaced !!! Im going to my gp to see if he can help as he was kind and sent me for nhs scan last year . My point to harley is the second operation was because THEY fitted the wrong ones in the first place . Im crying with worry , They look worse now than before I ever had implants . The first ones were great , but unfortunately pip ones . Do others think i have a point that harley should pay again ?

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monfrite said on 22 January 2013

I had bilateral NHS breast implants at Mount Vernon in 1987. They had been in place for over 25 years with only 1 hospital follow up consultation. I wasn't aware that I had developed capsular contraction in the L.breast and routine mamograms had also failed to indicate problems. (I now know that only certain MRI scans will conclusively indicate the presence of leaked silicone) but I certainly had all the symptoms of Fibromyalgia from about 1996. I had an acromeoplasty and excision of L.shoulder blade in 2007 - probably caused by the wastage of the pec muscle that was 'melted' by leaked silicone. Despite surgery, my fibro symptoms worsened. Then, in the summer 2011, I thought I'd found cancer. A biopsy confirmed silicone leakage in the R.breast. Bi-lateral explantation followed in September 2011 but the L.implant breached. My condition deteriorated post-op and I was told I was a 'mystery.' Antibiotics were having no impact. Over the following 8wks the tissue in L.breast became necrotic and most of it was ultimately removed at the end of Nov 2011 after watching it 'die' for 8 agonising weeks. Exactly the same is now happening to the r.breast, only this time the leaked silicone that should have been a straightforward removal in Feb 2012 has now migrated to the tubes in the mammary gland as well as the nipple, muscle tissue and armpit. Ironically I had asked for a bilateral mastectomy in the first instance but I keep being told it is better to leave well alone.This is a living nightmare and my body clearly does not want this evil toxic substance any longer ! I have private medical insurance but treatment is denied because my implants, although done on the NHS, were not related to cancer. All complications since the explantation are also regarded as related to cosmetic not medical needs. Yet although I am not entitled to any NHS counselling, I'll be offered reconstruction the same as any other cancer patient. It all seems very unfair and frustrating - Help !

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Maria Mahon said on 22 August 2012

Great thread. @Joanm- I am in the exact same position- I had NHS implants put in 5 years ago when I was 25 (after a big battle to get them!) but one of them never felt right and I just ignored it and continued my daily exercise regime- running mainly. Anyway I got an infection last year in the same boob and my breast swole up really badly- it was never fully explained to me at the docs but she gave me antibiotics and the swelling went down. The surgeon sent me away as well. After 6 months I asked to see surgeon again, did a number of MRI scans and they finally agreed it is capsular contracture and to re-operate and replace the implant. The operation is going to be tomorrow and while I am pleased I'm scared in case the other one looks deformed on some level. Any feedback or speculation would be most welcome! Thanks!

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Joanm said on 19 May 2012

I also had implants on nhs 15 years ago and had one check up 2 weeks later I had no problems till about 8 years ago I stepped off the side and the worst pain ever shot through my breast I called nhs direct and they advised me to go to casualty when I got there my breast was swollen red and hot to touch and the slightest movement caused pain I was examined by a doctor who said I had an infection in the muscle behind the implant I was given antibiotics which cleared the swelling ,pain and redness ever since my breast has looked lower than the other I haven't been back to the doctors as I don't have any other symtons other than it looking lower no pain I now am concerned that my breast had ruptured as I do always feel tired but put that down to being a mum of 3 and working I would welcome any advice thanks

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samantha68 said on 19 May 2012

to the person who is having a problem with transform..go to a solicitor and find out your rights as I had dealings with that clinic and got no were untill I found a solicitor to take on my case.

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girlessex said on 12 April 2012

I had breast implants on the NHS 15 years ago. Because of all the worrying press over PIP,
I contacted the hospital. i got an appointment and was assured that mine are not PIP, I asked if I could have a scan anyway because I had them put in so long ago. I just wanted confirmation that they are fine.I had a scan and was shocked to be told they are ruptured,
I have never had any problems with my breasts, no lumps or pain so would not even have known if I hadn't made contact. I have however had other health problems over the last 5 years which i'm now wondering if they could be the result of leaking silicone. When I had my implants i recieved 2 follow up appointments after year 1 and year 2. since then i have never been contacted by the nhs for any sort of after care or scan. Am i the only patient who didn't recieve any further appointment, this is for 13years. I was not unduly worried because I thought if an implant ruptured I would have know, so if my breasts had changed or hurt i would have gone to my GP for a referal. I am now thinking that surely the nhs know that they can rupture without obvious symptoms and so it should surely be their responsibility to continue to care for their patients or call them in for a scan every few years to check the condition of them or at least make patients aware that they can rupture and you wouldn't even know it so you could book a scan yourself every few years. Please let me know if you have had implants for a considerable length of time with or without any follow up appointments. thanks

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j1963 said on 31 March 2012

I had saline breast implants about 8 years ago. I am now having problems with them, lumpy and painful under my arms. Does anyone know if my GP can refer me on the NHS to get them checked out or do I have to go private again? I know if I have to have them replaced I'll have to pay but not sure if I'll have to pay for a scan.

Any help would be appreciated.

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poppydoppydoo said on 24 January 2012

Went to Transform to check if my implants were PIP they weren't. However I discovered that I had a ruptured implant. Now Transform say I am not covered for the cheap removal that is granted to PIP implants and they have reneged on the fee they were going to charge me and now want to inflate the price for removal. I now don't know what to do. Does anyone know your rights if your implant ruptures, I don't expect them to replace them for free, but I had the surgery because I was told I would have a lifetime guarantee that if anything went wrong they would remove the implants free. Now Transform are saying this has never been a part of their guarantee. Can anyone help with advice on what to do?

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User551539 said on 30 April 2011

These are things that need to be spelt out clearly and carefully prior to surgery. However because this is an industry that is primarily profit-oriented, it will tend to only appear in the small print. Plus, most women who are seeking breast augmentation are so highly motivated that it is unlikely there will give this musch thought. Lately there has been further reason for a pause for thought as seen in this short article: http://www.pregnancy-bliss.co.uk/breast_implants_cancer.html

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bluetwo said on 07 September 2010

I am in the same position as you all now. Have any of you had any luck with anything? I am at my wits end now.

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louise1970 said on 31 October 2009

i had breast implants on the n h s 10 years ago, they have now changed shape gone hard, point in opposite directions, and look awful!! i went to see my g p who referred me to a surgeon, who said i needed them replacing and told me what he would do, then added the n h s do not fund this sort of op any more, so i would have to apply for funding which i have done so twice now, and been turned down, i hate my boobs so much i could quite happily cut them off, i feel worse now then when i was flat chested!!

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fun said on 14 July 2009

Hi, I've just found out today that II have the exact same problem! ! it doesn't seem fair that I paid all that money just for them to go wrong a few years later(5yrs) and for the private hospital and doctors not to care unles your willing to pay the full price! the NHS will remove my ruptured implant but wont replace it.(which I kind of understand)
Any how I have just come across a help and advice line on product liability claims.There number is 0800 10 757 95 e-mail www.youclaim.co.uk/product-liability-breast-implants.htm
I hope this will be of some help to you?
I'm awaiting to hear from them to see what they can advise me. Until then I'm in the exact same position as you!!!!!

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caz16 said on 19 June 2009

I had breast aug 10 years ago, to cut along story short I have a rupture & it has leaked into my lymph glands. the nhs wont replace & my breast tissue has compressed. I cannot afford to pay as my circumstances have changed since 10 years ago. I cannot bare the thought of not having my breasts let alond being disfigured (as said by my breast doctor! dont know which way to turn. I have to try and plead my case to primary care but dont hold much hope in having the breasts replaced. if anyone has advice or can help please let me know
thanx

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