Breast augmentation, also known as “the boob job”, involves the surgical insertion of prosthetic implants to reshape or enlarge the breast. The boob job has been one of the five most popular cosmetic procedures performed worldwide since 2006, with about 20,000 women in Australia and close to 300,000 women in the US requesting this annually.
Of the women who have breast implants, 75 per cent have breast implants to achieve a particular aesthetic appearance. The 20 to 39-year age group constitutes half of this group, and they generally request bigger or symmetrical breasts in contrast to the older age group, who describe wanting to restore their breasts following pregnancy or breastfeeding or to counter the effects of ageing, weight loss and gravity. A smaller portion of this group is for gender reassignment. About 25 per cent of requests for breast implants are for reconstruction after breast cancer surgery or prophylactic mastectomy.
Breast implants do not last forever: they have a lifespan of somewhere between 10 and 15 years, which means that for most of the early implant recipients a decision on removal or replacement is due. There has been an influx of requests for implant removal and my observation is that many women elected to have breast implants without involving their GP in making their initial decision. Presumably this has to do with having a sense of autonomy acting on an issue perceived to be exclusively about appearance and, therefore, not health-related.
Every now and again there is an “out-of-cycle” surge of inquiries triggered by statements shared by famous celebrities such as Pamela Anderson, who announce their decision to have their breast implants removed and not replaced for health reasons. As with many implants, joint prostheses, mesh and devices making headlines over time, breast implants are no different.
Whatever the reason, more women of all ages are now ready to discuss the next steps about their existing breast implants.
Most recipients of breast implants are pleased with the cosmetic outcome and experience no ill effects. However, the longer they remain in, the likelier that complications will occur. We are now into the sixth generation of breast implants since the early 1960s and the history of the breast prosthesis has been chequered with class-action lawsuits and worldwide and national implant recalls. Almost 50 years after the first silicone implants were disseminated, the 2010 conviction of a French implant manufacturer prompted Australia to establish the Australian Breast Device Registry. As with most cosmetic procedures, our trends mirror those of the US, and when implants are recalled for suspected or rare complications by the US Department of Food and Drugs Administration the headlines are alarming.
More recently, in 2019-20, there was an increase in the number of cases of breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL, a rare T-cell non-Hodgkin lymphoma, which resulted in a worldwide suspension and recall of certain implant types. This is a very rare complication and the consensus is that implants need not be removed even if they have been implicated, as this is fairly easy to detect early with annual surveillance using an ultrasound and/or magnetic resonance imaging to look for fluid build-up around the implant that suggests increased localised activity.
Common concerns women raise with me other than their fear of cancer such as the rare BIA-ALCL include breast pain, unsightly or painful scar tissue, implant hardening, implant leakage, distortion because of skin retraction, or movement or rupture of the implant or chronic infection at the implant site.
Some women describe a cluster of symptoms referred to in some circles as breast implant illness, or BIL, which includes a mix of generalised malaise, joint pains, fatigue, mental health decline, brain fog, auto-immune disease activation, hair loss and other diffuse symptoms. It’s a frustrating condition because symptoms can appear weeks or years after implant insertion, making attribution to the implants difficult to confirm. To further complicate things, often there are few or no abnormal blood markers identified that point to a BIL disease process, resulting in some sectors of the medical profession denying its existence. Some small studies report around 70 per cent rapid symptom resolution on removal of the implants. However research into BIL is in its early days and removal of breast implants is not recommended as a first-line response. If there are generalised symptoms in the presence of intact implants, it makes good sense to see your GP and have tests to exclude thyroid disease and other disease processes first. Before having breast implants inserted and even removed, it’s important to have a conversation with your GP about your options and possible complications down the track.
For women around the age of 50, routine breast screening should occur two-yearly as part of the national breast screening program. Although implants shouldn’t prevent a woman from having these routine screens, they can diminish accuracy, requiring more expensive, privately funded screening in the form of tomosynthesis and ultrasound, or mammogram with contrast, or MRI. Some women elect to fund their own MRIs to avoid damaging their implants from the compression required, which all adds to the cost of having breast implants.
Following the National Cosmetic Surgery Review (2022-23), seeing your GP for an assessment before cosmetic surgery with referral for the procedure is recommended. Resources can be accessed through your GP when you book to explore your options or from here. If there are symptoms you are concerned about down the track, you can report them here; however, make sure you also speak to your surgeon and your GP.
Dr Simonis is a member of the Therapeutic Goods Administration’s Breast Implant Post Market Device Expert Advisory group and National Cosmetic Surgery Review
This column is published for information purposes only. It is not intended to be used as medical advice and should not be relied on as a substitute for independent professional advice about your personal health or a medical condition from your doctor or other qualified health professional.
More Coverage
‘All is calm’: How Christmas carol services could reduce your stress
Science suggests the love, joy and nostalgia of singing at evensong can leave those who attend carol services less stressed and ‘significantly more tranquil’ than when they entered.
Tea and coffee linked to lower risk of mouth and throat cancer
Drinking three to four cups of coffee a day is associated with the biggest decrease in risk, according to a study.