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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

 

Introduction

PIP implants were withdrawn from the UK in 2010 after then were found to be manufactured using an unapproved silicone gel.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.

 

Red flags

  • 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 - Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) - GOV.UK


 

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.

 

Management
PIP implants:


 

Advice and Guidance

There is no advice and guidance service for breast surgery.

 


Referral

  • If meets suspected breast cancer criteria
  • 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 prosthesis removal or replacement) is only commissioned providing patients meet one or more of the following criteria:
      • After implant leakage or rupture  
      • There is severe capsular contracture (grade III/IV on the Baker classification). This will need to be confirmed by a specialist opinion
      • Implants are complicated by recurrent implant infection or seroma
      • Implant with capsule formation interfering with mammography  
      • Implant is a PIP implant
    • 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)
    • Patients whose initial procedure was privately funded should seek assurance from their private provider in the first instance. If, however, the patient meets one of the above clinical indications, and the private provider is unable to offer the patient surgery, the patient can be offered an NHS referral for breast implant removal but not for replacement.
    • Only patients whose initial procedure was funded by the NHS should be considered for both implant removal and replacement.
    • Where a patient is eligible for implant removal due to a problem associated with a single implant, bilateral implant removal should be offered.
    • The removal of breast implants due to symptoms termed as Breast Implant Illness (BII) or Autoimmune Syndrome Induced by Adjuvants (ASIA) on social media, or due to the risk of developing Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is not currently recommended.
    • In line with current guidance, patients eligible to have their implant replaced must be informed of the potential risk of BIA-ALCL 
  • Discuss lifestyle modifications with people having surgery — for example stopping smoking and reducing alcohol consumption — in order to reduce the risk of post-operative complications.
  • Other breast-cancer prosthesis related concerns e.g. requiring follow-up after moving to the area, specialist nurse support, or prosthesis fitting support:
    • refer to symptomatic breast clinic (2ww form)

 

 

Supporting Information

 For professionals

 

For patients

 

 

Page Review Information

Review date

6 April 2025 (partial update)

Next review date

6 April 2026

Clinical editor

 

Dr Laura Lomas

Dr Madeleine Attridge

Contributors

 

Mr Iain Brown (Consultant Breast surgeon)

Miss Polly King (consultant Breast surgeon)

Dr Rebecca Osborne (GPwSI Breast)