When the breast implant makes sick

In breast reconstruction, the 1-year incidence for capsular fibrosis is about 12% and the 5-year incidence is 30%. Particularly high rates are expected after radiotherapy.

One way to reduce the risk of capsular fibrosis is, for example, the Keller-Funnel technique. In this technique, the surgeon uses a stable funnel to insert the implant without contact.
The use of antibiotics during pocket washing or implant immersion contributed to lower infection rates.
In a cumulative meta-analysis of 577 publications on breast augmentation, the use of textured implants showed a lower incidence of capsular fibrosis. However, textured implants probably increase the risk of BIAALCL for the occurrence of BIAALCL (Breast Implant Associated Anaplastic Anaplastic Large Cell Lymphoma).
Highly textured implants (surface grade 3 and 4) carry the highest risk for BIA-ALCL, which is important when selecting implants. The diagnosis of BIA-ALCL is reportable and often requires interdisciplinary treatment approaches, depending on how the stage is determined. While most cases benefit from complete implant removal and complete removal of the implant capsule, a small percentage of patients require adjuvant chemotherapy.

The complex interactions between the implant and the immune system can cause autoimmune diseases such as ASIA (Autoimune Syndrome Induced by Adjuvants) and
other systemic side effects in the context of so-called “breast implant illness” or BII. These include migraine tinnitus, adverse gastrointestinal effects and weight loss, cardiovascular and pulmonary problems such as dyspnea and arrhythmias, as well as psychological symptoms such as anxiety and depression, and muscle- and joint pain.

An aesthetically unfavorable complication of subpectoral implants is the deformation of the breast with strong contraction of the pectoral muscle (“jumping breast”). In patients at risk for this, a 2-stage surgical approach could reduce the risk for this breast deformity after implant-based breast reconstruction.

Procedures for breast implant removal were also discussed.

Willen C (congress report)