All About Breast Implants
About Our Practice
At our practice, we use silicone breast implants, except in very rare cases where saline implants are indicated. Silicone implants has advanced to a very high safety standard (read below on safety of silicone), with a wide range of quality products on the market. We choose specific brands that have a consistent safety records and quality control measures - implants which are TGA approved. Silicone implants have many advantages over saline implants, including more natural breast appearance, feel and movement, as well as a greater range of products to suit the individual.
Breast implants come in all shapes and sizes. During your consultation, we will assist you in making the right choice of implant for your body type, shape and size. The following are considered when choosing implants:
- Implant surface - smooth or textured
- Implant shape - round or shaped
- Implant profile - how far the implant protrudes (when viewed from side profile)
- Implant size or volume - size typically ranges from 120 to 850 cc
- Implant filler - saline or silicone
The breast implant you choose is based on the look you would like to achieve, as well as other individual and anatomical factors. For example, you may want to restore your pre-pregnancy or pre-breast-feeding appearance or simply increase the size of smaller breasts. It is important that you discuss your goals and expectations with us openly and honestly so that we may be able to assist in making the right choices.
Specific breast implants and tissue expanders are also used for women with severely asymmetrical breasts or to correct congenital deformities of the breast. Breast reconstruction for women who have lost their breasts to cancer also uses similar breast implants.
During your consultation, options and recommendations will be made. Trialing with a sizer bra may also be performed to simulate the possible appearances of each implant size. It often helps if you bring a tailored button up shirt or a tight-fitting singlet/T shirt to your consultation. This will maximise your decision making with regards to which implant is right for you. Two consultations are mandatory, so there is no pressure to make a decision or pick your implant size during your first consultation.
What is silicone?
Silicone is derived from silicon a natural element. This is combined with oxygen to form silicon dioxide or silica. This is the most common substance on earth, existing as beach sand, crystals and quartz. When silica is heated with carbon at a high temperature, silicon is produced. This is then further processed to form long chemical chains known as polymers which are also known as silicone. Silicone can be a liquid, a gel, or a rubbery semi-solid. Silicone is one of the most common products found in everyday use in polishes, suntan and hand lotions, antiperspirants, soaps, processed foods, chewing gum, waterproof coatings and even in natural foods such as cow's milk.
Are silicone implants safe?
Specific and extensive studies have been done in regard to the safety of silicone. The Institute of Medicine has concluded after many years of reviewing literature, reports and evidence, that:
The incidence of auto-immune diseases is not higher in women with breast implants compared to that of general population. Similarly, there is no evidence associating breast implants with migraines, heart disease, or epilepsy.
Special studies have also determined that much higher levels of silicone have been found in cows' milk and commercially available infant formula than breast milk in women with implants. Having breast implants does not affect your ability to breastfeed.
Is it possible to have an allergy to silicone?
It is a possibility for anyone to develop an allergy to almost any substance. Silicone allergies are however very rare. We are constantly exposed to silicone every day in many household items. We also consume silicone in food such as milk and milk products.
How often does breast implants rupture?
Breast implant rupture rate has markedly improved since the 1980's; from 20% to less than 1% today. The rate of implant rupture is accumulative (i.e. the risk accumulates over time). With present day implants, rupture rates are quoted to be from 0.4%-1% per year depending on the implant. We only use implants from companies that have had substantiated safety records for at least a decade, if not longer.
Implants made by most companies after the turn of the millennium also have an addition safety feature. The silicone gel within the envelope of the implant is cohesive. This means that the polymer chains are cross-linked, thus the gel, although soft, is not 'runny'. The gel retains its shape and cohesion to the implant even when the implant ruptures. Dispersion of gel is only likely if the implant has been subjected to significant impact.
Silicone (when escaped from a ruptured implant) can travel in the body. Most commonly it may form deposits in lymph nodes and liver. However, these deposits have not been found to be associated with any systemic diseases or organ dysfunction. Silicone deposits in the liver are also incidentally seen in patients on dialysis and prolonged intravenous treatments. Silicone has not been reported to deposit in any other organs in association with breast implants. Silicone does not have the ability to erode or damage tissues. It is an inert deposit.
Silicone is an inert material. Most of the reaction it incites is one from the body itself. The body has a tendency to wall it off from surrounding tissue, which is a normal reaction when any foreign body is inserted inside the body. When an implant ruptures, the body forms a thick capsule around the seepage to contain and enclose it - this is also known as capsular contracture.
What is capsular contracture?
A natural reaction of the body to any device placed in the body is formation of scar tissue around the device creating a 'capsule' to isolate the device. This occurs with breast implants. Formation of a capsule is normal in anyone with breast implants. However, development of capsular contracture is not. Capsular contracture is when the capsule thickens and start to tighten around the implant resulting in perception that the implant has 'gone hard'. These capsules, over time, may also become calcified and altering the appearance of routine mammograms. This may progress to alteration of the shape of the breasts, movement of the implant upwards or outwards and unnatural appearance or movement of the breasts.
Capsular contracture is more common following infections, haematoma and seroma. It may or may not be related to implant rupture (see above). It is also more common if the implants are placed above the muscle. There have been some studies which have shown increased risk of capsular contracture with smooth surface implants, but there was no difference in the incidence of capsule contracture between saline or silicone implants.
Capsular contracture may develop as soon as a few months after surgery to several years after surgery. Symptoms range from firmness and mild discomfort, to pain, breast distortion, hard palpable implants and/or displacement of the implants. There are different grades of capsular contracture, and the most common indications for treatment are pain, distortion of breast shape and displacement of the implants. The treatment for capsular contracture is removal of the implants with its capsules. A choice is then presented as to whether the implants are to be replaced. If the implants were smooth surfaced and above the muscle, often the replacement implants will be textured and placed under the muscle to minimise recurrence of capsular contracture. Capsular contracture may still occur after repeated surgeries, this is often an indication of that particular body's strong reactions against any foreign device. Often, with recurrent and refractory capsular contracture, further replacement of implants may not be recommended.
After implant surgery, we recommend patients to continually massage their breasts to soften the scar tissue and stretch the capsule around the implant. This should be performed at least 4-5 times a day in the first 6 months, then once or twice daily for the lifetime of the implants. This has been shown in some studies to prevent development of capsular contracture.
What is the average life span of a breast implant?
Even though implants are not lifetime devices, they can last for a very long time if looked after appropriately. If you have breast implant surgery early in your life, they may need to be replaced sometime during your lifetime. This time period varies from woman to woman, some requiring replacement in a few years, some not for at least 20 years (or longer). There are several reasons as to why a woman may need an implant replaced, more commonly as a matter of choice rather than necessity. These include a size or style change, or due to complications such as capsular contracture or shifting of the implant. Rupturing of the implant is not always the cause for revisions.
If you are unsure as to whether your implants require replacement, you should contact your surgeon for a review. Patients who have had their implant surgery done at Creare Clinic are offered annual review consultations to check the integrity of the implants, as well as general breast examination. A referral from your GP is required for these annual checks.
Can I fly or scuba dive with implants?
It is recommended that you do not fly for at least 4 weeks after surgery and no scuba diving for at least 6 weeks after surgery. This is to allow healing of surgical site and for the implants to settle into position. This will also allow air bubbles around the implant to be reabsorbed prior to any significant pressure changes as seen in scuba diving.
In the long term, many women with breast implants fly and scuba dive safely. Slight contraction and expansion of the implant shell may occur with changes in pressure, and result in some air bubble formation. This could translate into 'gurgling' noises from your implants. These changes will spontaneously correct after 24 hours.
How does smoking affect implant surgery?
It is the policy of our practice that we will not perform any implant surgery in smokers. The criteria for surgery is total abstinence or at least six weeks before surgery and sustained abstinence for six weeks after surgery.
Smoking causes constriction of blood vessels, reducing blood supply and oxygenation of the surgical site. This results in decreased ability to heal, and an increase in the risk of infection. Implant infections are not minor events, often requiring prolonged hospitalisation and commonly, removal of the implants without replacement. Our no-smoking policy for implant surgery is based on patient safety and minimising clinical risk.
Am I too old for implants?
There is not ideal age for breast implant surgery. Cosmetic breast implant surgery with no medical indication is illegal in the State of Queensland under the age of 18. Breast implant surgery can be performed for girls under 18 if there is severe breast asymmetry (unequal in size), congenital deformities of the breast (e.g. tuberous breast deformity), or history of cancer resection in the breast.
There is no maximum age for breast implant surgery. General good health is the important factor, not age. However, one needs to be considered that it may be necessary to have revision surgery sometime in the future, thus it is important to consider the possibility of having surgery in 10-15 years' time when a decision is made to have breast implants.
How will pregnancy and breast feeding affect my breast implants?
Every woman's body responds differently to pregnancy and breast feeding. Your breasts will enlarge, and the degree of enlargement varies from woman to woman; similarly, the degree of post pregnancy and breast-feeding changes will depend on the amount of weight loss, your body's hormonal changes and its response. It is not uncommon that many women notice a gradual change in the shape of their breasts during this period, as seen also in women with no breast implants. The size of your breasts after pregnancy and breast feeding may change compared to pre-pregnancy period, due to hormonal effects and weight gain/loss. The size of the implants themselves do not alter.
Many women with breast implants have successfully breast fed their babies. Studies have shown that the level of silicone in not any higher the breast milk of women with silicone implants compared to those without breast implants. Certain incisions, such as the peri-areolar incision (around the nipple), may interfere with some woman's ability to breast feed, due to damage to the breast ducts during the insertion of the breast implant.
During breast feeding, some women experience mastitis inflammation of the breast and breast ducts. This may contribute to capsular contracture around the implant (see above). Prompt treatment with antibiotics when the symptoms first appear may minimise the potential to develop this problem. You should always report to your doctor with any signs of inflammation.
How will breast implants affect my mammograms?
Breast implants may interfere with finding breast cancer during mammography. It may also make mammography more difficult. However, breast implants are NOT a contraindication for breast cancer screening with a mammogram. It is essential, that even if you have breast implants, to have regular breast cancer screening. It is very important that you tell your radiographer that you have an implant prior to your mammogram. Special displacement techniques and additional views may be used to maximise the sensitivity of your mammogram. Any personal or family history of breast cancer must be discussed with your surgeon prior to any breast implant surgery. It is important that you are up to date with your breast screening prior to any breast surgery.
There is always a risk of implant rupture with mammography. This risk is small and should not exclude you from having mammography. This is minimised if the implants are placed behind the muscle and can be displaced as the breast is being compressed. Alternative screening for breast cancer apart from mammography is possible for women with breast implants, such as an ultrasound or an MRI, however, both of these modalities have their limitations. Please discuss your concerns with your surgeon or your doctor so that the best option can be recommended.
Do breast implants cause cancer?
No studies have ever shown that breast implants cause breast cancer in humans. There is no evidence that silicone itself causes breast cancer.
Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
The risk of developing BIA-ALCL in people with breast implants is quoted to be 1 in 18,000 to 1 in 86,000 around the world (depending on the type of implant). This is a very rare form of blood cancer, and this particular type has not been shown to be an aggressive malignancy. With appropriate treatment, most cases have had clinical resolution. In view of the number of breast implants that have been used world-wide, these cases are yet to be a cause for alarm. There has been no definitive evidence to explain how and why these cases have occurred, although certain factors have been found to be an association with its development:
- textured implants (with a higher risk for high surface area textures)
- bacterial contamination at the time of surgery to cause inflammation
- patient genetic predisposition
- time for the process to develop
Typical symptoms associated with ALCL include sudden swelling of the breast, asymmetry, lumps in the axilla, or masses within the breast itself. It develops between 3-14 years after implantation. Management of this disease requires surgery to remove the implant with the capsule (or breast tissue). Sometimes, adjuvant chemotherapy may also be recommended.
To find out more information about ACLC and breast implants from TGA, click here.
Breast Implant Associated Squamous Cell Carcinoma (BIA-SCC)
Not much is known about BIA-SCC at present. As of December 2022, there has only been one case reported in Australia and less than 20 cases around the world. It has been reported in association with both smooth and textured implants. Symptoms are similar to that of BIA-ALCL with or without skin changes.
For updates and further information from the Department of Health,click here.
Is there a Breast Implant Registry (BIR)?
We hold a personal registry of all patients who have had breast implant surgery performed by our surgeons. This contains clinical records, as well as the date of surgery with all pertinent implant information. We encourage our breast implant patients to have annual check-ups with our surgeons, and to contact the office if they have any questions or concerns about their implants.
All patients who have had breast implant surgery via our clinic before the 1st May 2015, (regardless whether it was cosmetic or reconstructive) have been encouraged to join the Breast Implant Registry (BIR) at the Australian Society of Plastic Surgeons (ASPS). This is a voluntary registry and the registration forms were given to you after your surgery with your implant information filled in. Although not compulsory, you were encouraged to sign, complete your personal details and send this form into ASAPS to become registered. We could not register your implants on your behalf as your consent was required for any release of your personal and clinical data.
The BIR at ASPS was created to provide a safe and secure database. It allowed patients to access and retrieve important information about their surgery and implants when required. It also ensured that the Registry could contact patients should there be any concerns regarding the breast implants they have received. The database is also used for research and educational purposes, where all information have been stripped of identifying data, and allows important advancements in the use of breast implants.
Unfortunately the old BIR at ASPS is now closed to new registrations. A new national registration program (ABDR) is now up and running via the Monash University. For those who are already on the old BIR, please be assured that this old registry is still active, despite the fact they are not accepting anymore new patients. You can access your implant details at anytime via the registry if required. To find out more about the Breast Implant Registry at Australian Society of Plastic Surgeons, click here. For those who are on the new registry ABDR with Monash University, you can visit their website for more information.
To read more about breast implants, check out our blogs on breast implants.
We use Mentor and Motiva implants at our practice.
For further information on procedures involving breast implants: