There has been increased media attention towards breast implants and their safety in recent
months. The main concerns relate to a rare form of lymphoma (BIA-ALCL).
Breast Implant Associated Anaplastic Large Cell Lymphoma (ALCL)
...is a rare form of lymphatic cancer that can develop near a breast implant. To date there have been less than 800 reported cases worldwide out of an estimated 35 million women with
implants. This condition appears to be associated only with textured implants and the risk of
developing ALCL ranges from 1:3000 to 1:80000 depending on the type of textured implant. To
date there are no reports of ALCL developing in a woman with only smooth implants.
Because this is such a rare disease the worldwide consensus is that women who have a textured
implants do not need to have their implants removed unless they have other specific problems.
ALCL is not to be confused with breast cancer, which is a separate condition that affects
approximately 1 in 9 New Zealand women in their lifetime.
Research into ALCL is ongoing but the evidence points to a combination of patient bacteria,
implant texture and patient genetics as contributing factors. The signs to look for with this
condition are a sudden swelling or enlargement of your breast or the development of a lump in
your breast. If you notice these changes please see your family doctor urgently or call my office if you are a patient of my practice.
Most cases of BIA-ALCL are cured by removal of the implant and the capsule surrounding the
implant. Agencies around the world continue to investigate the safety of breast implants
following the increasing number of cases of BIA-ALCL being reported. I have closely monitored the information and worldwide research efforts on ALCL since it was first raised in 2010. I stopped using Allergan Biocell textured implants in late 2010, and Polyurethane coated silicone implants in 2017. Today I recommend smooth silicone implants for almost all patients having either cosmetic procedures or reconstructive surgery after breast cancer treatment. There is still a role for some textured implants in very specific circumstances. This is always discussed with patients thoroughly before surgery.
Any operation carries some risk and it is the role of your surgeon and all of the team looking after you to do everything possible to minimize those risks for you. Of course we can only do this with your help and cooperation. It is vital that you are completely honest with your doctors and nurses about your medical health and about any medicines, drugs or supplements you are taking.
Smoking increases the risk of problems with wound healing and infection. All patients are advised to quit smoking before surgery, as many weeks ahead as possible but preferably a minimum of four weeks.
Is breast implant surgery right for me?
During your initial consultation we will take a full medical history and examine you before discussing your options and making recommendations. Your health and safety is our first priority. We will tell you if we believe having breast implants is not a good option for you and will discuss any possible alternatives.
Before meeting with Dr Januszkiewicz, you may want to discuss your concerns and expectations with his plastic surgery nurse. She will give you information about the procedure and discuss what is involved in detail, including post operative care and recovery. She will show you before and after photographs of patients who have had this surgery to help you understand what can be achieved.
What size should I choose?
You may know what size and shape of breast implant you would like. We will listen to your goals and desires and, after examining your breasts, we will discuss the various implant styles, shapes and sizes available that would be recommended for you. We will help you choose the implant that will best complement your body and advise you about the limitations according to your own anatomy and how much natural breast tissue you have. Implant size alone is not everything but too much volume will look disproportional and unnatural, while too little may leave you disappointed. You should take time to make sure the choice you make is the most appropriate. Please feel free to bring in photographs of examples that you like and go to our website gallery of actual patient results.
What types of implants are used?
We will only use the highest standard of medical implants approved by New Zealand's Medical Devices Safety Authority (Medsafe). For most patients a silicone implant will be recommended although saline implants are also available. The implants are made up of a durable outer shell filled with FDA approved medical grade silicone that is cohesive. For most patients we recommend using a smooth surface (non-textured) silicone implant.
What shape implant should I choose?
Implant shape will have some influence but depending on your circumstances
perhaps less than you might think. Most women seek a natural looking outcome.
The modern era of breast implant surgery limits the application for teardrop
shaped textured surface implants. A smooth surface round shape implant will be
recommended to most patients. Implant size, gel type and degree of projection
nevertheless do influence the shape of your result. There have been siginificant
technological leaps in smooth round implants over the past two decades. We will
help you understand the different choices.
How long will the implants last?
There is a common misconception that implants must be removed after 10 years. This is not true although it is probably a useful average figure to have in mind when it comes to implant reoperation.
Breast implants have been around since the 1950's but the modern generation of implants in use today, like most technologies, are a vast improvement on those older generation devices. Breast implants do not have a fixed lifespan or 'use by' date.
While in many patients the implant may last for decades they cannot be considered a 'lifetime' device. Eventually for most women further surgery will be necessary to remove or replace the implant.
Do my implants come with a warranty?
Manufacturers commonly offer a lifetime warranty to replace their implant if it undergoes rupture. Some implants manufacturers also offer a product replacement policy in the event of severe capsular contracture developing within 10 years. The manufacturer will replace the implant itself but they will not cover the costs of the replacement surgery including surgical, anaesthetic and
hospital fees. You will be responsible for these extra costs yourself. There are some circumstances where ACC may contribute.
Where are the implants made?
The modern implants we use are all manufactured by highly reputable companies who have been in this industry for 30 years or more and only use 100% medical grade silicone regulated by the FDA. The commonly used implants are US or European owned companies that manufacture their products in state-of-the-art facilities in Ireland, Germany or Costa Rica.
Unfortunately, as with any industry, there are also disreputable businesses in countries overseas distributing non-medical grade products that would not meet safety standards. There is a danger for patients going overseas for their surgery that they will receive a device that is not approved or considered medically safe.
How soon can I have surgery?
After your initial consultation we recommend you think over the information we have provided for two weeks before going ahead with surgery. It is important that you are certain that going ahead is the correct choice for you and that all of your questions or concerns have been fully explored.
How much time will I need off work?
Generally you can be back to light office work within a few days but getting back to more active or physical work will take longer. Of course this will vary depending on the type of work you do and what operation you need.
When can I get back to the gym?
Certain activities including gym workouts and driving a vehicle will be restricted for at least three weeks in order to reduce the risk of postoperative complications. Upper body physical exercise may be restricted for up to six weeks. We will be discuss this with you in more detail at your consultation.
Why not have the surgery overseas where it is cheaper?
Having surgery is an important decision and you will live with the results for a long time. We do not believe that a travel agent is the best person to advise you on your plastic surgery and how it can be done most safely. Meeting a surgeon for the first time only a day before surgery is risky (and is a practice prohibited by the NZ Medical Council). You do not have the opportunity to think things through. How do you know whether this doctor is properly trained or qualified? Many countries do not follow the same rigid medical standards enforced in New Zealand. What about the quality and safety of the medical facility and the implants that are used? Will an anesthetist be present and have the other staff been properly trained in emergency preparedness?
Surgery is not a holiday and after care is very important. What will happen to you if something goes wrong when you return home a week or two later? Please think through all of these issues before making your decision based on cost alone. Your health and your safety are on the line.
How much does breast augmentation cost?
Most surgical procedures are costed on the basis of operating room minutes and equipment used. A breast augmentation will typically involve 90 minutes of operating time. After your first visit with Dr Januszkiewicz we can provide you with an accurate costing. This includes the implant cost, surgeon and anesthetist professional fees, operating room charges and all surgical supply costs and recovery room fees. Your surgical after care and follow up visits for one year are covered. The costs will vary depending on the implants used and will be higher for some patients who require more complex or longer surgery but this will always be discussed with you before booking surgery. You may be eligible for financing through Nova Medical. Please call our staff to discuss your questions.
Can I breast feed afterwards?
Not every woman can successfully breast feed however the surgery to put in breast implants will not reduce your chances of breast feeding after pregnancy. There is no danger to your baby from the presence of the breast implant.
Is it painful afterwards?
During your surgery long acting local anaesthetic will be placed into the tissues so that when you wake up you should be reasonably comfortable. You will feel an ache or tightness initially and pain medications are prescribed to help with your recovery. It is important to take your pain relief regularly and follow our advice so as to manage this discomfort over the first few days.
Do I need to stay in hospital afterwards?
Most patients are able to go home the same day depending on the operation and their general health.
Are surgical drainage tubes necessary?
No. Drains are not usually necessary unless you have had implant surgery before and are having a revisional operation.
What will the scars be like?
Everyone scars in their own unique way according to their own tissue biology. Most patients having breast augmentation make very good quality scars, usually positioned to be hidden in the crease beneath your breasts. On rare occasions some patients can make lumpy or keloid scars which may need other treatments.
What is breast implant illness?
Breast Implant Illness is a general term used in reference to women who have breast implants and who describe symptoms of illness that they relate to their implants. It is a 'catch-all' diagnosis and
the list of symptoms reported includes fatigue, allergies, chest pain, difficulty sleeping, migraine,
joint pain, hair loss and depression. Of course many of these symptoms will occur in the absence
of breast implants but social media is helping to fuel anxiety levels so that it is becoming
increasingly difficult to untangle truth from fiction.
Currently there is no strong scientific evidence for a link between breast implants and a defined
illness. However we must recognize that some women are feeling unwell and it is important that
their concerns are taken seriously. Research is underway to try and better understand breast
implant illness.
An article published in the journal of the American Society of Plastic Surgeons in July 2019 1
states there is presently 'overwhelming evidence to support the safety of silicone breast
implants... To the best of our body of scientific knowledge to date, there have not been any
concrete or evidence-based studies or peer-reviewed data concerning the formation of a new
syndrome: "silicone implant illness".'
Rohrich, Rod J. M.D.; Kaplan, Jordan M.D.; Dayan, Erez M.D. Silicone Implant Illness: Science versus
Myth? Plastic and Reconstructive Surgery: July 2019 - Volume 144 - Issue 1 - p 98-109, doi:
10.1097/PRS.0000000000005710
I have worked with silicone implants since the mid 1990's and have confidence in the research
that shows silicone is a biologically safe product. However I hear and understand the concerns
of women about potential breast implant illness. If you are concerned about having this
condition and have been a patient of my practice for breast augmentation or breast
reconstruction, you are welcome to call and speak with my staff about your concerns. My staff
can provide you with all the details of your implant surgery and arrange a medical consultation if
you have further questions.
Women who have had their surgery elsewhere are encouraged to see the original surgeon who performed their breast augmentation or reconstruction.
If you are not a patient of my practice
but wish to speak with me about your concerns I recommend you first see your family doctor
and request a medical referral be sent that includes all of your medical notes and operative
records relating to your implant surgery.