Over the last 20 years, there has been extensive research performed on breast implants. Clearly, women have enjoyed and benefited from these devices. As clinical studies continue, plastic surgeons and the FDA continue to learn more about breast implants and their potential health effects.

How Implants Came to Be

I’d like to review the history of how breast implants came to be and focus on the implants we have available today. I will give my view on the latest information surrounding breast implant illness (BII) and a rare condition (BIA-ALCL) now linked to textured breast implants, once deemed the “safest” implant. Finally, I will highlight an implant that has withstood the test of time.

Even before breast implants were manufactured, women wanted the option of increasing their natural breast size. Many things were tried to make the breast larger. Early on, doctors injected oils, Teflon, sponges, rubber, and cartilage into the breast to increase its size. This proved unsuccessful, causing lumps, bumps, and infections. Doctors realized that injecting things into the breast tissue was not the answer. Instead, an outer container must be utilized for safe, lasting, breast augmentations. Thus, the first breast “implant” was introduced in 1962. Initially, the outer shell of the implant had poor integrity (too porous) and the inner contents leaked out. This led to problems including hardening, scarring, pain, and distortion.

We learned that liquid substances floating around in the breast are not well-tolerated. What was needed was an implant with better structural integrity, with an outer shell that prevented leakage.

As plastic surgeons, we saw increasing success as the outer shell became less porous and the inner contents became thicker. Today, silicone breast implants have an outer shell of silicone and an inner fill of silicone. The inner fill of silicone is cohesive meaning it behaves more like a solid than a liquid. This means it doesn’t drip or move around, even if the outer shell is ruptured. In other words, even if the outer shell were to break, the inner contents are not irritating to the body because the material is not free-flowing. This combination of thick inner contents and a non-leaky outer shell was the answer to breast augmentation.

Silicone implants have been around for more than 50 years. During this time, women have enjoyed and benefited from these devices for both reconstructive and cosmetic reasons. There has been ongoing research to develop implants with different materials, such as saline-based implants, which are still available today.

Shaped Versus Round Implants

As research continued, manufacturers marketed “shaped” (not round) implants with texturing. A shaped implant is not round, but wedge-shaped. You can imagine that a wedge-shaped implant should NOT 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, and bumpy so that it would “stick” or lock into place. Rough texturing has also been used in round implants to keep them in place as well.

So what happens when this rough outer shell doesn’t fixate and stay put? You guessed it: the implant moves, flips or rotates. This movement can cause a visual issue, distorting the breast as well as producing fluid, swelling, pain, malposition, and distortion. Perhaps it is this movement and irritation that causes a rare condition where abnormal cells appear in the tissue or fluid around the implant. This condition is called BIA-ALCL, Breast Implant-Associated Amorphous Large Cell Lymphoma. Interestingly, this condition is associated only with textured breast implants.

Uncommon Condition (BIA-ALCL) Now Linked To Textured-Surface Implants

What we now know is that a small percentage of women with textured, not smooth-surfaced implants develop abnormal cancer cells in the fluid and tissue around the implant. This is not breast cancer. It is a type of lymphoma called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). It has never been found in women with smooth implants. The aggressive texturing found in Bio-Cell Allergan implants has largely been the culprit of this condition. These implants have been recalled by the FDA. You can protect yourself by insisting on smooth implants when considering breast augmentation.

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 or feel of the breast. Notify your physician or surgeon if you notice any of these signs. Early diagnosis can lead to a cure.

My recommendation for anyone who has breast implants 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. I want to remind you of the importance of breast health surveillance including breast self-exams, mammograms, and yearly examinations by your physician.

Your Options for Removing Textured Implants

Over time, some women may feel their implants are causing them anxiety or worry. Or, they may be reconsidering their breast implants. It’s important to know that it is possible to have your textured implants replaced with smooth implants or have your implants removed entirely. I suggest finding a well-trained plastic surgeon who has experience removing and replacing implants. Often, additional procedures may be necessary after an implant is removed or downsized. You should be properly counseled on all your options, including en-bloc removal, removal and replacement, implant explant with a breast lift, and other procedures.

Smooth breast implants have become the gold standard breast implant and the only implant I have used for breast cosmetic surgery. They are natural-looking, soft, respond to gravity and movement, and are the closest thing to real breast tissue. Every patient on my website with breast augmentation, augmentation/lift, or remove and replace surgeries have smooth breast implants. See for yourself how beautiful and natural they are. When removing textured breast implants, your surgeon must be well-versed in how to safely and effectively reconstruct the breast for long-lasting beautiful results. Otherwise, problems may develop that will require additional surgery and expense.


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