“All silicone breast implants eventually require removal”

All silicone breast implants eventually require removal. The longer a person has these implants, the greater the chance of complications developing, and many patients have reported “complete resolution” of all symptoms when the implants are removed.

According to implant manufacturers Johnson and Johnson with the Mentor implant and Allergan with the Natrelle implant, breast implants are not considered lifetime devices and may require further surgery after insertion. Silicone implants have been linked to anaplastic large cell lymphoma (BIA-ALCL), a cancer of the immune system that can lead to death.

Healio spoke to me Shaher W. Khan, MD, a leading specialist in breast implant disease at Executive Plastic Surgery in Novi, Michigan, on the causes of breast implant disease, the removal procedure and the risks associated with silicone implants.

Healio: What are some of the most common reasons for wanting or getting breast implants?

Inn: This comes from the women themselves: Sometimes they have breast cancer, so they need reconstruction. The second reason for some younger women is hypomastia – they have a very small amount of breast tissue and this can be the driving force to add fullness to the breast. Sometimes, believe it or not, your significant other is very involved. Patients have told me many times, “I didn’t want breast implants, but the other person paid for them and I chose to have them.” This is also a relatively common reason why women choose to have breast implants. Some women said they wanted to look better and thought this was a fair choice and choice.

Healio: How common is breast implant disease in the US?

Inn: Ultimately, breast implant disease will affect every patient because implants are not meant to be in the body forever. Just today, my last two patients that I saw, one had a ruptured left saline implant and the other had a 30 year old set of silicone implants and both ruptured. The FDA clearly states that these are not meant to be in the body forever. They can cause breast implant disease as early as the first month or for some women up to 5, 7, 20 years later, but eventually everyone will develop breast implant disease.

I use the word “all” because of the many problems breast implants cause. They may be very limited at first, but like anything foreign to the body, implants begin to break down and disintegrate. And, when they start to leak silicone, the symptoms suddenly reach a limit where the patients cannot tolerate them.

Healio: What specific adverse medical outcomes can result from breast implant placement and what are some of the specific symptoms?

Inn: If you listen to the manufacturers themselves, be it Mentor or Allergan, you will see many problems with adverse effects: rupture, capsular contracture, infection, malposition of the implant along with asymmetry and scarring. One can get BIA-ALCL, and you can get squamous cell cancer, which the FDA has learned is directly related to the implants. So there is direct cause and effect, no questionable correlation, but direct correlation. If the patient did not have implants, he would not have cancer.

Cancer is very rare but underreported. Over time, some patients report “bottoming out” and poor lateral positioning over time. They may experience acute and chronic pain, and because of this effect of the implant, they may not be able to undergo regular monthly breast cancer screening. One in eight or nine women get breast cancer in the United States. Imagine that you have a large implant or a painful breast due to an implant, now they are not able to do a good palpable examination. Some women have chosen not to have a mammogram simply because they feel that pressure on the breast will damage the implant. As you can imagine, many harmful consequences are a direct result of breast implants.

Healio: Are there alternatives to breast implants?

Inn: The other reconstruction is where you can use abdominal skin/fat and then reconstruct the breasts. This is a reasonable alternative. This microvascular procedure itself has another set of associated risks. With surgery called a DIEP flap using the patient’s own natural tissue, there are good long-term results. This can be an unusually long surgery, from 6 to 14 hours or more, depending on the surgeon.

Healio: How easy is recovery from breast implant removal?

Inn: Breast implant augmentation to place them takes an average of 30 minutes to an hour. To completely and safely remove the implants in the exclusive way, it takes an average of 4 hours. Larger implants take longer to remove than smaller ones, and textured implants, given their inflammatory nature, take longer on average compared to smooth ones. Also, implants above the muscle are easier to remove than those below the muscle. Existing complications such as capsular contracture or tears require longer than normal operating times.

Healio: How can doctors warn their patients about the risks of breast implants if the patient is interested in the procedure?

Inn: They need to, No. 1, go to the FDA website and look at the warnings. No. 2, they can join, for example, my breast implant support group page and hear from the many other patients to see what their journey has been like.

There are not many surgeons who remove breast implants. If you talk to ten implant surgeons, you will get ten different implant methods. Patients need to be educated by going to the surgeon’s website and then talking directly with the surgeon to see where the incision will be made, what the explantation process is, and what is going to be removed and ultimately tested by pathology and microbiology. The patient must confirm the goal of the surgery, which is to absolutely remove not only the implant, but also the entire capsule in an EN BLOC manner preferably or a 100% total capsulectomy along with all the inflamed tissue and that the tissue removed should be checked for not only pathology, but also microbiology (aerobic/anaerobic/ and fungal cultures).

Many surgeons simply remove the implant, but this is imperfect. The implant must be removed along with the entire capsule plus all the inflamed tissue. The capsule should be checked for lymphoma because you cannot tell with the naked eye grossly if there is cancer or not. It is very important for the surgeon to collect cultures and send any abnormal tissue to pathology to check for malignancy. This has to be done in a very systematic and thoughtful way.

Healio: Is there anything else you would like to point out on this topic?

Inn: As you will see across the country, there is a national trend of patients now going to websites and saying, “We don’t feel better, it must be the implants.” Remember, silicone implants were banned before, in 1992, and now history is repeating itself. With the help of the internet, patients talk to each other and prevail over the many plastic surgeons and doctors. Their conclusions are: “It must be the implants because my best friend had an implant, we both had an implant together, and now that she’s had the implant, she feels so much better.”

In summary, breast implants, whether saline or silicone, are not safe devices and are fraught with problems. There are many risks that certainly outweigh the minimal benefits, which are very temporary.

Dr. Khan will host one free Zoom call March 8 to address patient and physician questions about breast implant disease.