Published reports from the U.S. FDA Center for Devices and Radiological Health, the National Institutes of Health, and the independent Institute of Medicine have found that no forms of disease are caused by breast implants. However, breast implants can interfere with two key means to diagnose breast cancer:
• Mammography
• Sentinel node biopsy
Mammography in women with breast implants must be performed at a certified mammography center with personnel having experience in taking and reading mammograms of women with breast implants. First, the compression necessary to take a mammogram film presents a risk of rupturing your implants. This is rare, and more likely occurs when the breast implant has a firm capsule of scar tissue surrounding it. It is important to tell the mammography center you have breast implants when scheduling your mammogram. Additionally, breast implants can make screening a mammogram more difficult, because the implant can block the ability to see all areas of breast tissue. As a result, it is possible that areas with breast disease may be present, but are hidden from view. To avoid the potential of an incomplete or inaccurate screening, additional mammography views will likely be required. Sentinel node biopsy is a surgical procedure performed to determine if breast cancer has spread to adjoining lymph nodes. In this procedure, a dye is injected around a tumor before it is completely removed. The dye is carried from the area of the tumor to the lymph nodes where the cancerous cells of the tumor may be likely to have spread.
Currently available research suggests that the surgical placement of breast implants should not impair your ability to have an accurate sentinel node biopsy, with the possible exception of the transaxillary incision. In addition, certain incision patterns to place breast implants, namely those around the areola (the dark tissue surrounding the nipple) and those in the axilla (the underarm area) may interfere with sentinel node biopsy and the diagnosis of cancerous cells in the lymph nodes. These incision patterns may cut or interrupt the lymphatic drainage channels and prevent the dye from spreading to lymph nodes where cancer may, in fact, have spread. There are alternatives, and you must discuss these with your surgeon prior to any procedure to diagnose or treat breast cancer, benign cysts, or tumors In addition, radiation therapy to treat breast cancer or other cancers localized near the breast may damage the tissue surrounding your breast implant, and cause an unnatural firmness and irregular shape to your breast. With regard to your overall health, breast implants can result in complications that affect your life, and thus your overall health. The potential for these risks are a trade-off you must consider in your personal fulfillment to enhancing or restoring your breast through the placement of breast implants.
The possible risks related to the use of breast implants include the risks of surgery in general, the risks of breast cosmetic surgery in general, and risks related to the type of implant and its physical placement at the breast site. Risks related to surgery include the risks related to anesthesia. Risks following surgery include infection, hematoma (pooling of blood beneath the skin), and the formation of blood clots. These risks can occur with any form of surgery, not just surgery to place breast implants. Any sign of infection must be reported immediately to your cosmetic surgeon. If not treated effectively, infection may lead to woundhealing problems or a loss of healthy tissue, which is called necrosis. Poor wound healing and necrosis are more likely if you:
• Have been using steroid drugs
• Are undergoing chemotherapy
• Have undergone radiation to the breast tissue
• Are a smoker
• Have used excessive heat or cold on healing wounds Risks related to any form of breast cosmetic surgery include a change in the sensation of the breast or nipple, an impaired ability to breast-feed, and breast tenderness.
Risks related to breast implants specifically include:
• Wrinkling of implants
• Palpability (how it feels under the skin)
• Asymmetry between the breasts
• Capsular contracture
• Calcification
• Ruptured or leaking implants
• Implant displacement
• Implant extrusion
Breast implant wrinkling is possible with all breast implants, particularly with saline implants that have been underfilled. The condition is likely not visible under clothing. Surgical replacement may be recommended in severe and visible cases of wrinkling. Much like wrinkling, breast implant palpability is a condition likely only detectable to the woman with breast implants. Palpability is described as the condition where the implant can be easily felt under the beast tissue or chest muscle. Like wrinkling, only replacement and repositioning the breast implant pocket under the chest muscle can minimize this condition. Capsular contracture results when the naturally formed capsule of tissue around the implant becomes irregularly firm or tightens. Where contracture is excessive, the capsule can squeeze the breast and result in a change to the breast shape and/or position, and in some cases may even cause discomfort. Capsular contracture is more likely with sub-glandular placement of breast implants (under the breast tissue and above the chest muscle), with silicone implants, and with larger implants where little breast tissue covers the implant. Capsular contracture sometimes may be the result of previous bleeding or a low-grade infection. Where a woman has had breast implants placed uniformly at each breast, the condition may not develop uniformly.
In fact, it may develop on one breast and not the other. Breast implants also have the potential risk to leak or rupture. This may happen suddenly as the result of trauma to the breast, or for no apparent reason at all. Calcification is a condition where calcium deposits develop around the breast implant capsule, causing firmness and occasionally pain. This is not capsular contracture, as the deposits are localized and they do not affect the entire breast. In addition, where calcium deposits cannot be differentiated from those that are early signs of breast cancer, they must be removed and examined to ensure your health, and to prevent damage to the breast implant. Displaced implants can only be corrected surgically. Symmastia is a condition where the capsule or pocket in which breast implants are placed is too close, or where the breast implants displace into one large pocket. The result is that the implants actually meet in the middle of the chest and appear to be one big breast. Correction of symmastia requires that the breast pocket be internally and permanently sutured smaller, and that implants be replaced and repositioned. Symmastia must be addressed by a cosmetic surgeon qualified and experienced in treating this condition. Extrusion is an extreme risk where a breast implant may actually break through to the skin surface and become exposed. This condition is very rare, and must be evaluated immediately, because it can result in permanent scarring and loss of healthy breast tissue and skin.
Changes in your breast shape and appearance as you age and that result from pregnancy or weigh fluctuations are not a risk of breast implants. This can happen to women who don’t have breast implants. In fact, the insertion of breast implants may, in fact, allow your breasts to retain their shape better over time than a natural breast. According to data published by the U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health, the following implants are reported to be more palpable (more easily felt): textured implants, larger implants, sub-glandularly placed implants (on top of the chest muscle, below the breast glands), and implants in patients with smaller amounts of breast tissue. The U.S. FDA also reported that there is no greater risk of capsular contracture with textured implant shells than smooth-shelled implants.
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