Update on Breast Implants

In GP-bulletin by Karina Cox

Download PDF Version

  • Breast implants are made of a silicone elastomer shell that contains a filler material. Only 2 types of filler material are currently in use in the UK namely a highly cohesive silicone gel or saline and silicone filled implants are by far the most commonly used.
  • The surface of the shell can be smooth or textured. Texturing was introduced to reduce scarring and movement. Each implant manufacturer has a unique texturing process and around 99% of all implants used in the UK are textured.
  • Breast implants are used both for cosmetic augmentation and for breast reconstruction after mastectomy.
  • After cosmetic implant augmentation, it is possible to have a mammogram. The mammographer will use the ‘Eklund technique’ to displace the breast tissue and maximise the accuracy of the mammogram. However, the presence of an implant significantly reduces the sensitivity of mammographic screening. There is no reliable evidence that mammograms can cause implants to rupture. Breast Implant Associated Anaplastic large Cell Lymphoma (BIA-ALCL)
  • It is a rare sub-type of T-cell non-Hodgkin’s lymphoma and has been found associated with breast implants in a small number of cases worldwide. The estimated risk in the UK is thought to be 1 per 24,000 implants. In most cases, BIA-ALCL is found in the scar tissue and fluid around the implant, but in some cases it can metastasize.
  • The most common presenting symptom is a swollen breast caused by a delayed (>1 year since implant placement) seroma.
  • Current evidence indicates that BIA-ALCL occurs mainly with the use of textured rather than smooth implants but the aetiology remains unknown.
  • On the 2nd of April 2019, the ANSM (French Health Regulatory authorities) decided to take a precautionary measure and withdraw macro textured and polyurethane coated implants from the French market.
  • However, the MHRA have not followed suit and these types of implants have not been removed from the UK market.
  • People with macro textured or polyurethane coated implants do not need to have them removed.