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Implant Problems -
What Can Be Done
Hardening of breast implants (Capsule formation)
This is created when the body forms an increasing layer of scar around the implant. It is not in itself dangerous but will progress as the years go by. About 10% of patients will form capsules over a 10 year period. A smaller numbers will develop them much faster.
Options for treatment include removal of the implant and scar tissue and a new implant used. When feasible it may be better to change the implant position i.e from under the breast to under the muscle. The new implant usually needs to be slightly larger. Certain types of implants may have a slightly lower risk of hardening (saline and polyurethane) and these may be considered. This is the most common treatment for implant problems. Note that a larger scar is required to remove an implant.
Other options are removal of the implant and to reshape the remaining breast using a breast lift (mastopexy). This is a very good option if the patient has enough breast tissue to make a reasonable breast shape. If the skin is very lax with hardening then a combination of a new implant and a breast lift can be considered.
Implant Rupture
This causes a lot of concern to patients. Some of this concern has a sound basis although much of it does not. Most surgeons would consider removal of a ruptured breast implant. However, this is not always needed. Silicone is known to be very safe and we have over 40 years of studies to support that statement. When an implant ruptures the silicone can either lie within the scar capsule (Intracapsular rupture) or it can leak beyond this into the breast and beyond (Extracapsular rupture). When the latter occurs the implant should always be removed. This can cause silicone lumps (silicone granuloma), deformity, infections and pain.
However, if the silicone is all held within the breast capsule there are differing approaches. If the breast shape or texture needs altering, or the patient prefers then the implant can be replaced. However, there are occasions when the implant feels and looks completely normal and the patient is happy with the shape. It is feasible in this scenario to leave things alone. The concern is always that the silicone will leak from beyond the capsule but this can be monitored. These differing approaches can be discussed at consultation.
Loose skin, droop or poor scars
Depending upon the scenario the breast can be lifted or the scars re-done. Depending upon the age of the implant and its feeling then this may be replaced at the same time. There is an argument that if a patient is having an operation with implants greater than 10 years of age to replace then. However, this is certainly not an absolute requirement.
