With all the recent publicity surrounding breast implants, how is a woman who has breast implants best advised?
The first point is to establish for how long she has had the implants, are they textured or smooth-walled, silicone or saline filled, in front of or behind the muscle.
Note that smooth-walled saline implants are the safest of all and have not been associated with any recall.
Patients with smooth-walled silicone implants do have the possibility of developing symptoms known as Breast Implant Illness and we have a questionnaire in order to assess the severity of their symptoms.
If the implants are smooth-walled then there is no risk of Anaplastic Large Cell Lymphoma (ALCL).
If however the implants are textured then the degree of risk depends on the degree of texture. Basically the more textured the implant then the greater the risk.
The implants with the most texture are the implants manufactured by Allergan and also the polyurethane covered implants (known as the furry Brazilian). Implants with the least texture are the implants manufactured by Mentor.
The difference is that the implants with a course texture have a 1:1000 risk of ALCL whereas the implants with the fine texture have only a 1:80,000 risk.
So the problem is how do we advise patients who have a macro textured implant when we know that there is 1:1000 risk of developing Anaplastic Large Cell Lymphoma.
Currently both the TGA and the Australian Society of Plastic Surgeons are advising patients not to panic but to see their surgeon if they have any concerns.
Of relevance is the fact that the average time to development of ALCL is 8 years. Although at least 1 case has developed after only 2 years.
So basically it depends on the patient’s tolerance of risk. On the basis of our current information, it would seem reasonable to suggest replacement of these implants prior to 8 years.
The realty is, however, would you recommend a person get on an aeroplane when we know that there is a 1:1000 chance that the plane will crash.
This risk is actually too high for comfort and so the best approach is to advise patients that there is no rush but they should plan for removal and replacement of these macro textured implants in the near future. It would be terrible to advise that there was no need for removal and for the woman to then develop ALCL.
The operative plan would consist first of removal of the implants and subsequent choice about what further surgery is required or desired.
For many patients only removal of the implants is required.
Some will desire or require a breast lift (or auto augmentation).
Some will desire a slight augmentation especially of the cleavage and upper pole by autologous fat transfer.
Some may require or desire maintenance of a higher volume which will entail a new implant.
In this case we would recommend a smooth-walled saline implant placed behind the muscle as this has the best proven safety record and these implants usually last well over 20 years without any ill effects.
Some patients may require a Hybrid procedure.
For more information visit Removal and Replacement of Implants