Implant Side Effects: What Are the Possible Complications?

Breast implant surgery is the most common plastic surgery procedure performed worldwide among women. And its popularity is increasing: compared to 2000, breast augmentation procedures rose by 41% in 2021. Yet in October 2021, the FDA took steps to increase public awareness about the complications associated with breast implantation. So, what potential risks should you be aware of if you have had or are considering implants?

Possible complications of breast implants

Complications of breast implants range from mild, short-term inconveniences to serious problems that may require implant removal or other treatment. Complication rates are highly variable. Infection occurs in 1.1–2.5% of patients receiving breast augmentation, and up to 35% of patients undergoing breast reconstruction after a mastectomy. A 2023 systematic review found a complication rate of 5.2% among 4,784 patients who underwent breast augmentation with one type of silicone implant.

Infection

Like with any surgical procedure, breast implantation carries the risk of skin infection (cellulitis) around the surgical site. In some cases, the implant itself can become infected. Signs of infection after breast surgery include fever, breast pain, swelling, and redness. The incidence of implant infections peaks in the acute postoperative period (six days to six weeks after surgery), but often occurs six months after surgery, too. Diagnosis is confirmed by detecting the presence of bacteria in the fluid surrounding the implant. Treatment involves antibiotics and sometimes implant removal depending on the depth of the infection and response to antibiotics.

Scarring

Scarring at the incision site is a normal and expected part of breast implant surgery. Scars can take up to 18 months to fully heal and mature and may get worse before they start looking better. According to the American Society of Plastic Surgeons (ASPS), some treatments for pronounced scars include vitamin E supplementation or topical cortisone cream. Additionally, patients can attempt to accelerate incision site healing and reduce scar formation through avoidance of smoking, staying out of the sun, eating nutritious foods, and staying hydrated during their surgical recovery.

Pain and swelling

Some degree of breast pain and swelling is often a normal part of the healing process and can last over the course of several weeks to months. Pain or swelling that affects one breast more than the other and is accompanied by other signs such as fever or redness may signify a more serious problem, such as a tumor or infection that requires diagnosis via imaging studies. Because there can be so many different causes of breast pain and swelling, it is best to consult with your physician if you have any concerns.

Changes in nipple or breast sensation

According to one study, changes in nipple or breast sensation after breast augmentation surgery are very rare, occurring in only about 0.1% of patients. Decreased sensitivity (e.g., numbness) is usually temporary, although the time it takes to regain sensation can vary from days to weeks. Larger size implants can lead to more skin stretching and damage to nearby nerves, increasing the risk of sensation loss. Some patients may describe a tingling sensation that should also recover with time.

Hematoma

A hematoma is a collection of blood underneath the skin due to damage to nearby blood vessels. One study showed that hematomas are rare following breast implant surgery, occurring in 0.92% of patients and, on average, 37 days after the operation. A breast hematoma can present with skin discoloration (like a bruise), pain, swelling, and a lump. Small hematomas can usually resolve without treatment, but any signs of a hematoma should prompt a medical evaluation. This is because large or rapidly expanding hematomas may raise the concern for active bleeding and require surgical intervention.

Seroma

A seroma is a collection of clear fluid under the skin that occurs in days to weeks near an incision site. It feels like a squishy lump underneath the skin. Seromas commonly occur after mastectomies or lumpectomies, when tissue is dissected leaving ‘dead space’ for fluid to build up. One study found that seromas occurred in 2.78% of patients within six months following breast implant surgery. Small seromas may resolve on their own. Larger seromas may cause tight skin, breast pain, or restriction of shoulder motion; in these cases, drainage may be necessary. Since seromas can become infected, it is important to seek medical attention if your seroma progresses to include fever, breast warmth, or redness.

Asymmetry

Breast asymmetry can occur in the days to weeks after implant surgery because the rate of swelling can differ between the breasts. Moreover, implants can take a long time to settle fully into their final position, and during this time, the breasts may appear uneven. Some experts recommend giving at least three to six months for implants to fully complete the ‘drop’ and ‘fluff’ process, which refers to the implants moving downward (‘drop’) and filling out the lower breasts (‘fluff’). If breast asymmetry is accompanied by a lump or a mass, it may need to be evaluated to rule out a hematoma, seroma, or tumor.

Stretch marks

Stretch marks can occur following breast implant surgery because the tension applied to the skin by the implants outpaces the skin’s ability to expand. One study found that 7.06% of patients developed stretch marks following breast implant surgery. Risk factors included a larger implant size, younger age, smoking, and low body mass index. Stretch marks are not harmful but can be aesthetically unpleasing for some people. Stretch marks tend to be permanent, although their appearance does tend to fade out over time.

Sagging

Breast sagging after implant surgery is typically not a direct result of the implants themselves but rather the normal aging process for breasts. When it does occur from surgery, however, it is due to improper placement of the implant by the surgeon (e.g., too low on the body). Breast sagging is not harmful, but some people may opt to undergo a breast lift (mastopexy) for aesthetic reasons.

Capsular contracture

A capsular contracture (CC) refers to the hardening of the breast around the implant due to the buildup of connective scar tissue. When a foreign object, such as an implant, is inserted into the body, the body forms a barrier of scar tissue around it. This is helpful for breast implants because it keeps them in place, but sometimes, the scar tissue stiffens too much and starts to contract around the implant.

About 92% of CCs occur within the first 12 months after surgery, but the risk increases the longer implants are in place. Up to 20.4% of patients can experience some degree of CC between 5–10 years after breast augmentation.

CCs are graded in severity on a scale of I–IV. Grades III and IV are considered severe, as the breasts feel firm and take on an abnormal, misshapen appearance. Breast pain is associated with a grade IV CC.

The gold standard treatment for a grade III–IV CC is the surgical removal of the capsule of scar tissue as well as the exchange of the breast implant. In fact, CCs are one of the most common reasons for breast implant revision surgery. In some cases, medications may be tried to reduce the severity of the CC without surgery.

Rippling

In some people, breast implants can cause folds that are seen and felt as ‘ripples’ underneath the skin. This can be caused by many factors, some of which include receiving too large of an implant, under-filling of saline implants, loss of saline implant volume, poor surgical technique, or the use of textured implants. Since rippling will not go away on its own, it may need to be addressed by implant revision or replacement.

Rupture

Both saline- and silicone-filled breast implants can rupture. When a saline-filled implant ruptures, it often leads to a noticeable deflation of the breast implant within a matter of days. A silicone-filled breast rupture might go undetected because the silicone can be trapped in the surrounding tissue (called a ‘silent rupture’). Signs of a silicone-filled implant rupture include changes in breast shape and size, as well as increasing pain, firmness, and swelling over a period of weeks.

The longer breast implants stay in the body, the greater the risk of rupture. The FDA recommends that people with silicone-filled breast implants undergo breast MRI screening to evaluate for silent ruptures 5–6 years after surgery, followed by every 2–3 years thereafter. In some cases, silent ruptures can be observed without surgery. Most times, however, ruptured implants need to be surgically removed, as they increase the risk of other complications, including CC.

In 2019, the FDA recalled specific models of textured breast implants — implants with a thicker, rougher outer silicone shell — due to an increased risk of a cancer called anaplastic large cell lymphoma (ALCL).

While it is not known exactly how textured implants might cause ALCL, one hypothesis is that they promote the formation of bacterial biofilms that increase inflammation in the body. At least 1,400 cases of breast implant-associated ALCL have been recorded to date. The cancer affects 1 in 355 women with textured implants and is diagnosed on average 11.7 years after breast reconstruction surgery. Research is still underway to confirm whether smooth implants increase the risk of ALCL. The type of filling (silicone or saline) does not appear to play a role.

In September 2022, the FDA released a safety communication warning that an aggressive cancer called squamous cell carcinoma (SCC) has also been found in patients receiving breast implants. SCC arises from the fibrous capsule surrounding the breast implant and has been seen in silicone, saline, textured, and smooth implants. A study of the available literature found 16 reported cases of breast implant-associated SCC, occurring on average 23.56 years after implant placement. According to the ASPS, the rarity of cases to date makes it difficult to determine what factors increase patient risk.

Suboptimal post-marketing surveillance of patients receiving breast implants may be one reason it has taken the FDA so long to discover and inform the public about the risk of cancer in this population. The FDA has since partnered with the ASPS and the Plastic Surgery Foundation to develop the PROFILE Registry to facilitate ongoing physician reporting of ALCL and SCC cases.

Breast implant illness

Fatigue, joint pain, headaches, or brain fog occurring after breast implant surgery may signify a condition called breast implant illness (BII). BII originates from the immune system’s reaction to breast implants — a foreign agent. BII is not an official medical diagnosis, and its prevalence is unclear. However, a 2023 study confirmed that BII is a true clinical entity causing significant morbidity, which can be reversed with breast implant removal.

People with autoimmune diseases such as type 1 diabetes, lupus, psoriasis, or rheumatoid arthritis are thought to have an increased risk of developing BII due to a dysregulated immune response. They may also have more severe manifestations of the disease compared to those without autoimmune diseases.

Symptoms of BII can occur any time after breast implant surgery, from days to years later. Over a hundred symptoms have been associated with BII, including anxiety and depression, chronic pain, hair loss, muscle weakness, gastrointestinal problems, and skin changes.

If you have symptoms of BII, it is important to see your physician to determine whether there may be another medical explanation for your symptoms. If your symptoms are attributed to BII, the only definitive treatment is the removal of the implant. A small study showed that 70% of patients with BII experienced symptomatic improvement after implant removal.

What should you do if you have breast implants?

Unfortunately, many complications of breast implant surgery are unavoidable. The risk of complications increases the longer breast implants stay in place. They are not considered lifetime devices, and the ASPS recommends that they be removed or replaced about every 10–15 years.

If you do have breast implants, it is important to monitor for any signs or symptoms that may suggest a problem with your implants. Since changes that occur as part of the normal recovery process can be difficult to distinguish from those that point toward a more serious complication, always consult your physician when things don’t go as expected. Be sure to follow your physician’s instructions to reduce the risk of damaging your breast implants. Some providers may recommend doing breast implant massages to help with the recovery process.

When to consider removing or replacing your breast implants

For many people, breast implants can last a long time without significant side effects or complications. For others, however, they may need to be removed or exchanged for any of the following reasons:

  • Capsular contracture
  • Rupture or deflation
  • Infection
  • Breast implant illness
  • Breast cancer

Additionally, sometimes, patients may elect to have implants replaced if they are dissatisfied with how their breasts appear after the implants have fully settled, or if their implants have rotated or shifted. One study found that cosmetic concerns were the most common complaint among women leading to breast implant removal.

In breast implant removal surgery, your surgeon will make a similar incision as when you received surgery for your original implant placement. They will then remove the implants and sometimes the surrounding scar tissue. The incision is closed, and recovery usually takes several weeks.

If you still desire implants, your surgeon will typically remove the old implants and place new ones during the same surgery unless there are complications — such as an active infection — necessitating that the new implants be inserted at a later time. In some cases, such as cancer or BII, the implants must be removed permanently to treat the associated problems.

Who should not get breast implants?

Breast implants are not advised for everyone who wants them. For instance, people with a history of breast infections, breast cancer (or abnormal mammograms), autoimmune disease, certain other medical conditions, and sensitivity to silicone are urged not to pursue breast implantation.

Individuals under age 18 are also not good candidates for breast implantation because their breasts are naturally still developing. Implantation prior to breasts’ completing their development can lead to deformities.

Breast augmentation is not typically recommended for people who plan to get pregnant. Women with breast implants are more likely to be unable to breastfeed and less likely to exclusively feed their infants breast milk than those without implants. It is recommended to wait three months after ceasing breastfeeding before getting breast implants.

If you decide to get breast implant surgery, you find yourself in good company, as breast implant surgery has become more popular with time. However, modern reports of breast implant-associated cancers and growing awareness of short- and long-term complications have raised increasing concerns about their safety. Always discuss the risks, benefits, and process of breast implantation with a board-certified plastic surgeon to help you make an informed decision as to whether this procedure is best for you. Importantly, remember to love yourself and your body the way it is — breast implants or not.

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