At least 4 million American women have had breast implants. Breast augmentation is performed by placing implants under the pectoralis muscle or, less desirably, in the subcutaneous tissue of the breast. Most implants are made of an outer silicone shell filled with a silicone gel, saline, or some combination of the two. Capsule contraction or scarring around the implant develops in about 15–25% of patients, leading to a firmness and distortion of the breast that can be painful. Some require removal of the implant and surrounding capsule.
Implant rupture may occur in as many as 5–10% of women, and bleeding of gel through the capsule is noted even more commonly. Although silicone gel may be an immunologic stimulant, there is no increase in autoimmune disorders in patients with such implants. The FDA has advised symptomatic women with ruptured silicone implants to discuss possible surgical removal with their clinicians. However, women who are asymptomatic and have no evidence of rupture of a silicone gel prosthesis do not require removal of the implant. Women with symptoms of autoimmune illnesses often undergo removal, but no benefit has been shown.
Studies have failed to show any association between implants and an increased incidence of breast cancer. However, breast cancer may develop in a patient with an augmentation prosthesis, as it does in women without them. Detection in patients with implants may be more difficult because mammography is less able to detect early lesions. Mammography is better if the implant is subpectoral rather than subcutaneous. Prostheses are usually placed retropectorally after mastectomy, but prepectoral placement is used more commonly. Local recurrence is usually cutaneous or subcutaneous and is easily detected by palpation. Rarely, lymphoma of the breast with silicone implants has been reported.
If a cancer develops in a patient with implants, it should be treated in the same manner as in women without implants. Such women should be offered the option of mastectomy or breast-conserving therapy, which may require removal or replacement of the implant. Radiotherapy of the augmented breast often results in marked capsular contracture. Adjuvant treatments should be given for the same indications as for women who have no implants.
et al. NCCN consensus guidelines for the diagnosis and management of breast implant-associated anaplastic large cell lymphoma. Aesthet Surg J. 2017 Mar 1;37(3):285–9.
et al. U.S. epidemiology of breast implant-associated anaplastic large cell lymphoma. Plast Reconstr Surg. 2017 May;139(5):1042–50.
et al. Complications and recurrence in implant-sparing oncologic breast surgery. Ann Plast Surg. 2017 Jun;78(6S Suppl 5):S269–74.
et al. Breast implant-associated anaplastic large cell lymphoma: a systematic review. Plast Reconstr Surg. 2015 Mar;135(3):713–20.
ML. Silicone gel breast implants at 50: the state of the science. Aesthet Surg J. 2012 Nov;32(8):1031–4.