Getting breast implants is an informed decision. It is good to know that there are risks associated with any surgical procedure and there is a chance of complications; so too is the case with breast augmentation. Most of the complications are not serious and are easily corrected. MOOI Clinic is happy to inform you properly and fully about breast augmentation surgery and also about the possible risks.

Breast implants have been used since the 1960s. Meanwhile, 3% of Dutch women have breast implants. Over the years, breast implants and health risks have been widely studied. The product has also undergone extensive development to minimize the risk of complications. From the so-called “cohort studies” in which women with and women without breast implants were asked to complete a health-related questionnaire at different times, no significant differences in terms of health complaints emerge. This does not mean that complications and symptoms cannot occur after breast augmentation with implants, but that this is true for a small percentage.

DBIR and LIR, registration of your breast implants

Since April 2015, all surgical data have been recorded in the DBIR. DBIR stands for Dutch Breast Implant Registry. Thus, the Dutch Society for Plastic Surgery (NVPC) aims to monitor and improve the quality of care and breast implants. At www.implantaatcheck.nl you can find your breast implants by the serial number of your implant.

As of January 1, 2019, the Care Quality, Complaints and Disputes Act is in effect. Since then, all implants have also been registered in the National Implant Register (LIR). Should a safety risk arise around an implant, the LIR lists which individuals are wearing the implant.

Risks and complications before or during surgery

Full anesthesia

Breast augmentation is always done under general anesthesia so you won’t notice or feel anything from the surgery. With all forms of anesthesia, there is a risk of side effects and complications such as injury, nerve damage, allergic reaction and, in extremely rare cases, even death.

Damage to other parts of your body

There is a very small chance that other parts of your body will be damaged during surgery. For example, nerves, blood vessels, muscles or lungs. The damage may be temporary or permanent. There is an even smaller chance that much will be damaged in the body by the surgery, especially if multiple or extensive procedures are done at the same time.

Allergic reactions

Very rarely people get an allergic reaction to treatment. For example, if disinfectants, tape, sutures, plasters, skin glue or blood products are used. Always tell the plastic surgeon if you know you have an allergy. This topic comes up during our intake and safety checks.

Bleeding

It is unusual but during surgery, (severe) bleeding can occur.

Risks and complications after surgery

Immediately after surgery, you’ll notice that you have had surgery. The following complaints may occur:

• After breast augmentation, the breasts feel sore and tense. This diminishes within a few days. Consult with the doctor about pain medication.
• The sutures may cause skin irritation.
• There may be bruising and swelling after breast augmentation. The skin may also become locally discolored or thicker. In most cases, this is not permanent.
• Bleeding may occur. In severe cases, emergency treatment is necessary to remove the accumulated blood.
• After breast augmentation, your nipples may be less sensitive or more sensitive. This usually recovers within a few weeks to months, but it can also be permanent.
• Some fluid can and will always accumulate around the implant, which will disappear on its own after a few months. The accumulated fluid is more likely to cause problems, such as infection or capsular contracture.
• Very rarely, blood or fat clots develop in the legs (thrombosis).
• During surgery, scars are made that always remain slightly visible. Complications can arise around the healing of the scars (an infection or the opening of the scar).
• Pain, fever or feeling sick may indicate a (deep) wound infection. Antibiotics are usually necessary. Sometimes additional surgery is needed to remove the implants.
• Naturally, most breasts are uneven and even after surgery, there may be a slight difference between the two breasts.
• The breast implants may be noticeable. This is especially common when there is little tissue between your skin and the implant. Also, in this situation, the skin may fold over the breasts. This is called crease formation. This risk occurs mainly in people with low BMI and/or little mammary gland tissue.
• For most complications, a larger implant also carries greater risks. For example, increased risk of displacement, sagging of the implant, numbness or pain, fold formation, stretching/thinning of your own breast tissue.

Long-term risks and complications of breast implants

There are a number of long-term complications known, which may or may not originate from the media. There is medical evidence for some of these complications, while for others there are not.

Capsule formation

Encapsulation is a normal phenomenon that occurs because a foreign object (the implants) has been placed in your body. Your body responds by creating a layer of connective tissue around the implant.

However, a small percentage of women with breast implants experience excessive capsular formation and capsular contraction. This happens when your body makes too much connective tissue around the implant, which can lead to pain and a change in the shape of the breast. Your breasts may also feel harder and look less beautiful. The longer you have the implant, the more chance there is of capsular contracture.

Shifting or rotating an implant

There is a very small chance of implants shifting or rotating. With round implants, you don’t notice any of this. With anatomical implants, this can affect the shape of the breast.

Cracks or leakage

Breast implants can rupture and leak. For example, due to wear and tear, an accident or unclear reason. When a silicone breast implant ruptures, you don’t notice it much at first. The gel content ends up around the implant, but usually stays within the formed capsule. There is no evidence that this is harmful to the body, but this is currently being researched. It is important to have the implants checked and replaced if necessary after 10 years. Encapsulation and/or rupture of the implant is the main reason to have the prosthesis replaced in the long term. Preventive replacement of implants after 10 to 15 years, is recommended by more and more manufacturers. It is important to realize that this implant replacement also involves costs and surgical risks.

Sweating silicone (Gel Bleed)

When an implant begins to “sweat,” the implant releases molecules of silicone. The silicone gel released does remain in the capsule. However, the potentially harmful effects of sweating have not been scientifically established. In addition, we ingest silicone particles daily through our food and drinks, but also consider makeup and the pacifiers we give to children. Our bodies are able, to a greater or lesser extent, to dispose of these silicon particles. Most manufacturers have had a special extra layer inserted into the capsule of the implant to prevent sweating. How effective this is in the (long) term we do not yet know.

Lymph node cancer (BIA-ALCL)

In recent years, it has been discovered that women with breast implants have an increased risk of a rare form of lymphoma: BIA-ALCL. It occurs in the fluid or capsule surrounding the breast implant, causing either a sudden enlargement of the breast or a lump in the breast. It is a different type of cancer than breast cancer. ALCL is very rare. And if it develops, it is usually treatable; about 95 percent of women who get the disease are cured. These results have been shown in part by research conducted by plastic surgeons from MOOI Clinic. It further appears that BIA-ALCL occurs mainly in implants with a rough texture. The risk of developing ALCL is very small (1 in 3,800 patients with implants will develop ALCL during her lifetime), smaller than surgical risks to replace these implants preventively.

At MOOI Clinic, we primarily place Motiva brand implants. These breast implants fall into the category of smooth implants. No cases of ALCL have been identified with smooth implants to date.

Breast implant illness (BII).

Here and there, stories appear of women who have become ill from their breast implants (Breast Implant Illness). It involves unexplained symptoms such as fatigue, headaches, cramps, anxiety attacks, etc. BII is not an official medical diagnosis and is attributed to the breast implants by the women themselves. However, the majority of women did report that they felt better after the implants were removed. Much is still unclear about BII and whether these symptoms are related to, for example, the risk of sweating implants or excessive capsule formation. To date, there is no test or scientific evidence for this disease. The plastic surgeons at MOOI Clinic are involved in various studies that study whether and how often these complaints occur and what the reasons are.

In conclusion

Few medical devices have received as much attention and speculation as silicone breast implants. Currently, there is overwhelming evidence to support the safety of silicone breast implants. Implants also contribute to self-confidence and quality of life. Ultimately, the choice to obtain, retain, replace or remove breast implants is the patient’s choice. At MOOI Clinic, we see it as our responsibility to inform our patients as thoroughly and comprehensively as possible when choosing a breast implant. As plastic surgeons, we want to provide our patients with the best scientifically supported care. Therefore, we are very critical of the implant manufacturer in our choice of implants. The Netherlands is the first country to register implants nationwide and also to track complications nationwide in order to contribute to improving implant knowledge and science. Through MUMC, we contribute to scientific research on implants.

During the consultation, we always properly educate you about the possible risks. For further information on risks and complications, please also refer to the NVPC information leaflet, also the source of this article.