Breast Implant Complications

 

This guideline applies to women over 18 years.
 

See also Breast Lumps, Breast pain, Mastitis and Breast Abcess and Familial Breast and Ovarian Cancer

 

 

PIP implants were withdrawn from the UK in 2010 after then were found to be manufactured using an unapproved silicone gel. They are more prone to rupturing that other breast implants.

 

 

• Breast implant-associated anaplastic large cell lymphoma:
   
• A rare sub-type of T-cell non-Hodgkin lymphoma (NHL). It is thought to be associated with textured implants.
   
• Presentation is usually a collection of fluid (seroma) around the implant over 1 year following implant insertion.
   
• The current risk is approximately 1 in 24,000 implants.
   
• There is currently no MRHA recommendation to remove any asymptomatic implant.

See Association of Breast Surgery – BIA-ALCL.

 

Key Features of Assessment

 

History:

• Implant changes - ask about unexplained breast enlargement, asymmetry, fluid build-up
   
• Previous breast implant/expanders – whether saline or silicone and whether a PIP implant was used.

 

 

PIP implants:

• Give PIP implants patient information

 

 

 

There is no advice and guidance service for breast surgery.

 

 

 

 

• If meets suspected breast cancer criteria
  • refer 2ww – see breast symptoms guidance
• Change in breast size, fluid build-up or swelling
  • refer to symptomatic breast clinic (2ww form)

• Suspected implant rupture/contracture/capsule formation and PIP implants:
  • Revision mammoplasty (including removal or replacement) is only commissioned providing patients meet the following criteria:
    • Proven implant rupture 
       
    • Bake grade IV capsular contracture 
       
    • Implant with capsule formation interfering with mammography 
       
    • PIP implants 
  • If the breast implant was fitted by the NHS or was due to breast reconstruction following surgery for cancer, then refer on the symptomatic breast clinic (2WW form)
  • If fitted privately, direct the patient back to the private provider for removal and replacement 
    *Please note that in the event that the private provider is unable to support the patient, and the patient had the implant for reasons other than breast reconstruction following surgery for cancer, then the NHS will only commission removal of the implant and not replacement.  The NHS Cornwall and IoS board reserve the right to seek reimbursement from the provider.
  • See Commissioning policies 2022 to 2023 (icb.nhs.uk)

 

• Breast cosmetic Issues:
  • If procedures of limited clinical benefit e.g. breast augmentation see individual funding request policy.

 

• Other breast-cancer prosthesis related concernse.g. requiring follow-up after moving to the area, specialist nurse support, or prosthesis fitting support:
  • refer to symptomatic breast clinic (2ww form)

 

 

 

For professionals:

• NHS Royal Cornwall Hospitals – Breast Webinar 2022 [video: 1 hour 17 minutes]
• PIP Implants
• Breast Implant associated Lymphoma and SCC
• NHS Cornwall and Isles of ScillyCommissioning policies 2022 to 2023 (icb.nhs.uk)

 

For patients:

• Breast Cancer Now:
  • Breast Lumps and Benign (Not Cancer) Breast Conditions
  • Information and Support
• CoppaFeel – Information and Resources

 

 

 

Review date	15 January 2024
Next review date	15 January 2026
Clinical editor	Dr Madeleine Attridge
Contributors	Mr Iain Brown (Consultant Breast surgeon) Miss Polly King (consultant Breast surgeon) Dr Rebecca Osborne (GPwSI Breast)