What Could Go Wrong
- thick, obviousscarring
- the breast feeling hard because scar tissue has shrunk around the implant
- a ruptured implant this may cause small tender lumps , which are only noticeable on breast scans the implant will need to be removed
- creases or folds in the implant
- the implant rotating within the breast, resulting in an abnormal shape
- rippling of the implant this happens when the implant is only covered by a thin layer of tissue, which sticks to the surface of the implant and is very difficult to treat
- nerve problems in the nipples they may become more sensitive, less sensitive, or completely numb this can be temporary or permanent
- not being able to breastfeed or producing slightly less breast milk than you would without implants
Also, any type of operation carries a small risk of:
- bleeding and clots blood clots can be life threatening
- infection this is rare and would need to be treated with antibiotics
- an allergic reaction to medicine or products used during surgery, such as antibiotics or latex
Your surgeon should be able to tell you more about these problems, including how likely they are and how they’ll be corrected if you have them.
Factors That Do Not Increase Breast Cancer Risk
Many factors have been studied to see whether or not they increase the risk of breast cancer.
Some of these factors have been proven to be unrelated to breast cancer and dont increase risk. Some may even decrease risk .
A full list of factors that dont increase breast cancer risk is too long to present here. Some, however, deserve mention because theyve been studied more than most or theyve gotten a lot of media attention.
Our Breast Cancer Risk Factors Table compares these and other factors by level of risk and strength of evidence.
The factors below are listed alphabetically.
Research clearly shows no link between abortion and the risk of breast cancer .
Since 2003, the American College of Obstetricians and Gynecologists and the National Cancer Institute have agreed the scientific evidence does not support a link between abortion and breast cancer . The ACOG reaffirmed its conclusion in 2019 that theres no link between abortion and breast cancer .
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Breast Implant Safety: A Decades
Since the 1960s, implants have been used to restore the look and shape of the breasts after a mastectomy and for cosmetic breast enlargement . Theyve grown in popularity in recent years despite the fact that for decades there have been heated debates over their safety. In 2018, more than 101,000 breast reconstruction procedures were performed in the U.S., and 82% of them used implants. In addition, more than 313,000 breast implant surgeries were performed for cosmetic augmentation. 3
Some breast cancer patients more than 18,000 in 2018 chose reconstruction using their own tissue rather than implants. 3 Women who opt for autologous surgery tend to have higher long-term satisfaction with their reconstruction. But autologous surgery is less common because fewer plastic surgeons have experience with it, its a more complex surgery with a longer recovery time, and some women arent candidates, usually because they dont have enough extra tissue.
Plastic surgeons are supposed to carefully go over the risks and benefits of a reconstruction procedure, and the alternative treatment options, with a patient before the surgery takes place. Recently, a number of women who got breast reconstruction with implants have raised concerns about whether they received enough information from their doctors about newly emerging risks before they agreed to the surgery.
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How Will These New Rules Likely Impact Patients
Women considering breast reconstructive surgery using implants at MSK are routinely informed of the risks and the benefits of breast implants. Our patients are also presented with the other options reconstruction with their own tissues or external prosthesis, for example that may be suitable. At MSK, we take pride in providing individualized treatment plans for each patient. Our doctors and nurses clearly explain the pros and cons of each procedure, empowering our patients to make the best possible choices for themselves.
Reporting Of Confirmed Cases
The U.S. Food and Drug Administration specifically recommends that all confirmed cases be reported to the PROFILE registry. The PROFILE registry is a joint effort of the FDA and ASPS/PSF. If you have been diagnosed with BIA-ALCL, please ensure your physician has reported the case to the PROFILE registry for tracking of cases. Information reported to PROFILE is updated with the FDA on a monthly basis. While PROFILE is a physician reporting system, if you would like to report your case directly, you may contact PSF who can get you in contact with a physician willing and able to report your case.
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What Kinds Of Surgery Can Reduce The Risk Of Breast Cancer
Two kinds of surgery can be performed to reduce the risk of breast cancer in a woman who has never been diagnosed with breast cancer but is known to be at very high risk of the disease.
A woman can be at very high risk of developing breast cancer if she has a strong family history of breast and/or ovarian cancer, a deleterious mutation in the BRCA1 gene or the BRCA2 gene, or a high-penetrancemutation in one of several other genes associated with breast cancer risk, such as TP53 or PTEN.
The most common risk-reducing surgery is bilateral prophylactic mastectomy . Bilateral prophylactic mastectomy may involve complete removal of both breasts, including the nipples , or it may involve removal of as much breast tissue as possible while leaving the nipples intact . Subcutaneous mastectomies preserve the nipple and allow for more natural-looking breasts if a woman chooses to have breast reconstruction surgery afterward. However, total mastectomy provides the greatest breast cancer risk reduction because more breast tissue is removed in this procedure than in a subcutaneous mastectomy .
Even with total mastectomy, not all breast tissue that may be at risk of becoming cancerous in the future can be removed. The chest wall, which is not typically removed during a mastectomy, may contain some breast tissue, and breast tissue can sometimes be found in the armpit, above the collarbone, and as far down as the abdomenâand it is impossible for a surgeon to remove all of this tissue.
Breast Implants And The Risk Of Alcl
Recently the Food and Drug Administration has identified a possible association between textured breast implants and development of a rare form of cancer called anaplastic large cell lymphoma .
The majority of the data suggests the cancer risk is associated with breast implants that have textured surfaces rather than those with smooth surfaces. The risk is low and thus far only a small percentage of patients with textured implants have been found to have ALC in the United States. Nevertheless, out of an abundance of caution the FDA has recalled a specific brand of textured implants.
The Division of Plastic Surgery at U of U Health has stopped using all brands of textured implants in light of the recent concern of developing ALCL. Please note that the recall of these implants does not mean that the implants need to be removed. If you have concerns or questions regarding the recall please refer to the FDA website or speak with your doctor.
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Risk Factors You Can Change
- Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.
- Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.
- Taking hormones. Some forms of hormone replacement therapy taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives also have been found to raise breast cancer risk.
- Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.
- Drinking alcohol. Studies show that a womans risk for breast cancer increases with the more alcohol she drinks.
Research suggests that other factors such as smoking, being exposed to chemicals that can cause cancer, and changes in other hormones due to night shift working also may increase breast cancer risk.
Family History And Inherited Genes
Some people have a higher risk of developing breast cancer than the general population because other members of their family have had particular cancers. This is called a family history of cancer.
Having a mother, sister or daughter diagnosed with breast cancer increases the risk of breast cancer. This risk is higher when more close relatives have breast cancer, or if a relative developed breast cancer under the age of 50. But most women who have a close relative with breast cancer will never develop it.
Some people have an increased risk of breast cancer because they have an inherited gene fault. We know about several gene faults that can increase breast cancer risk and there are tests for some of them. Having one of these faulty genes means that you are more likely to get breast cancer than someone who doesnt. But it is not a certainty.
Two of these faulty genes are known as BRCA1 and BRCA2. These are not common. Only about 2 out of every hundred of breast cancers are related to a change in the BRCA1 or BRCA2 genes.
Ionising radiation includes tests such as x-rays and CT scans and treatment such as radiotherapy.
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Breast Cancers Detected At Smaller Size In Women With Implants
- Thursday, March 29, 2018
Breast augmentation with implants does not interfere with the ability to detect later breast cancersin fact, cancers may detected at a smaller size in breasts with implants, according to a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons .
But mammography may be less likely to detect cancers in breasts with implants, according to the research by Michael Sosin, MD, of MedStar Georgetown University Hospital, Washington, DC, and colleagues. The study also shows some differences in breast cancer diagnosis and treatment in women who have had breast augmentation, including a higher rate of mastectomy.
Main Risk Factors For Bia
Breast implants have a silicone outer shell that can be either smooth or textured, and the main known risk factor for BIA-ALCL is having a textured implant.
The risk factors for BII arent as clear but are likely to include having a personal or family history of autoimmune conditions, allergies, and conditions such as irritable bowel syndrome, migraines, chronic fatigue, or fibromyalgia.
Both smooth and textured implants are filled with either silicone gel or saline . Silicone gel-filled implants are the most common in 2018, 88% of breast implants sold in the U.S. were silicone gel-filled. 3 Much of the attention and research related to the question of whether breast implants can cause autoimmune symptoms or other health problems has centered on silicone gel-filled implants in particular.
While more research is needed on whether implant fill type is linked to a higher risk of BII or BIA-ALCL, its important to know that both conditions have occurred in women who got silicone gel-filled or saline-filled implants for reconstruction or for cosmetic augmentation. A history of breast cancer also doesnt, in itself, appear to increase the risk for BII or BIA-ALCL.
Learn more about each condition, including specific risk factors and possible causes, number of cases, diagnosis, treatment, and more:
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Should My Implants Be Removed Even Though I Have No Symptoms
Medical experts do not recommend removing your breast implants if you do not have symptoms of BIA ALCL, even if your implants are no longer supplied in Australia. This is because BIA ALCL is a rare cancer with excellent cure rates if it is detected early.
The risk of developing BIA ALCL is lower than the risks associated with an anaesthetic and surgery. The complication rate of revision surgery involving implant removal or replacement is also higher with each revision procedure.
Generally, breast implants are not lifetime devices, regardless of breast implant associated cancer. Typically they are removed after 10-15 years. The longer you have the implant, the more likely it will need to be removed. Common reasons for removal are contracture or movement of the implant.
Breast implant associated cancer is rare, but the risk is higher with certain types of breast implants. If you do not remember whether your implants are smooth or textured, or what brand they are, your surgeon or the clinic that holds your operation record should be able to advise you on these details.
It is best to discuss with your surgeon what they would recommend in their clinical opinion given the type of implant you have and the benefits versus risks of removal of implants in a healthy person with no symptoms. You can also discuss a plan for regular check ups. You can seek a second opinion to help you decide on options, or if you are unsure or concerned about the advice you receive from your surgeon.
Do Breast Implants Affect Breast Cancer Risk
|In the United States, plastic surgeons performed 334,052 breast augmentations in 2004. That’s up 19 percent from 280,401 in 2003, and more than a tripling from 101,176 in 1997. Breast augmentation is now more popular than nose reshaping, according to these figures, the latest available from the American Society for Aesthetic Plastic Surgery.|
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Have You Developed Symptoms
The most common symptoms are unexplained breast enlargement, asymmetry, fluid buildup or a lump in the breast or armpit, but may be rarely more subtle such as overlying skin rash, hardening of the breast. Women who develop these symptoms should see their physician to be evaluated with a physical exam and further testing.
Implant Rupture With Mammography Is Rare
Worried that your implant might burst under compression? Its not a common occurrence.
A 2004 study in the Journal of Womens Health examined problems with mammography for women with breast implants. When researchers reviewed adverse events reported to the U.S. Food and Drug Administration , they identified just 44 incidents involving breast implant rupture with mammography.
In a separate review of published studies, FDA researchers identified another 17 cases involving breast implant rupture during compression.
Yet there are almost 300,000 women who undergo breast augmentation each year, says the American Society of Plastic Surgeons.
In many rupture cases, Dr. Baker suspects the implant was already compromised and the compression just helped it along.
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Considering Reconstruction With Implants
Breast cancer patients considering implant reconstruction should discuss the benefits and risks of different types of implants with their physician. There are many breast implant options such as smooth, textured, round, shaped, saline, and both liquid and solid silicone. A physician may suggest a certain implant shape, surface and fill to achieve an optimal reconstruction while minimizing potential complications. BIA-ALCL is an emerging risk of textured implants and patients should be aware when choosing the implant that is right for them.
What Should You Do If You Have Breast Implants
At this time, the FDA does not recommend removal of these or other types of breast implants for patients who have no symptoms due to the low risk of developing BIA-ALCL.
So, the FDAs recent announcement should not change anything for the overwhelming majority of patients who have smooth-surfaced implants or textured implants by other manufacturers, says Henry Hsia, MD, a Yale Medicine plastic surgeon.
Dr. Hsia strongly advises, though, that no matter what kind of implant a person has, its important to be breast aware and report any persistent symptoms to your doctor. Anyone with pain or discomfort or other concerning changes in her breasts should get in touch with her plastic surgeon, he says. Changes include swelling, lumps, or painall are symptoms of BIA-ALCL to look out for.
For years, all of our breast reconstruction patients at Yale Medicine have been counseled extensively when they come for their initial preoperative consultation visit about the BIA-ALCL risks , and the FDA announcement should hopefully only reinforce the counsel and advice that they originally received from their providers, Dr. Hsia says.
Here are some tips to keep in mind if you have implants or are considering them:
Follow FDA advice. If your physician deems that there is BIA-ALCL, you should undergo implant removal as well as removal of the surrounding scar capsule. It may be possible to replace the device with one not associated with BIA-ALCL.
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Additional Screening May Be Necessary
Mammography remains the tool of choice for breast cancer screening. But sometimes doctors recommend additional imaging.
Usually we only do ultrasound screening for women who are high risk or women who have dense breast tissue, Dr. Baker explains. But if the radiologist has trouble seeing breast tissue because of implants, a screening ultrasound is a consideration.
Ultrasound is not a substitute for mammography, he adds, because each yields different information. Mammography picks up tiny calcium deposits that can be a precursor to breast cancer, while ultrasound does not. Ultrasound may reveal a small mass hidden by the implant that mammography cannot detect.