Like all surgery, implant surgery has some risks. Many of these risks are the same as the risks for mastectomy. However, there are some risks that are unique to implant reconstruction.
Scars: No matter which type of surgery you decide to have, you will have scars in the breast area. Scars do fade and recede over time in most women, but they don't go away completely. Still, most scars are generally out of sight during daily activities, even in a bathing suit or low-cut top or dress.
Capsular contracture: Once a breast implant is in place, scar tissue forms around it, creating what's called a tissue capsule. These tissue capsules usually are soft or slightly firm and not noticeable. But in a small number of women, a hard tissue capsule forms that can be painful and distort the shape of the breast. This is called capsular contracture. Research has shown that implants with a textured surface can help reduce the risk of capsular contracture compared to implants with a smooth surface.
Radiation therapy given after reconstruction surgery can increase the risk of a scar tissue capsule forming. If you and your doctors decide that radiation therapy is right for you after you've had implant reconstruction, tell your radiation oncologist right away that you have an implant so you can minimize any risk.
If capsular contracture does happen, a surgeon can break up the scar tissue and replace the implant if necessary. The exercises your surgeon or physical therapist prescribes for you can help reduce the risk of a hard tissue capsule forming. Massage can also help. Ask your surgeon or nurse to show you how to massage the implant and the area around it to help prevent a hard tissue capsule. Find out more about managing scar tissue formation.
Tissue breakdown: Sometimes the tissue in the breast area doesn't heal properly because of pressure from the implant or expander. The network of vessels that supply blood to the tissue could have been slightly damaged during surgery or radiation. Smoking and diabetes also can damage the small blood vessels that supply blood to the tissue and promote healing.
Doctors call this tissue breakdown “necrosis.” Some symptoms of tissue necrosis include pain and bleeding, the skin turning dark blue or black, numbness, and sores that ooze a bad-smelling discharge or pus. You also may run a fever or feel sick.
If tissue breakdown happens, the dead tissue will need to be removed and the open area has to be closed, either by regrowth of your own tissue or by using a dermal matrix product. In some cases, your surgeon may recommend a skin or tissue graft (taking skin or tissue from another place on your body) to cover or fill in the affected area.
There is also a high risk that the implant will have to be removed as a result of contamination.
Pain around implant: Some women feel pain or discomfort from the tissue expander, the implant, or scar tissue putting pressure on a nerve or other sensitive area. Your doctor may prescribe a program of exercise, stretching, and massage, and possibly anti-inflammatory medicines, to relieve mild pain. Acupuncture, breathing exercises, yoga, and meditation also can help. If you have pain that is intense, your doctor may recommend physical therapy, seeing a pain specialist, or stronger medicines.
“Dynamic distortion,” or distortion with movement: A breast reconstructed with an implant may move in unnatural ways as you flex your chest muscle (pectoralis muscle). Because the skin tends to scar down to the underlying muscle, any movement may cause distortion in the shape of the breast. Although this isn’t dangerous, some women find it uncomfortable or distressing -- especially if it wasn’t discussed as a possibility before surgery.
Shifting, leaking: There's a small risk that your implant might shift slightly over time. If that happens, you may be able to massage it back into place. If your implant shifts a lot, schedule an appointment with your plastic surgeon to discuss ways to stop the problem. In some cases, your surgeon may have to build a reinforced pocket in your chest to hold the implant in place. This pocket is made from your own tissue and a dermal matrix product, if needed.
All implants have a slight risk of rupturing. The chance of your implant rupturing increases over time. Most implants that have been in place for 10 to 15 years have some leakage, but it's usually very small and not a problem.
If a saline implant ruptures, the saline leaks out quickly and the breast appears somewhat deflated, so you know immediately that it's ruptured. The salt water is absorbed by the body.
If a silicone implant ruptures, the gel leaks out more slowly because it's thicker, so it may take you longer to realize that the implant has ruptured, or you may not realize it at all. Silicone gel is not absorbed into the body and can show up on an MRI (magnetic resonance imaging) scan or sometimes on a regular X-ray. The FDA recommends that you receive MRI screening for “silent rupture” 3 years after receiving your implant and every 2 years after that for the rest of your life. Getting health insurance to cover this can be challenging, so you may have to work with your doctor’s office on this. If at any time you think your silicone implant is leaking, have your doctor check it. A leaking silicone implant should always be replaced. Your body may react to the silicone by forming more scar tissue, which might be uncomfortable or cause a distorted breast shape.
Breast implants and the risk of breast anaplastic large-cell lymphoma
In January 2011, the U.S. Food and Drug Administration reported a possible link between both saline and silicone breast implants and a very rare form of lymphoma -- anaplastic large-cell lymphoma (ALCL) -- in the tissue near the implant. The possible link came to light when a study identified 34 women diagnosed with ALCL in a breast with an implant. Because ALCL is incredibly rare, the researchers doing the study and the FDA took notice when these women were diagnosed. Breast ALCL usually developed in and around the tissue capsule that forms naturally around an implant.
It's very important to know that the FDA ISN'T SURE that a link exists between breast implants and breast ALCL. The FDA has emphasized that even if there is a link, the risk of breast ALCL in women with breast implants is still extremely low. Currently available FDA-approved breast implants are safe when used as recommended by the manufacturer. The FDA advised "women with breast implants who are not showing any symptoms or problems, such as pain, lumps, swelling, or asymmetry, require only routine follow-up."
If you're considering implants, know that the FDA doesn't think that the possible link between implants and ALCL should discourage women from implant reconstruction.
If you have a breast implant, be reassured by the FDA's advice about implants. Still, don't hesitate to call your doctor if you're concerned. Definitely call your doctor if you have symptoms or problems with your implant, such as pain, lumps, swelling, or asymmetry.