Posts Tagged silicone breast implants
Here we have images of a woman I first saw a few years ago. She had had two breast implant operations before and noted after her second (an enlargement with full lift) that her left breast progressively dropped (over about a year). I recommended re-operation to re-set the lift and downsize her implants. She agreed to the lift but not the implant size decrease. Smaller implants do not weigh as much so the rate of recurrent sag should have been less. As these were silicone gel implants this is particularly important. They weigh more than saline-filled implants.
The After image was taken at 1 month. She moved Out of State, but I predict that the sag probably recurred at least to some extent.
(1) Large implants are hard to keep up. Plan on smaller implants or more surgery later if you select larger implants. Large silicone implants also harden (capsular contracture) more frequently/severely than smaller implants or saline implants. This also contributes to a higher redo rate.
John Di Saia MD
Originally posted 2007-05-15 07:30:21.
A short video shows a 27 year old ruptured silicone gel implant and the calcified scar capsule the patient’s body made to try to contain it. It helps explain why some silicone breast implant patients develop rock hard breasts and what can be done to fix the situation.
It also helps explain why most often I prefer saline-filled breast implants that do not tend to encourage the formation of rock hard breasts. Seeing calcium deposition on the implant capsule (which is what makes the breasts really hard) in a woman who has never had silicone gel implants is extremely rare.
John Di Saia MD
Originally posted 2011-05-30 07:30:13.
Reader Laura’s Comment:
“An actress who works in English television has come out as one of the women who received the PIP implants. She recently had the implants removed after one of them ruptured. In this story there are pictures of both of the implants that she had removed. Usually when I hear about an implant leaking I don’t imagine one looking like it had literally exploded. I imagine one with a small opening at the most. Is this what implants can look like when they are removed after rupturing? Are they usually that yellow color or do you think that has to do with the fact that these types of implants were alleged to be filled with industrial silicone instead of medical? The actress says in this story that she felt her implant swell before it ruptured. Have you ever heard of an implant swelling?”
An actress who appeared in Coronation Street and Hollyoaks has spoken of the horrific pain she felt when her PIP breast implant swelled to the size of her head – and then exploded. Vanessa Halstead, who played a cocktail waitress as an extra in Coronation Street, got implants to help boost her glamour modelling career. But she was shocked when her right DD breast suddenly started expanding eight years after breast enlargement surgery. Soon she was struggling to move, and after having an ultrasound she discovered her breast implant had ruptured.
Silicone gel implants can occasionally do unusual things. While I have not heard of them exploding, I have seen the occasional case in which they reacted with the patient’s tissues to expand over time. In my experience, this has not been a rapid process but happens over years. The discoloration seen in this woman’s ruptured implant reminds me of one such unusual case.
The more common pattern with silicone gel implants is slow encapsulation over time sometimes with the addition of a calcium shell. This can make for a rock hard breast over ten to twenty years. Both breasts do not always react similarly. Take a look at this video I made of old silicone implants one of which had a crispy hard eggshell capsule:
As I have said many times before, I feel safer with saline filled implants that do not exhibit this kind of unusual behavior. It is the silicone gel that more frequently adds drama to the equation.
Whether the PIP implants and their less than well made components accelerated this process in this woman’s case is hard to say. It is possible.
John Di Saia MD
It is interesting in this economy how some patients are thinking about breast implants. The more limited funds available in a down economy might be good for one thing: people are thinking implant surgery through much better on average than in years gone by.
A forum at which I occasionally answer questions reflected this in a question. The poster indicated that the decision of whether or not to place breast implants with her planned breast lift may revolve around the risk of revisions.
I can’t afford to have revisions. If I have to replace implants I should not go for it then.
As we have discussed previously plastic surgery can be performed with the main goal of limiting the need for further surgery. In the case of breast implant surgery, limiting long term risk can be best accomplished by:
(1) Limiting implant size.
(2) Sticking with saline-filled implants which tend to simply rupture as opposed to encouraging scarring and significant capsule formation that requires more involved surgery to treat. Saline implants break and need simple replacement far more often than anything else at least when they are not huge.
(3) The other issue with saline implants is that rupture can be covered to an extent by buying an extended warranty at the time of their original implantation. This specifically covers breast implant rupture. The main problem that occurs with the smaller saline implants is rupture.
It is true that the extended warranty only covers the implants for ten years, but that is more coverage than you can get with silicone breast implants for the problem that is the most common with saline.
John Di Saia MD
It should seem no surprise that the first modern silicone breast implant operation occurred in Texas. Although the Japanese and even the Texan pioneers of these newer implants tried simple injections of various substances including silicone gel beforehand, they found inflammation and pain made these ill-advised.
The way Timmie Jean Lindsay was convinced into being the first patient for silicone breast implants is kinda amusing:
Earning £19 a week from her job at an electronics factory, she qualified for free treatment at a charity clinic, the Jefferson Davis Hospital, where a friendly young plastic surgeon, Canadian-born Frank Gerow, offered to remove the roses (a tattoo) with dermabrasion – a procedure in which the upper layers of the skin are removed.
A plastic surgery professor at Houston’s esteemed Baylor University medical school, Gerow worked at the clinic pro bono, using it as a training facility for his students and, as Timmie Jean soon would learn, a recruiting ground.
When she returned for a check-up in the autumn of 1961, male medical students joined him as he explained he had been working with a colleague, Dr Thomas Cronin, to develop an implant for women who had sagging breasts following multiple childbirths. He suggested Timmie Jean should be the test case, the first woman in the world to undergo this delicate procedure.
She had surgery in spring of 1962. She has had problems with capsular contracture, but has reportedly not had additional surgery to improve these symptoms.
John Di Saia MD
We have discussed the FDA’s recent consternation with the status of the post-approval silicone breast implant studies. In few words, patients don’t tend to co-operate with studies on their breast implants. This was the case when we the doctors were forced to administer these studies as well. Patients also are not willing to spend thousands on post-surgery MRI scans that their insurers refuse to cover. These MRIs are not happening making the requirement practically unenforceable.
Now the FDA is thinking about a Breast Implant Registry probably for just silicone gel breast implants. Although the FDA has supported their previous statement that these implants are “safe,” they haven’t indicated what that really means. They also have yet to indicate how they will get the patients to actually show up for their studies.
“We believe it’s a good idea to have a conversation about a breast implant registry. … (But) we believe implants are safe and effective and should remain on the market,” Dr William Maisel, deputy director of the FDA’s devices division, told reporters after the meeting. In 2006 the FDA approved silicone gel-filled breast implants sold by Allergan (AGN.N) and Johnson & Johnson’s (JNJ.N) Mentor unit on condition both companies follow 40,000 women for 10 years to look at safety issues, as well as extend smaller pre-approval studies.
I use many more saline-filled than silicone gel implants. I believe they are safer. They require no MRI scans afterward, no special FDA mandated consent paperwork and much less worry about follow-up. Simple.
John Di Saia MD
Reader Laura’s Comment:
The FDA has announced that the makers of silicone breast implants have not been following up with the women who have received them as requested when they re approved silicone implants. How long can a woman safely have their implants in before they should have them removed or replaced? Is 10 years the norm? Do you have specific time in mind for replacement when the implants are first but in? Do you recommend that your patients get MRIs?
Makers of silicone breast implants have not followed up on thousands of women who received them as required by the Food and Drug Administration as a condition of approval, agency advisers said Wednesday. Mentor Worldwide and Allergan Incorporated received FDA approval for their silicone gel-filled breast implants in 2006 after agreeing to do large, 10-year post-market studies. But in a two-day meeting to update two FDA panels on the status of those trials, the companies admitted they had lost track of large numbers of women after implantation.
Silicone gel breast implants leak small amounts of silicone gel into a patient’s body over the time in which they reside there. There has never been much of an argument there. The real question is whether or not this is well tolerated. The answer is sometimes more than others. It has always left me a bit unsatisfied when implant makers and their spokespeople have stated that silicone breast implants are “safe.” What does that really mean? I recommend silicone breast implants for a small minority of my breast implant patients when their risks seem warranted by benefits. I do not call them “safe” however.
If my wife were to have breast implants she would be having saline-filled models. My opinion is that they are much safer over time.
On the subject of breast implant studies, most patients simply don’t like them. For years we tried to follow our silicone breast implant patients for purposes of follow-up studies. This was back before the FDA made study administration the implant manufacturer’s problem again. The average patient has little interest in coming in for re-evaluation unless there is a problem. Blaming the implant companies for lack of follow-up in this light is not fair.
On the longevity of silicone gel implants, that is an unknown. The newer generation “gummy bear” implants have not been around that long. I think replacement over a ten year cycle is probably conservative, but patients do not always stay with the same surgeon for ten years and that cycle time is not standard.
Breast MRIs are recommended for silicone gel implant patients at intervals but few of these women get them. Breast MRI studies are expensive and health insurance does not cover them usually. In fact, a woman admitting that she has breast implants can get her insurer to refuse to extend policy coverage or rescind it in many cases.
Silicone gel breast implants are controversial and by the looks of things are going to stay that way for the foreseeable future.
John Di Saia MD
I had breast implant removal without replacement (250cc after 23 years) five weeks ago, going from 38D to 38 A/B. I also had a lift at the same time. I understand there was some silicone leakage in my right breast, but had a capsulotomy on each breast as well. Both breasts, individually, look pretty good now. My problem is the left breast is at least 1 cup size larger than the right, very noticeable in a bathing suit or camisole. Any swelling reduction seems to have occurred equally so far in both. In your opinion, what are the chances the left one is that much more swollen. I think my surgeon may have closed my left breast before realizing the leakage required additional tissue removal on the right as they were visibly uneven immediately after surgery. Have you ever seen evening out weeks or months out?? I will not get an implant to even it them out and I can’t imagine cutting into the left breast to further reduce it. Please share your opinion. Regards!
Re-operative breast implant surgery can get complicated particularly when it involves leaking silicone gel implants. Leaking silicone gel can encourage a body response involving scarring, inflammation and profound hardening. The individual breasts may react differently to that leakage as well. During redo surgery, this reactive scar tissue must be removed to soften the breast allowing a good result. On the next page I will put up the images you sent, so we can flesh out what likely happened.
Originally posted 2010-02-18 07:30:56.
I am thinking of getting breast implants. Do silicone implants leak? If they do, does the silicone go all over my body and cause problems? Are the newer gummie bear ones any better than the older silicones? How do you decide to use saline or silicone implants?
Silicone gel implants can leak and they can also leech gel residue. The newer generation cohesive gels (also called “gummie bear implants”) have a “jello” consistency, so they really shouldn’t “leak” as the gel isn’t a liquid.
Leeching refers to the tendency for all gel implants to kinda weep smaller amounts of silicone into the tissues around them even through intact implant casings. This may spread the gel somewhat over the years, but the real question is how much for the newer “gummie bear” implants. The answer is that we won’t know for years. It takes 10-20 years to study something like this. I tell my breast implant patients that newer generation silicone gel implants are probably safer than the older ones, but the bottom line is that they likely represent at least a little more risk than the saline-filled version. We just don’t know how much yet. The question of which implant to use is the patient’s choice after a discussion of risk versus benefit. Some patients do not mind the risk and others stick with saline implants.
With age, older generation silicone implants were associated with hardening of the breasts (capsular contracture.) The hope is that the newer ones will do this to a lesser extent.
John Di Saia MD
Originally posted 2009-11-12 07:30:09.
I am asked pretty regularly about what a woman should do with old breast implants. The answer depends upon how things look and feel and what kind of implants are in place. Silicone gel implants in my opinion should be changed more frequently.
Silicone gel implants degrade over time and our bodies react with the gel creating scar and calcium. This hardens the breasts and requires removal of the implants and capsules to repair. This is amongst my reasons for preferring saline filled implants as they cause much less of this reaction than the silicone gel implant types. Newer generation gummy bear silicone gel implants will hopefully cause less reaction than their predecessors, but we won’t know how much for about another 10 years.
The images on the next page are those from a recent case in which I removed 25 year old silicone breast implants and the scar capsules that surrounded them. In this case the patient didn’t realize that her right implant was ruptured until an imaging study was obtained. In addition, since her breasts had hardened slowly over years, she didn’t connect it with her implants.
John Di Saia MD
Originally posted 2010-04-28 07:30:32.