How does a bag of silicone or saline arouse such strong emotions? Bring up the topic of silicone gel implants at a cocktail party and you’re likely to hear all sorts of stories about how so-and-so died from their implants, or which celebrity “went too big.” Even Seinfeld has an entire episode dedicated to the subject –
The echoes of the high-profile lawsuits of the 1980’s still reverberate today. The entire landscape of plastic surgery changed. Everyday in my practice I address these issues and there are certain myths and part-truths that routinely come up. I’ve put together 6 myths regarding breast implants that I hear often and present the facts that I discuss with my own patients. I hope this helps clear up some of the confusion!
Myth #1 – All Breast Implants look “fake”
Fact – The “natural” breast augmentation is more common than you think
Certainly Baywatch (notably Pamela Anderson) gave many women the wrong impression of a breast augmentation. Sure, it is easy to create round, fake appearing breasts that double as flotation devices. But the reality is that many breast augmentations look very natural. In fact, you probably have friends who have breast implants and you don’t even know it. The trend today is towards bio-dimensional planning. This technique matches the patient’s natural breast anatomy and the implant dimensions. The result is a breast which is pushed forward by the implant so that the breast itself is accentuated rather than the implant. Newer tear-drop shaped (gummy bear) implants allow for an increase in breast size without creating a round upper pole to the breast. The results are “natural” appearing breasts that make women feel better both in clothing and out.
Myth #2 – Breast implants are dangerous!
Fact – Breast implants are safe, effective medical devices when used appropriately
The concern regarding health effects of breast implants are typically levied against silicone gel implants. These concerns regarding silicone implants and the possible side effects were brought to a national spotlight in the 1980’s. Multiple class-action lawsuits against implant manufacturers led to significant changes in the design of implants, an increase in research regarding the safety of silicone implants, and a 1991 moratorium on the use of silicone gel implants in cosmetic cases until safety data had been established. The new generation of silicone implants were redesigned to have a lower rupture rate and a stickier (more cohesive) silicone gel to reduce migration and gel bleed. In 1999, the Institute of Medicine released its report regarding the safety of silicone gel implants – READ IT HERE. In November of 2006 the FDA approved the use of silicone gel implants for cosmetic use for women age 22 and older. An integral part of the approval was that the FDA required large post-approval studies to assess long-term complication and adverse outcome data. The data collected from the post-approval studies will further impact future recommendations by the FDA. You can read the information posted by the FDA HERE. The most recent FDA review was in 2011 and these were the findings:
- Silicone filled breast implants have a reasonable assurance of safety and effectiveness when used appropriately.
- Silicone and saline breast implants have no apparent association with connective tissue disorders, reproductive problems, or breast cancer.
- Breast implants do have a higher risk of local tissue complications such as capsular contracture (scar tightening around the implants), breast pain, reoperation, wrinkling, asymmetry, scarring, infection, and implant rupture.
- The longer a woman has breast implants, the more likely she will experience a local tissue complication or adverse event. Women with breast implants will need to monitor their breasts for signs of complications throughout their lives.
- MRI is the most effective method of detecting a silent silicone gel implant rupture. Frequency of MRI is recommended at 3 years post-implantation and every other year after that.
- Women may have a very small but increased risk of being diagnosed with anaplastic large cell lymphoma (ALCL). For more information on ALCL – CLICK HERE
- Routine replacement of breast implants is not necessary, but many women may need to modify, remove, or replace their implants.
What this data tells us is that breast implants may cause local tissue complications, and some of these may be severe. However, there is insufficient data to show a cause and effect relationship between breast implants and cancer, autoimmune disease, or reproductive problems. Implants are not lifetime devices and women may require surgery in the future.
Myth #3 – Breast implants need to be replaced every 10 years
Fact – Routine replacement of breast implants is not currently recommended
It is true that in the past, many plastic surgeons recommended replacement of silicone breast implants after 10 years. This was due to the higher chance of rupture with these older implants Rupture rates of ~2% per year, cumulative up to 10 years were seen. A ten-year rupture rate of 20% led some to recommend implant replacement every 10 years. Today, the implant rupture rates are much lower (Mentor – 0.2% at 3 years, Allergan – 0.5% at 2 years). As such, the recommendation is to replace implants only when a rupture is known. For saline implants a rupture deflates the implant and is obvious to both the patient and the physician. For the silicone gel implants, we have not reached a time frame in which rupture rates would indicate that routine replacement is recommended. Instead, patients are advised to undergo regular MRIs to evaluate the integrity of the implants. If a rupture is suspected, then replacement is recommended. To help patients who have a rupture, the implant manufacturers offer lifetime warranties on their implants for ruptures and often give stipends for replacement if the rupture occurs in the first 10 years.
Myth #4 – Women with implants cannot have mammograms
Fact – Implants can make mammograms more difficult to read, but are not contraindicated
Women with breast implants are encouraged to continue having their routine mammograms. The implants can interfere with the visualization of the breast tissue and certain techniques (Eklund views) are used to move the breast tissue around the implants for better visualization. In some circumstances the use of additional imaging (Ultrasound or MRI) may be used to better visualize areas of the breast. It is important to note that there are no studies which show a statistically significant increase in breast cancer rates for patients with silicone breast implants.
Myth #5 – Women with breast implants cannot breastfeed
Fact – The ability to breastfeed may change, but there is no contraindication to breastfeeding
There are really two questions here –
- Do implants affect the ability to breastfeed?
- Is it safe to breastfeed if you have implants?
A breast augmentation procedure may affect the ability of a woman to breastfeed. If there is a division of the milk ducts to the nipple, the ability to breastfeed may be compromised. However, it is important to note that not all women are able to breastfeed regardless of whether they have had a breast augmentation or not. Women should be counselled that the ability to breastfeed may be compromised following a breast augmentation.
It is unknown if a small amount of silicone may pass through from the breast implant into breast milk as there are no current methods available to accurately detect silicone levels in breast milk. One study looking at silicon (a component of silicone) levels in breast milk did not find higher levels in breast milk from women with silicone gel-filled implants when compared to women without implants.
A related question is whether breast implants affect pregnancy. Studies have also been done looking at whether children born to women with breast implants had more birth defects or a higher mortality rate. A Scandinavian study found no difference in rates of perinatal mortality, congenital malformations, esophageal disorders, or rheumatic disorders in children born to mothers with implants from women without implants.
Myth #6 – Gummy Bear implants are “leak-proof”
Fact – All currently available breast implants can leak
This is a relatively recent myth which has begun to make the rounds. Gummy bear implants are highly cohesive, form-stable, anatomically shaped silicone gel implants. This means that the gel on the inside of the implant is so sticky, that it is able to keep its tear drop shape regardless of position. Still, these implants can and do rupture. The 7 year data from Allergan for their highly cohesive 410 implants showed a rupture rate of 11%. However, none of these patients with a ruptured 410 implant demonstrated extracapsular silicone. In other words, although the implant ruptured, all of the gel remained inside the implant capsule.
A unique complication of these types of implants is something called gel fracturing. This is where a fissure or crack appears within the gel of the implant. It is uncertain as to what clinical effect this may have on the implant. From the approval studies, gel fracturing did not appear to affect the rupture rates. More data is needed to determine if this will have any effect on the longevity of the implants.
The Bottom Line…
It is important for women who are contemplating a breast augmentation to know the facts regarding breast implants. Unfortunately, the internet is a wonderful source of misinformation and doctors in all fields deal with their own medical “myths” everyday. This is why board certification matters, why consultations matter, and why we spend so much time educating our patients. Breast implants are safe devices, but that does not mean that complications cannot or do not arise. As with any cosmetic surgery, each patient must determine whether the perceived benefits outweigh the known risks. Hopefully these answers and the links provided will de-mystify breast implants for women in the future.