Get checked with A/Prof Bish soliman

Are your implants healthy?

An annual physical examination is a reasonable routine, with breast imaging every two to three years. Women aged 40 and over should also continue regular mammograms every two years as part of general breast health, which is separate from implant monitoring.

These are general intervals rather than a formal national screening program, and no such program exists for breast implants in Australia. Your own schedule may differ depending on the type of implant you have, how long you have had it and whether you have any symptoms. The more important principle is that monitoring is symptom-led as well as scheduled. A new change in one breast matters considerably more than whether you are exactly on schedule, and it is worth being seen sooner rather than waiting for the next routine appointment.

No. There is no rule requiring replacement at ten years. Implants are medical devices and are not designed to last forever, so many people will eventually need further surgery, but that is different from a fixed expiry date. Replacement is prompted by a problem, not by an anniversary.

The ten-year figure circulates widely and worries people unnecessarily. What is true is that the chance of needing revision surgery increases over time, whether from rupture, capsular contracture, changes in the breast around the implant, or simply a change in what you want. Silicone implants can rupture without obvious symptoms, which is one reason imaging forms part of long-term monitoring. If your implants are comfortable, unchanged and causing no problems, routine replacement is not automatically recommended.

New swelling in one breast is the main one to act on. The others worth an earlier appointment are a lump in the breast or the armpit, a breast that has changed shape or feels firmer, pain that is new or will not settle, a rash on the skin over the breast, and fluid gathering around an implant. When a change affects one side and not the other, have it looked at rather than waiting.

Swelling that develops well after surgery, typically more than a year later, is the symptom most associated with BIA-ALCL, and it is one to act on rather than watch. Changes can also reflect capsular contracture, rupture, or something unrelated to the implant altogether, including ordinary breast conditions that occur whether or not you have implants. The point of assessment is to find out which. If you cannot get a specialist appointment quickly, see your GP in the meantime rather than waiting.

BIA-ALCL is a rare cancer that begins in the immune system and can develop within the scar capsule surrounding a breast implant. It is not breast cancer. The TGA describes published risk estimates as ranging between about 1 in 1,000 and 1 in 10,000, and the risk is associated with textured implants.

It usually presents as swelling or a lump well after surgery, on average around eight to ten years later. According to the TGA, most cases are cured once the implant and the capsule around it are taken out, which is why early reporting of symptoms matters so much. Implants carrying the highest risk have been removed from the Australian market. No case has yet been confirmed in someone with smooth implants only. If you have textured implants and no symptoms, current guidance points to monitoring rather than surgery.

Not on the basis of the implant type alone if you have no symptoms. The TGA has advised that removal or replacement of macro-textured breast implants or tissue expanders in asymptomatic patients is not recommended, and that because BIA-ALCL is rare, experts do not recommend removing implants where there is no problem with them.

The reasoning is a comparison of risks. Any operation carries its own risks of anaesthesia, bleeding, infection and an unsatisfactory result, and for most people those outweigh the risk of developing BIA-ALCL. There is also no published evidence that exchanging textured implants for smooth ones reduces that risk. That said, this is your decision to make with proper information, and some patients do choose removal after weighing it up. A check is the place to have that conversation, rather than deciding from what you have read online.

BIA-SCC is squamous cell carcinoma reported in the capsule around a breast implant. It is a separate condition from BIA-ALCL and appears to be extremely rare. The TGA issued a safety alert about it in September 2022 and stated at that time that it was not aware of any Australian cases.

There is not yet enough information to say whether breast implants cause it, or whether any particular implant type carries a higher risk. Cases have been reported with both smooth and textured implants, and with both silicone and saline. The TGA continues to monitor the situation alongside international regulators. In practical terms this does not change what you should do: report new symptoms, keep up your monitoring, and do not have implants removed on the strength of this alone. Understanding is still developing, so the TGA website is the place to check for current advice.

Breast implant illness is the term used for a collection of symptoms some patients report and attribute to their implants, including fatigue, joint pain, difficulty concentrating and rashes. It is not a formal diagnosis and research is ongoing. Symptoms being unexplained does not make them imaginary.

There is no test that confirms or excludes it. What an assessment can do is review your symptoms properly, examine your implants, arrange imaging where indicated, and consider other causes that are treatable, since conditions such as thyroid disease and autoimmune disorders can produce similar symptoms. Some patients who have implants removed report improvement and others do not, and it is not currently possible to predict which. Anyone offering certainty here, in either direction, is going beyond what the evidence supports.

Every implant ends up with a capsule of scar tissue around it. Capsular contracture is what happens when that capsule tightens and hardens. It can cause firmness, distortion of the breast shape, discomfort or pain. It is one of the more common reasons people end up needing further implant surgery.

It is usually graded by how noticeable it is, ranging from something detectable only on examination through to a breast that is visibly distorted and painful. Mild cases may simply be monitored. More troublesome cases are generally managed surgically, which can involve releasing or removing the capsule and replacing or removing the implant. Contracture can recur after treatment, so it is worth discussing how likely that is in your situation rather than assuming one operation settles it for good.

Ultrasound is usually the starting point. Where a rupture is suspected, or the ultrasound does not settle the question, MRI shows considerably more. A mammogram has a different job altogether: it screens for breast cancer, and because the implant sits behind the tissue, part of that tissue can be hidden on the images.

A silicone implant can rupture without causing any symptoms. This is often called silent rupture, and it is the reason imaging is used alongside examination over the long term. Saline behaves differently, since a saline implant tends to deflate in a way you can see, so imaging is rarely needed to confirm it. One practical point: when you book a mammogram, say that you have implants, because extra views are taken to capture as much breast tissue as possible. Your GP or your surgeon can organise the right scan and go through the report with you.

Start with your operative records. Your original surgeon’s rooms or the hospital should hold the implant details, including manufacturer, model and serial number, and many patients were given an implant identification card at the time of surgery.

In Australia, the Australian Breast Device Registry records breast device procedures and can be a route to identifying what was implanted if your own records are incomplete. This matters because the type of implant, particularly whether it is textured or smooth, affects how BIA-ALCL risk is assessed for you. If you had surgery overseas or a long time ago, records can be harder to trace, and imaging can sometimes help characterise the implant. Bring whatever you have to your appointment, even if it feels incomplete.

Yes, and this is a point that catches people out. An implant check and a breast screen look for different things, so neither one stands in for the other. BIA-ALCL, for example, arises in the immune system and is not a breast cancer, which means implant monitoring does nothing to cover your breast cancer risk. Both need to continue.

Implants can make part of the breast tissue harder to see on a mammogram, which is why the screening service needs to know in advance so that extra views can be taken. From the age of 40, women are generally advised to have a mammogram every second year. Alongside that, keep up with getting to know what is normal for your own breasts, and see your GP promptly about any new change rather than waiting for your next scheduled appointment.