Over the last 20 years, there has been extensive research done on breast implants. Clearly, women have enjoyed and benefited from these devices. As research and clinical studies continue, largely through reputable organizations such as The Plastic Surgery Research Foundation, the American Society of Plastic Surgeons, and the American Society for Aesthetic Plastic Surgery, we continue to learn more about breast implants and any effects they may have on patients.

I’d like to explain some basic information, discuss how I have seen breast augmentation (enlargement) change over the years, and make you aware of a condition (BIA-ALCL) now associated with textured implants.

The Evolution of Breast Implants

Even before breast implants were manufactured, women wanted to have the option of not “putting up with” or “living with” their natural breast size and wanted the choice to have larger breasts, if possible. But it wasn’t until 1962 that a truly viable option was introduced.

In the past, doctors have injected substances such as oils, teflon, sponges, rubber, and cartilage into the breast to increase its size. This proved unsuccessful and often resulted in lumps, bumps, and infection. They realized that something was needed to contain the substances, so they developed devices with an outer “shell” and an inner substance, or “fill.” These were surgically inserted to enlarge the breast, creating the first “breast implants”. Early on, the outer shell had poor integrity (too porous) and the inner contents eventually leaked out. This lead to problems including hardening, scaring, pain, and distortion. Doctors learned that liquid substances floating around in the breast are not tolerated. So plastic surgeons realized that the implant needed better integrity. The outer shell needed to prevent leakage.

As plastic surgeons, we saw increasing success as the outer shell became less porous and the inner content became thicker. Today, most breast implants have outer shells of silicone and inner content of silicone. The outer shell is no longer porous (so it has better integrity) and the inner silicone is cohesive (meaning even though it is a liquid, it behaves more like a solid).  In other words, even if the outer shell were to rupture or break, the inner contents are not as irritating to the body because the material is not free-flowing. Rather, it is more like jello than it is like syrup.

Silicone implants (which consist of a silicone shell with silicone fill) have been around for more than 40 years. There has been ongoing research to develop implants with different materials, such as saline-based implants, which are still available today. Occasionally, women with implants develop medical problems and some believe that breast implants lead to illness (specifically, BII or Breast Implant Illness). However, plastic surgeons continue to learn more about breast implants and about breast implant illness in the future.

Shaped Implants

As research continued, manufacturers marketed “shaped” (not round) implants. A shaped implant is teardrop- or wedge-shaped. You can imagine that a wedge-shaped, dense implant must move once it is inserted; otherwise, it would face the wrong direction. If it did move, it would cause the breast to have a bizarre shape. To keep the shaped device in place, the outer shell was made rough, textured or bumpy so that it would “stick” or lock into place. Rough texturing has been used in round implants to keep them in place as well.

So, what happens when this rough device doesn’t fixate and stay put? You guessed it, it moves. This movement can cause an irritating “scratching” effect on the inside of the body. In turn, this friction could generate fluid or a change on the internal tissues which could possibly cause abnormal cells to form.

Are your implants textured?

What we now know is that a small percentage of women with textured implants develop abnormal cancer cells in the fluid and tissue around the implant. This is not breast cancer. It is a type of lymphoma. It has not ever been found in women with smooth devices. This type of lymphoma is Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).

How do you know if you have a problem? The signs to look for include: swelling, redness, lumps, discomfort, or a change in the appearance of the breast. Notify your physician or surgeon if you notice any of those signs. Early diagnosis can lead to a cure.

My recommendation for anyone who has, or who has had, breast implants, whether for post-mastectomy reconstruction or for cosmetic breast enlargement, is to find out the details of the implant used in your procedure. To find these details, you can call your plastic surgeon, look at your implant card, or you can request your surgeon’s operative note. It is important to find out what type of implant you have.

BIA-ALCL research is ongoing and we will continue to learn more about this condition. In closing, I want to remind you of the importance of breast health surveillance including breast self-exams, mammograms (if applicable), and yearly examinations by your physician.


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