Breast Implant Problems & Procedures

There can be problems with breast implants. Many of the difficulties are related to local effects of the implants – the implants may be too high, too low, or not the same on each side. In general, it is best to wait at least six to twelve months before deciding if there is an issue because often it just takes time for the implants to settle into their final position.

While most the problems with saltwater implants are problems with positioning, silicone gel implants deserve a special warning. They are more prone to local problems, such as hardening or encapsulation, than the salt water implants. In fact, some studies state that a gel implant placed underneath the breast tissue has a 70 to 100% rate of encapsulation after ten or twenty years. This has been my clinical experience. In addition, the gel implants are more likely to break than the saline implants. Again, there is probably a 50% leakage rate at seven to fifteen years for the gel implants versus around 10% for saline implants at ten years. While the actual numbers can be debated, the trend is there: the gel implants are at least three times more likely to break, and when they do break, you may not realize it. The first sign can be a lump, or a silicone granuloma. The gel implants have recently received FDA approval for women over the age of 22. Manufacturers still recommend that they be replaced every ten years or so, or be followed by regular MRI studies every 1 to 3 years. There are web sites devoted to problems with implants – Toxic Discovery (toxicdiscovery.com) are two active and helpful sites.

Here are some examples of implants problems as wells as explant solutions.

Before and After Photos

Patient A (Double Bubble Syndrome)

A double bubble usually only occurs if the breast starts with some degree of droop. If you can hold a pencil (or an entire box of crayons) with your breast, then you are at risk for a “double bubble” – if and only if the implant is placed underneath the muscle.

This young lady wanted to have a voluptuous look. She is 5’5″ and about 170 pounds. She underwent a breast augmentation using a 700cc filled to 750 cc. At six weeks she has a double-bubble. You can see a line where her breast tissue used to be, and another where the implant is sitting – which makes it look like two bubbles on top of each other, hence the name. This sometimes just happens when the implants are large and the skin envelope is tight.

Front View

Before
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Six weeks
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One year
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Side View

Before
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Six weeks
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One year
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It takes time for the skin to stretch out so as to accommodate the implant – just like blue jeans stretch out with time. Patience is the answer here, not more surgery. At one year, the skin has stretched out, and her implants now feel natural and soft, and her bubble has disappeared.

Patient B (Removal)

Front View

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Side View

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This very active young lady had implants placed in the early 2000’s, but they never felt quite right to her. They were fortunately placed underneath the muscle – if the implants are placed underneath the muscle, when they are removed the muscled retains its contractility and can pull itself back up into place, especially if it has not been detached. As the muscle pulls itself back up, it can pull the overlying breast tissue back up with it. This means that the skin will not be stretched out, and if the muscle returns to its pre-operative location, it will pull the skin up with it. Hence, no lift was required, and she looks pretty much the same as she did before the surgery, only 6 or 7 years later.

Patient C (Encapsulation or Hardening)

Front View

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Side View

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This is a classic case of encapsulation or tissue hardening around a silicone gel implant. This is a Baker IV capsular contracture. This well known complication occurs probably in more that 70% of patients with sub-glandular gel implants after 7 years. They are also very hard and uncomfortable. She had the gel implants removed and a breast lift. She also put in small, saline implants placed behind the muscle, but she could just have easily had a lift and no replacement.

Patient D (Encapulation)

Front View

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Side View

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This young woman had silicone gel implants placed many years ago, and although they were under the muscle, they became encapsulated with scar tissue. Scar tissue builds up in response to the implants, like an oyster making a pearl, causing the implants to feel hard. In this instance, the implants themselves did not actually change, but the scar tissue build up on the outside causes them to feel as firm as a baseball. They also do not move. In my experience, excessive scar tissue formation is much more common around silicon gel implants. The excessive scar tissue was removed and she had new implants placed under the muscle.