As the former director of French breast-prosthesis company Poly Implant Prosthese (PIP) contemplates the hefty jail sentence that he and his cohorts have just received for selling defective breast implants around the world, it may be time for a closer look at implants and how best to live with them.

A breast implant is not just for Christmas – it’s a long term commitment, yet not a “happily ever after” that you have done and never have to bother with again. In recent years, encouraged by the “extreme make-over” culture, the eye-popping silicone-enhanced bosoms of squadrons of celebs and the greater affordability of cosmetic procedures, breast enhancement has taken off in unprecedented ways.

Not everyone is thrilled with this, however. Last year a survey in Britain showed a high level of concern about the marketing of “cut price” surgery:

“The proliferation of advertising for cosmetic surgery and its use in TV make-over programmes was felt to trivialise surgery and its risks, while making excessive claims of its impact on people’s emotional well-being” – Sir Bruce Keogh, summarising responses from the public in December 2012.

For women undertaking surgery for cancer, the situation can be even more difficult. After all, cancer did not wait for you to choose a ‘new look’ or even to research the options. Cancer restructures you without permission!

The fact is that women’s bodies, especially our breasts, are an emotive issue – not only for individuals but for society in general. The only people with a simple attitude to the female breast are breast-fed babies, for whom the breast is comfort and survival. For the rest of us, it’s complicated….

Controversy over dangers posed by silicone implants, whether sub-standard or not, continues to rattle around the blogosphere. On the one hand, a recently released research report found no scientific evidence that silicone gel is more than a nuisance factor, even if it leaks into local tissue and/or is transported away from the breast.

Women, however, are unique individuals and complex, unexpected emotions can follow breast implantation including constant irritating awareness of the implants, anxiety, breast pain and difficulty sleeping (especially if you are a stomach or side sleeper). Symptoms such as pain must be taken seriously because it could be a low grade infection (see below). Saline (salt water) implants are an alternative to silicone, but they are prone to collapse and don’t feel like natural breast tissue, which makes them less popular with breast surgery patients.

So what is a woman to do? Cosmetically, the results of early breast reconstruction can be excellent, which is a huge help in getting your confidence back after a cancer scare. And, the world is what it is. Not many women as yet have the courage to do this though we think it’s a great trend.

We’re just happy to see a woman walk out of Bay Breast Care all smiles, full of confidence and relief that surgery is behind her, and she has a good-looking prosthesis. However, like any other asset, your implant needs looking after if you want to be sure it doesn’t become a liability.

Capsular Contracture

This sounds rough but is the body’s natural response to a foreign body that’s there to stay – a protective capsule forms as connective tissue knits around the implant. Over time, this can pull too tightly against the implant, which makes the breast feel hard and can also become painful. If this happens, you’ll need a small operation called an “open capsulotomy” to relieve the tightness and give the implant room to move again. It’s also possible to remove all the scar tissue that has formed (“open capsulectomy”) but this is a bigger operation and not often needed.

Rupture of implant

Along with leakage this was the main problem with PIP implants, but even good quality implants can rupture as they get weaker over time. Occasionally, the implant is damaged during the operation to insert it, is faulty, or is damaged after insertion by a bruise or other injury to the chest. A ruptured implant should always be removed and replaced. If it’s not clear that the implant has ruptured, a scan should be done to make sure all is well.

Siliconomas

Silicone is mobile, and if the cover of the implant ruptures it can spread through the scar capsule and into surrounding tissue, forming small lumps called siliconomas which may feel tender to the touch. If sore, they had best be removed. Siliconomas will also need removing if they spread into muscles, lymph nodes or even to the nerves of the arm which lie quite close to the armpit. This is not common but is something to be aware of.

Gel bleed

Even if the implant does not rupture and is of good quality, tiny molecules of the gel escape over time and are taken up into surrounding tissues or the lymphatic system, where they may cause swelling of the nodes. It’s not thought that silicone can trigger any auto-immune condition and it is not toxic, but if the enlarged node is uncomfortable a doctor or surgeon should be consulted.

Some women have complained of fibromyalgia (muscle pain), depression and anxiety after having implants. Whilst scientific evidence that this can occur is weak, it’s your body and your health after all. If you start to feel that you’d do better without the implant, call your doctor and talk it through.

Skin oddities

The outcome of an implant is not always cosmetically perfect: sometimes there is scarring, creasing or folding of the skin, especially if the breasts were small before. Tempting as it may be to go as big as you can (and some surgeons seem to share this temptation), the results are likely to be better if you keep the breast size small. Changes in sensitivity of the skin, and of the nipple if preserved, are also common after implant surgery, though this will probably settle within six months.

Infection and bleeding

Infections after cosmetic breast implantation are not common as long as the work is done by a reputable clinic, but following cancer surgery there’s a higher risk. It’s really important to keep a check on this and to call your surgeon if you’re at all worried or uncomfortable.

Our approach is an excess of caution: yes, breast surgery can be difficult emotionally and yes, women do sometimes experience pain that has no direct physical cause or treatment – but we would rather be on the safe side, listen to the patient, and keep checking until she is happy and comfortable.

If there is an infection or abscess, it doesn’t mean the end of your new breast, though for a bad infection the implant will have to be removed so that you can treated with antibiotics. When the infection has cleared up, it’s usually recommended to wait about three months before re-inserting the implant but there’s no problem in doing so.

 

Whether you choose to have a silicone implant, a saline implant, a soft external prosthesis, nothing at all or a dramatic tattoo, the most important thing is that you are able to make your own choice with full knowledge of the problems that might arise and how to handle those problems.

Above all – don’t panic. The Internet is full of people who are miserable with their implant choices – whilst those who are content are much less likely to be blogging or chatting about it and more likely to be getting on with their (probably quite ordinary) lives. But if you’re at all worried call your doctor and talk it over.

From Bay Breast Care here in Port Elizabeth, we wish our patients and readers a joyful Christmas and a healthy, prosperous New Year!