Should my breast implants be removed?

It is now known that both breast implant associated illness (BIAI) and the much more serious breast implant associated anaplastic large cell lymphoma (BIA-ALCL) are associated only with textured breast implants. 

It seems puzzling to us to ban a defective device that may cause cancer and at the same time advise implanted women that there is no need to remove their defective devices. If one asks a plastic surgeon what they would do if they or a loved one had Allergan Biocell implants they invariably answer that they would have the implants removed. 

It would  seem prudent for women with textured breast implants to have them removed and replaced either with their own fat or with a smooth walled implant.

But what about the capsule? This is the thin layer of collagen that always forms around breast implants. Most surgeons now dispute the value of a prophylactic capsulectomy, which refers to the removal of the capsule which is formed around the breast implant when it is clearly not diseased. The problem with prophylactic capsulectomy is that it is a procedure which involves high risk. It  has also been shown to be of no value. Women who have had a prophylactic capsulectomy for capsular contracture have still subsequently developed BIA-ALCL. 

In view of the lack of evidence for efficacy, the recommendation is for explantation or implant exchange with smooth walled implants without capsulectomy in women who have no evidence of  BIA-ALCL. The patient risk, morbidity and expense are much less when the capsules are preserved. In the extremely rare event that BIA-ALCL is diagnosed later, it is still treatable especially if it is diagnosed early and is contained by an intact capsule.

In this practice we arrived at the conclusion several years ago that the way textured breast implants caused these problems was not because of the silicone they contained and not because of any bacteria that may be present. Our thesis was that both breast implant associated illness and BIA-ALCL were caused by constant irritation of the surrounding tissues due to the textured (rough) surface of the breast implants. This irritation causes chronic inflammation and many surgeons now agree with us and recognize this to be the reason behind the problems caused by textured implants.

We know that risk increases with the length of time the implants have been in place and this correlates with chronic inflammation as the cause.

The conclusion is clear. Women should not be instructed to do nothing. They should not be told that implant removal and replacement with their own fat or with a smooth walled implant is riskier than doing nothing, in the hope that they are lucky enough not to develop BIA-ALCL. But it is important when selecting an operation. to avoid an operation with high risk and no benefit. That means not performing a total capsulectomy.