Category Archives: What You Need To Know

Breast Implants After Mastectomy: Risks You Need to Know

Diana Zuckerman, PhD

The complication rate for getting breast implants after mastectomy has been described by experts as “alarmingly high and arguably unacceptable,”1 even though most of the information about complications is based on studies that were paid for by companies that make breast implants or silicone.

How safe are breast implants and how many women have complications after getting reconstruction with breast implants after a mastectomy? When the Food and Drug Administration (FDA) approved breast implants, they acknowledged that the complication rate is very high for all women, especially those undergoing reconstruction after a mastectomy. What the FDA did not know, however, is that early-stage breast cancer patients that undergo mastectomy and reconstruction with breast implants are 10 times as likely to commit suicide as other early-stage breast cancer mastectomy patients.

Complications from Implants

We do not know why the suicide rate is so high for mastectomy patients with breast implants, but we do know that complications are very common. For example, a study conducted by implant manufacturer Inamed (now called Allergan) found that 46% of reconstruction patients needed additional surgery within the first 2 to 3 years after getting silicone gel breast implants 2. Not surprisingly, the implant maker did not publish an article describing this high complication rate, which was more than twice as high as the 21% reported in a study funded by a company that makes silicone (Dow Corning).1

Why was the complication rate lower in the Dow Corning study? One explanation is that the women in that study had breast implants for an average of only 23 months, compared to 2-3 years in the Inamed study. Even so, the Dow study found that 31% of the women developed at least one serious complication and 16% developed at least 2 serious complications in that short period of time. The Inamed study reported that 25% underwent implant removal, 16% experienced Baker III-IV capsular contracture (which is painful breast hardness), 6% experienced necrosis (death of breast tissue), 6% had other types of breast pain, and 6% had an implant that ruptured, and other women reported infections and other complications.2  This shows that both studies found very high complication rates despite a short follow-up of less than 3 years.

The Dow-funded study concluded that “reconstruction failure (loss of implant) is rare.” Of course, it should be rare after less than 2 years. In contrast, when Inamed used Magnetic Resonance Imaging (MRIs) to detect rupture, they found that 20% of reconstruction patients had ruptured implants by the third year;3 but very few ruptures were detected without MRIs. Since Henriksen did not use MRIs. Since the Dow Corning study did not use MRIs to detect rupture, they couldn’t accurately count the number of failed implants.  Moreover, FDA scientists concluded that the risk of rupture would likely increase exponentially every year.4

Many plastic surgeons claim that the Institute of Medicine concludes that breast implants are safe. However, the Institute of Medicine report was completed in 1999, years before most research was conducted. Most research on breast implant patients was published after 1999, making the report very outdated. Many of the studies reported higher levels of diseases or symptoms among women with breast implants, which would have reached statistical significance if the studies were larger and women were followed for a longer period of time.

Can implants cause cancer or other serious diseases?

Experts around the world now agree that breast implants can cause a type of cancer of the immune system called ALCL (anaplastic large cell lymphoma).  In fact, there is now a specific diagnosis called breast implant associated ALCL (BIA-ALCL).  If caught early, removal of the breast implants can be very effective, but if not treated quickly it can be fatal. 5

The link between breast implants and other cancers remains controversial.  Studies paid for by plastic surgeons or implant companies tend to conclude that breast implants are safe. Since breast implants can cause cancer of the immune system, it seems logical that implants might have an impact on other diseases of the immune system or other cancers.  For example, FDA scientists reported a significant increase in fibromyalgia and several other autoimmune diseases among women whose silicone gel breast implants were leaking, compared to women with silicone implants that were not leaking outside the scar tissue capsule.4 In addition, scientists at the National Cancer Institute (NCI) found a doubling of deaths from brain cancer, lung cancer, and suicides among women with breast implants compared to other plastic surgery patients.6 National Cancer Institute scientists concluded that more research was needed to determine if implants increase the risk of cancer or autoimmune diseases.5,6

The Bottom Line

Many women choose mastectomies to “get rid of the cancer once and for all” hoping that it is the safest strategy for dealing with breast cancer.  However, research shows that women who have lumpectomies live longer than women with the same diagnoses that chose mastectomies instead. Research makes it clear that there are many complications from breast implants that often keep women needing additional surgery and medical help in the years after breast cancer is removed, including the possibility of cancer of the immune system.  Unfortunately, many women tell us that their doctors did not warn them about these risks. [Read a New York Times article about a woman with ALCL here.]

Some of the information from this article was based on Dr. Zuckerman’s article published in Archives of Surgery, Vol 141, pages 714-715. The original article can be found here.

Are Mastectomies Necessary for Women with BRCA1 or BRCA2? What About for Women Without the Breast Cancer Gene?

Diana Zuckerman, PhD, and Megan Polanin, PhD, National Center for Health Research

When Angelina Jolie publicly announced her double mastectomy in 2013, she was praised for possibly saving many women’s lives. But we know more today than we did then and experts now agree that too many women are undergoing unnecessary mastectomies. Here are the facts.
A review of 10 studies found that the risk of getting breast cancer for an average woman with BRCA1 is 57%. The risk is 49% for a woman with BRCA2.[1] Keep in mind that for younger women, the lifetime risk of breast cancer is very different from the risk of getting breast cancer in the next 10 years or even 20 years. According to experts, a 40-year-old woman with the BRCA1 gene has a 14% chance of getting breast cancer before she turns 50.[2] That is not nearly as frightening, and with regular screening and all the progress in breast cancer treatments, the survival rate from breast cancer is higher than ever. Many breast cancer patients live long and healthy lives.
Most women are diagnosed with breast cancer at early stages, making it safe to undergo a lumpectomy (which removes just the cancer) rather than a mastectomy (which removes the entire breast). Yet American women are undergoing prophylactic mastectomies at a higher rate than women in other countries — many of them medically unnecessary.[3] Breast cancer experts believe that many women undergoing mastectomies do not need them and are getting them out of fear, not because of the actual risks.
In recent years, we have seen an increase in women with early-stage breast cancer choosing to get a double mastectomy. For example, a 2015 study conducted by researchers at Vanderbilt University reported that, for women diagnosed with early-stage breast cancer in one breast, the rates of double mastectomy increased from 2% to 11% from 1998 to 2011.[4] Researchers found that decisions to have a double mastectomy increased more for two groups of women: 1) Women with ductal carcinoma in situ (DCIS) where there are abnormal cells inside a milk duct in the breast that won’t spread and aren’t dangerous and 2) Women with cancer only in the breast that has not spread to the lymph nodes.
This year, researchers from Emory University and colleagues published a study focused on women diagnosed with early-state breast cancer in one breast.[5] They found that, from 2004 to 2012, the percentage of these women 45 years or older who got double mastectomies more than doubled from 4% to 10%. For women ages 20-44, the percentage tripled from 11% to 33%. Researchers found that it mattered where women lived in the United States. For example, in five Midwestern states (Nebraska, Missouri, Colorado, Iowa, and South Dakota), 42% of the women who got surgery decided to get a double mastectomy.
For many years, experts have known that women who undergo lumpectomies for a non-invasive condition called ductal carcinoma in situ (DCIS) or for early-stage breast cancer live just as long as women undergoing mastectomies. However, the latest research goes a step further: a study conducted in the Netherlands of more than 37,000 women with early-stage breast cancer found that the women undergoing lumpectomies were more likely to be alive 10 years later than women with the same diagnosis who underwent a single or double mastectomy.[7] They were also less likely to have died of breast cancer.
In 2016, Harvard cancer surgeon Dr. Mehra Golshan published a study of almost half a million women with breast cancer in one breast. She reported that those undergoing double mastectomies did not live longer than women undergoing a mastectomy in only one breast.[6]
These are just the most recent studies. For more information about the many studies that show the benefits of less radical surgery, see this article.
The bottom line is that women with DCIS or early-stage breast cancer have more effective and less radical treatment options than mastectomy. We need to stop thinking of mastectomy as the “brave” choice and understand that the risks and benefits of mastectomy are different for every woman with cancer or the risk of cancer. In breast cancer, any reasonable treatment choice is the brave choice.
The research clearly shows that mastectomies are not the best choice for most women if they want to live longer. Women should be aware of treatment choices for breast cancer and encouraged to make decisions based on their own unique situations. For each woman, it is important to weigh her own risk of cancer — in the next few years, and not just over her lifetime – and the risks of various treatments. Each woman should make the decision that is best for her, based on the facts, not on fear.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
1. Chen, S., & Parmigiani, G. (2007). Meta-analysis of BRCA1 and BRCA2 penetrance. Journal of Clinical Oncology, 25(11), 1329-1333.
2. Chen, S., Iversen, E. S., Friebel, T., Finkelstein, D., Weber, B. L., Eisen, A., … & Corio, C. (2006). Characterization of BRCA1 and BRCA2 mutations in a large United States sample. Journal of Clinical Oncology, 24(6), 863-871.
3. Metcalfe, K. A., Birenbaum?Carmeli, D., Lubinski, J., Gronwald, J., Lynch, H., Moller, P., … & Kim?Sing, C. (2008). International variation in rates of uptake of preventive options in BRCA1 and BRCA2 mutation carriers. International journal of cancer, 122(9), 2017-2022.
4. Kummerow, K. L., Du, L., Penson, D. F., Shyr, Y., & Hooks, M. A. (2015). Nationwide trends in mastectomy for early-stage breast cancer. JAMA surgery, 150(1), 9-16.
5. Nash, R., Goodman, M., Lin, C. C., Freedman, R. A., Dominici, L. S., Ward, K., & Jemal, A. (2017). State variation in the receipt of a contralateral prophylactic mastectomy among women who received a diagnosis of invasive unilateral early-stage breast cancer in the United States, 2004-2012. JAMA surgery.
6. Wong, S. M., Freedman, R. A., Sagara, Y., Aydogan, F., Barry, W. T., & Golshan, M. (2017). Growing use of contralateral prophylactic mastectomy despite no improvement in long-term survival for invasive breast cancer. Annals of surgery, 265(3), 581-589.
7. van Maaren, M. C., de Munck, L., de Bock, G. H., Jobsen, J. J., van Dalen, T., Linn, S. C., … & Siesling, S. (2016). 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study. The Lancet Oncology, 17(8), 1158-1170.
8. Hwang, E. S., Lichtensztajn, D. Y., Gomez, S. L., Fowble, B., & Clarke, C. A. (2013). Survival after lumpectomy and mastectomy for early stage invasive breast cancer. Cancer, 119(7), 1402-1411.
9. Kurian, A. W., Lichtensztajn, D. Y., Keegan, T. H., Nelson, D. O., Clarke, C. A., & Gomez, S. L. (2014). Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998-2011. JAMA, 312(9), 902-914.

2016 Update: When should women start regular mammograms? 40? 50? And how often is “regular”?

Diana Zuckerman, Ph.D. and Anna E. Mazzucco, Ph.D.
Updated 2016

In recent years, there has been a growing concern that annual mammograms starting at age 40 may do more harm than good for many women. That is why the U.S. Preventative Services Task Force, an expert group that reviews the latest research findings, recommends that mammography screening for most women start at age 50 rather than 40, and that the frequency be every two years (instead of annually) through the age of 74.

The Task Force is widely used as a gold standard for determining medical treatment and screening. In this case, they recommended raising the age to 50 after the American College of Physicians recommended the same thing, and they also recommended that women continue to undergo mammograms until age 74. They say that there is no evidence of what the benefits might be for women 75 and older.

For many years, the American Cancer Society (ACS) recommended annual mammograms starting at age 40, but in October 2015, they issued new recommendations that moved in the direction of those of the medical experts. They now recommend that women at average risk of breast cancer start mammography at 45, that they undergo annual mammograms from 45-54, and continue to undergo mammography every other year after that. Experts do not recommend MRIs for screening women of average risk, but clinical studies are being done to determine whether they should be.

So what is best for you?

A key reminder: these recommendations are for screening mammograms. Mammograms are still needed at almost any age if a lump is found. The mammography recommendations also do not apply to all women, only for the average woman. Experts agree that women at especially high risk of breast cancer, such as those with mothers or sisters who had breast cancer, may want to start mammograms between the ages of 40 and 50 or in rare cases, even earlier.

The bottom line is that mammograms help detect breast cancer earlier. However, like most medical procedures, there are risks as well as benefits.

Whether to start at age 50, or 40, or even earlier depends on several different factors.

For most women, who are not at especially high risk of breast cancer, regular mammograms can start at age 50. Or, to be cautious, a woman can get one mammogram earlier (around age 45) and then if it is normal, wait until she is 50 for her next mammogram. This is the advice that the National Center for Health Research and their Cancer Prevention and Treatment Fund have been giving since 2007.

Women at higher risk of breast cancer should not wait until they are 50 to have regular mammograms. Please remember that the higher age– 50– is only a guideline (not a strict rule) and only for screening women with no symptoms and not at high risk of breast cancer. In addition, if a woman finds a lump on her breast, a mammogram is still very important, regardless of the woman’s age. For a woman at high risk of breast cancer because of her family history or environmental exposures, regular screening before age 50, or even before age 40, may be a very good idea.

Women who are carriers of the BRCA genetic mutation were previously recommended to begin yearly mammograms between ages 25-30, since this mutation puts them at much higher risk of getting breast cancer. Newer studies have found that starting yearly mammograms before age 35 has no benefit and may instead be harmful. Women end up with higher exposure to radiation for mammograms over their lifetime, which increases their chance of getting radiation-induced breast cancer that they may not have gotten otherwise.7

Most women who have a mother, sister, or grandmother who had breast cancer at the age of 50 or older, or who are at high risk of breast cancer because of obesity or other reasons, may want to have regular mammograms (every two years) starting between ages 40 and 50. If their relatives had breast cancer at a young age, women may consider mammograms even before age 40. Unfortunately, younger women tend to have denser breasts, which often look white on a mammogram. Since cancer also shows up as white, mammograms are less accurate for younger women (and other women with dense breasts). For those women, a breast MRI is likely to be more accurate than a mammogram, and they are safer than mammograms.

Breast MRIs are more expensive than mammograms, costing an average of $2,000 (compared to about $100 for a mammogram). The Task Force says there isn’t enough information to recommend for or against MRIs. For that reason, insurance may not cover the cost. If you want insurance to pay for an MRI, you probably need your doctor to recommend it because of your high risk. Women with dense breasts are at higher risk, especially women with mothers or sisters who had breast cancer at a young age. It is logical that they could potentially benefit from regular breast MRIs, but research is lacking to draw conclusions.

Which kinds of cancer risks can help me decide?

A 2011 article by Dr. John Schousboe and his colleagues published in the Annals of Internal Medicine examined mammography for women at different ages and with different risk factors.2 Biennial mammography (screening once every two years) had health benefits and was cost effective for all women 40-79 with high breast density or with both a family history of breast cancer and a breast biopsy, regardless of breast density. Biennial mammography was also beneficial for women aged 50-69 with average breast density and women 60-79 with low breast density and either a family history of breast cancer or a previous breast biopsy. Annual mammography was not cost-effective for any group.

The study’s authors concluded that each woman’s decision about mammography screening should be based on the following risk factors: age, breast density, history of breast biopsy, family history of breast cancer, and personal beliefs about the benefits and harms of screening. This study supports the Task Force guidelines that women at an average risk of breast cancer can start biennial screening at age 50 and that women at a higher breast cancer risk should consider screening before age 50.8

The chances of getting breast cancer increase with age, and the disease is much more likely after age 50 than before. So, from a public health and cost-effectiveness perspective, annual screening mammograms do the most good after age 50. Earlier mammograms are less accurate and more likely to result in unnecessary anxiety or unnecessary biopsies. Unlike Schousboe and his colleagues, the Task Force did not recommend routine screening for women 75 and older, because there was not enough evidence to conclude whether or not the benefits outweigh the risks. However, the American Cancer Society recommends that screening every other year continue for older women whose health is good enough that they are likely to live at least 10 years. That is a difficult standard to implement: How many doctors want to tell their healthy older patients that they are not likely to live at least 10 more years?

Isn’t more frequent mammography better?

Remember that mammograms expose women to radiation, which can increase the risk of breast cancer. Increasing the age of mammograms to age 50 for most women, and reducing the frequency to every two years could save lives because it would drastically reduce radiation exposure. Experts believe that less frequent mammograms also means a lower false alarm rate, and that means fewer unnecessary tests, anxiety, and possibly fewer unnecessary surgeries.910

Do mammograms save lives?

Between 1975 and 2000, dramatic improvements in treatments for breast cancer became available. Surgery options were improved, important chemotherapy agents were discovered, and tamoxifen, a hormonal treatment for estrogen-sensitive breast cancer, came into widespread use. At the same time, mammography became more popular. In 2000, about 70% of women 40 and over reported that they had a mammogram within the previous two years. Mammography rates more than doubled between 1987 and 1999, but more recently rates have decreased slightly.

The result of these important advances has been a dramatic decrease in the number of breast cancer deaths, even while more cases of breast cancer were being diagnosed. The five-year survival rate for breast cancer increased from 75% between 1974 and 1976, to 88% by 1995-2000. Have the survival rates improved because of mammography or because of better treatments?

This became a full-fledged medical controversy in recent years. Two issues were at the root of the debate: 1) was mammography simply uncovering more tiny, slow-growing cancers that would never have developed into a health threat even if they had never been discovered? and 2) were we doing more harm than good by subjecting so many women to cancer treatment without knowing whether some of these very early cancers would really become dangerous? Since 2009, research has shown that some tiny cancers disappear on their own without treatment. For example, experts now conclude that most ductal carcinoma in situ (DCIS) will never become an invasive breast cancer, even without treatment.

Regular screening mammography helps diagnose cancer earlier but the latest research suggests it may not be saving lives, except possibly for the highest risk women. Researchers estimate that for 40-year-old women, fewer than 2 lives will be saved out of 1000 women who have annual mammograms.11 During that time, approximately 600 of these 1000 women will have false alarms, and approximately 5-10 will have unnecessary surgical treatment that could be harmful to them. This latest research did not consider the benefits compared to the risks of regular mammography (every two years) after age 50. We believe that starting less frequent mammography at 50 (and for women at high risk between the ages 40 and 50) continue to provide benefits that may outweigh the risks for most women. Although about 90% of worrisome findings from mammograms turn out to be false alarms — not cancer — the overall benefits have been established for women over 50.

What about breast self-exams? The Task Force recommends against teaching women to do breast self-exams, because evidence suggests the risks outweigh the benefits. There are many “false alarms,” and by the time a cancer is large enough to be felt in a self-exam, it will soon be found anyway, in the shower or while dressing. And the Task Force and the American Cancer Society no longer recommend that doctors do breast exams on their patients, for the same reason.

For more information:

U.S. Preventive Services Task Force, Breast Cancer Screening Final Recommendations, 

For information about insurance coverage for free mammograms:

Less Radical Surgery is a Healthier Choice for Women with Breast Cancer

Brandel France de Bravo, MPH and Diana Zuckerman, PhD

Updated 2017

Experts have long advised that lumpectomy patients live as long as mastectomy patients.  But the latest research, based on hundreds of thousands of women, indicates that women with DCIS or early-stage breast cancer are more likely to live longer, healthier lives if they choose less radical surgery.

Four studies indicate that lumpectomy patients live longer.

In a study of almost half a million women with breast cancer in one breast, Harvard cancer surgeon Dr Mehra Golshan  reported in 2016 that those undergoing double mastectomies did not live longer than women undergoing a mastectomy in only one breast.[1] On average, women who underwent a lumpectomy instead of mastectomy lived longer than women undergoing either a single or double mastectomy for cancer in only one breast.

Similarly, a study of more than 37,000 women, also published in 2016, women with early-stage breast cancer who underwent lumpectomy with radiation were more likely to be alive 10 years later, compared to women who underwent mastectomies.[2] They were also less likely to have died of breast cancer or of other causes.  This was true even when age and factors that could influence survival were taken into account.

Dr. Shelly Hwang and her colleagues found similar results in a 2013 study of more than 112,000 California women who had lumpectomies to remove their early-stage breast cancer were more likely to be alive and free of breast cancer 5 years after surgery than women who had mastectomies.[3] The women had been diagnosed between 1990 and 2004 with either Stage 1 or 2 breast cancer. All of them had either a lumpectomy with radiation or a mastectomy. After surgery, their health was monitored for an average of 9 years (the women were all studied for 5-14 years). The women who had a lumpectomy and radiation tended to live longer than the women who had mastectomies, when controlling for age at diagnosis, race, income, education levels, tumor grade or the number of lymph nodes with cancer. Lumpectomy with radiation was especially effective for women who were 50 years and older with hormone-receptor positive tumors: they were 19% less likely to die of any cause during the study than women just like them who had mastectomies. Perhaps more surprising, they were 13% less likely to die of breast cancer than women just like them who had mastectomies.

In a study published in 2014, Dr Allison Kurian and her colleagues at Stanford studied 189,734 California patients diagnosed from 1998 to 2011 with early-stage breast cancer in one breast, ranging from Stage 0 (DCIS) to Stage 3.[4The study showed that the percentage of women having both breasts when only one breast had cancer (called bilateral mastectomies) increased dramatically, but there was no advantage to that more radical approach.  Instead, the women who underwent lumpectomies (removing only the cancer, not the entire breast) lived longer and were more likely to be alive 10 years after diagnosis compared to women undergoing a mastectomy.  Women who had both breasts surgically removed did not live longer than those undergoing a mastectomy on one breast.

Compared to women in other countries, women in the U.S. who are diagnosed with early-stage breast cancer are more likely to remove both breasts even if only one has cancer. It is not known why bilateral mastectomy provides no medical advantage, but a study of more than 4,000 cancer patients by Dr. Fahima Osman at the University of Toronto indicates that having a healthy breast removed in addition to the breast with cancer increases the chances of medical complications.[5] Removing the healthy breast (“contralateral breast”) doubled the chances of having wound complications in the first month after surgery: from about 3% for women who had only the breast with cancer removed to about 6% for women who also had the healthy breast removed. About 4% of women who had a single mastectomy experienced some kind of complication (not necessarily wound-related) in the 30 days after surgery, compared to 8% of women who had both breasts removed. The risk of cancer in that healthy breast was already less than 1% per year unless the woman has a BRCA gene or some other very high risk factor.[6] Hormone pills such as tamoxifen or aromatase inhibitors can further reduce that already low risk.

The Bottom Line: these enormous studies of women in the U.S. and other countries make it clear that women with DCIS or early-stage breast cancer should undergo surgery to remove only the DCIS lesion or cancer, not the entire breast.   The women who undergo lumpectomy with radiation usually live longer than those who undergo mastectomy or bilateral mastectomy.  In addition, mastectomy patients who have breast implants are more likely to kill themselves compared to mastectomy patients without implants. Unfortunately, the fear of breast cancer and desire to “get rid of the problem” has resulted in too many women undergoing mastectomies or bilateral mastectomies that threaten their lives.  Physicians and breast cancer advocacy groups need to make sure that patients understand why lumpectomy with radiation is a better idea.

For a free booklet on treatment options for DCIS, click here.  For a free booklet on treatment options for early-stage breast cancer, click here.


  1. Wong, S., Freedman, R., Sagara, Y., Aydogan, F., Barry, W., & Golshan, M. Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer. Annals of Surgery. 2016 March; doi:10.1097/SLA.0000000000001698
  2. Marissa C. van Maaren, et al, “10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study”. Lancet Oncol. 2016 Aug; 17(8): 1158–1170. Published online 2016 Jun 22. doi: 10.1016/S1470-2045(16)30067-5
  3. Hwang ES, et al “Survival after lumpectomy and mastectomy for early stage invasive breast cancer: The effect of age and hormone receptor status” Cancer 2013 April 1; 119(7); DOI: 10.1002/cncr.27795.
  4. Kurian, Allison W., Daphne Y. Lichtensztajn, Theresa H. M. Keegan, David O. Nelson, Christina A. Clarke, and Scarlett L. Gomez. “Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998-2011.” The Journal of the American Medical Association 2014; 312(9): 902-914. DOI:10.1001/jama.2014.10707
  5. Osman, Fahima, et al “Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database.” 2013 Oct; 20(10): 3212–3217. Published online 2013 Jul 12. doi: 10.1245/s10434-013-3116-1
  6. National Cancer Institute. Breast Cancer Treatment (PDQ®).

The Facts About Breast Implants

What exactly are breast implants?
Breast implants are silicone envelopes filled with a liquid or gel. They are used to increase the size of a breast or to replace a breast that was removed because of breast cancer.

Most breast implants in the U.S. are filled with saline (salt water). The envelope is made of silicone and also contains other chemicals. So even if you get saline implants, you will still have some silicone in your body.

Breast implants filled with silicone gel were approved by the FDA for the first time in 2006, but only for women ages 22 and older. The FDA has not approved silicone gel breast implants as safe for augmentation for women under the age of 22 because of safety concerns.

If implants are filled with anything other than saline or silicone, they are experimental. You are taking a bigger risk if you try them. Unless you want to be a guinea pig, don’t be fooled by stories about how they are “very popular in Europe.” They aren’t.

Breast implants vary in their surface (smooth or textured), shape (round or shaped), profile (how far it sticks out), volume (size), and shell thickness. Breast implants include an envelope or shell made of silicone, a filler, and a patch to cover the manufacturing hole.

Breast implants can break and rupture, which can cause a variety of serious health problems. Implants can break in a few weeks, a few months, or a few years, although some can last 15 years or more. According to the FDA, by the time a woman has had implants for 10 years, at least one of them has broken. So, anyone who gets implants should expect to have to replace them at least once every ten years. Many women have to replace them more often because they can cause other problems in addition to breaking, and the two implants may break at different times.

Think of it like you would think about buying a new car – usually a new car doesn’t cause problems at first, but causes more and more problems as it gets older. But some cars cause problems right away, and it’s not always possible to fix them. The difference is that breast implants are in your body, and if something goes wrong the only way to fix them is to pay for surgery. There is no way to know how long your breast implants will last or whether they will cause problems.

Before You Get Implants

Are they safe?
The FDA has approved silicone gel breast implants but only for women who are 22 or older. And because of serious concerns about safety, the FDA is requiring implant makers to study 80,000 women with breast implants for 10 years.

Saline breast implants are approved by the FDA for women over 18.  Why the difference?  All breast implants will eventually break and leak into the body.  The FDA believes that there are more serious safety questions as well as cosmetic problems when silicone gel implants leak into the body, than when saline implants leak.  That’s because saline is salt water, which is not dangerous.

The FDA has approved saline breast implants made by two manufacturers, Inamed (also called McGhan or Allegan) and Mentor. The FDA has approved silicone gel breast implants made by those same two companies, and also by Silimed.  All breast implants can cause problems, but breast implants made by other companies haven’t been tested for safety and are not allowed to be sold in the U.S.  If you get implants made by other companies in other countries, they may be more likely to break or cause problems.


The FDA decided that breast implants are “reasonably safe” for most women, but that women need to be accurately informed about the risks.

“Reasonably safe” does not mean safe for everyone. The FDA found that most implant patients have at least one serious complication within 3 years after getting their silicone or saline implants.

The purpose of the 10-year studies is to find out how many health problems are likely during the first 10 years that a woman has implants.  Unfortunately, there have been so many problems with the studies that they are not likely to be able to answer those questions.

What complications should I expect?
Capsular Contracture
Breast pain, breast hardness, and numbness in the nipple are common complications that may last for years, and may never go away.  The most common, called capsular contracture, is when the scar tissue inside your body tightens around the breast implant.  That can cause the implant to feel very hard and painful, and can make the shape look unnatural, as if you have 2 balls on your chest.

The most serious complications include toxic shock syndrome, implants breaking through the skin, or skin dying. A few studies have shown that patients have died or had gangrene as a result of breast augmentation surgery. These are rare but they do happen.

Many breast augmentation patients need additional surgery within 5 years of getting breast implants. Within 10-12 years, most women will need at least one additional surgery, and some will need 2 or more surgeries.

Complications are even more common among women getting breast implants after a mastectomy.  Four out of every 10 reconstruction patients need additional surgery within three years of getting implants.

If you are thinking of having children in the future, it is important to know that breast implants may interfere with your ability to breastfeed.  Breast milk is the best food for babies, so you may want to delay getting breast implants until after you are done having children.

How long do breast implants last?
It is impossible to predict how long an implant will last. Some implants break within a few days, weeks, or months, while others last for many years.

Like most new products, most implants seem fine for the first few years. Think of implants as being as reliable as a car – problems can happen anytime, but the older they get, the more problems you are likely to have, the more expensive those problems are going to be.

Eventually, you will need to get your implants replaced.  A study by FDA scientists found that by the time a woman has implants for 10 years or more, at least one of them has broken.

Why do implants break?
All breast implants have the same basic design. Implants are made up of a silicone envelope, with a filling of some kind–usually either saline or silicone gel. Because of this design, all breast implants can develop a tear or hole. Whether the hole or tear is large or small, it’s called a rupture.

Ruptures can happen simply as implants age, or because of a blow to the chest, such as in a car accident or a bad fall. Tears or holes can be caused by a defective implant, by a nick from a needle during a biopsy, or even when the surgeon is closing the incision in your chest after putting the implants inside you.

Saline implants have a valve. If you have saline implants, the surgeon will place the empty silicone envelope in your chest, and then use the valve to fill the envelope with saline. If the valve is defective, or breaks, it will leak.

The pressure from mammography can cause an implant to break, especially if the implants are old or the mammography technician is not trained to work with breast implants. You should always tell the technician that you have breast implants, and make sure that he or she is qualified to perform your mammogram.

Closed capsulotomy can also cause an implant to rupture, and should never be done.  Closed capsulotomy is the name for a procedure when a woman has capsular contracture and the doctor squeezes the breast very hard to try to break the scar tissue capsule. Unfortunately, the squeezing can break the implant as well as the capsule.

How much do breast implants cost after the initial surgery?
Most women pay $4,000-7,000 for their first augmentation surgery with saline implants, and approximately $1,000 more with silicone gel implants. If a doctor is charging less than that, be very cautious. Make sure he or she is a board-certified plastic surgeon and is very experienced with implants.

Experts at the FDA warn that women with silicone gel breast implants should have a breast MRI three years after getting silicone implants and every two years after that. The purpose of the MRIs is to determine if the silicone gel breast implants are ruptured or leaking, because there are often no symptoms. It is important to remove silicone implants if they are ruptured, to avoid the silicone leaking into the breast or lymph nodes. Breast MRIs usually cost at least $2,000, sometimes more.

Women with saline breast implants do not need MRIs to detect rupture because saline implants deflate when they are ruptured.  That makes it obvious that the implant has broken, but it is not dangerous unless there are bacteria in the implant.

Your health insurance will not pay for breast augmentation or other kinds of cosmetic surgery. Most insurance companies will not pay for most complications or medical problems that result from breast augmentation, and they will not pay for MRIs to check for rupture. Before your surgery, check to see if your health insurance company covers complications from breast implants.

Every week we hear from women who want to have their implants removed and cannot afford to do so.

If you have to pay for breast implants on an installment plan or by borrowing money, then it is very risky to get breast implants. You might still be paying off your surgery when serious implant problems arise. It often costs more to get implants removed than to have them put in.

Do breast implants cause cancer?
Breast implants do not cause breast cancer, but they make it more difficult to detect breast cancer because they can hide tumors.

Mammograms can’t see through breast implants, and the most recent research indicates they will miss the tumors of half of the augmented women who have breast cancer.

Mammograms must be performed by a skilled technician who is aware that you have implants. This costs more, takes longer, and will expose you to more radiation each time you have a mammogram. And according to a study by FDA scientists, mammograms can cause implants to rupture.

Research by the National Cancer Institute has found that women with breast augmentation are more likely to die of brain cancer or lung cancer compared to other plastic surgery patients.  However, the scientists who did the study aren’t sure whether that is conclusive or just happened by chance.

What to ask your doctor
If you decide to get breast implants put in or taken out, make sure you only use a board-certified plastic surgeon.

If your doctor shows photographs of patients, ask if they were his or her own patients. Ask to see photographs of how they looked a few years later.

If your doctor tells you that breast implants are proven safe, ask what kinds of problems can happen to women who have breast implants.

Ask your doctor for written information about the risks of breast implants and read that information at least one week before surgery, so you have time to ask questions or gather more information.

Any woman who considers silicone gel implants should ask for the informed consent form at least one week before surgery.

If your doctor says all of his or her patients are happy with their results, ask to speak to patients who have had implants for at least 7-10 years.

Legal Issues
Many women wonder why implant companies agreed to a legal settlement for billions of dollars to help women harmed by breast implants, and yet breast implants can still be sold today. To read a report summarizing these legal issues, written by the Alliance for Justice, click here.

What do the experts say about breast implants?
Well-respected women’s health expert Dr. Susan Wood and the former president of the American Society of Plastic Surgeons, Dr. Scott Spear, spell out the risks of silicone breast implants in a new article. To read a summary, click here.

How Will Breast Implants Change Your Life?

More Surgeries

You will have to get many more surgeries to either replace your old implants at least every ten years or surgery to simple remove them and try to get your breasts looking like they did before implants.

Breast Implant RemovalIn addition, you may need extra medical treatment or surgeries to help treat any cosmetic or medical problems caused by the implants. Implants are not a one time deal and will have to be dealt with throughout the rest of your life.

Attention Grabbers

While many girls get implants to make themselves stand out more, you may not like the attention as much as you think. Guys may stare at your chest instead of looking at your face when they talk to you, and your girlfriends may be uncomfortable and awkward about your new breasts as well. Several celebrities have spoken about feeling like their breasts entered a room before they did. It may be hard to ignore their stares and comments.

Also, keep in mind that you will have to buy new clothes to fit your new body. While this may sound exciting, it can be even more challenging for a thin or average weight girl or woman to find clothes that fit bigger breasts as it was to find clothes that fit smaller breasts.

Implants will affect you forever

Whether you are happy or unhappy with your implants, implants will affect you forever. You may be completely satisfied with your implants, and satisfied when you have to replace them. But just keep in mind, that they don’t work out for everyone, and you may be left with breasts that are as hard as rocks or looking like a very elderly woman. Seriously think about if you want this kind of drastic change in your life, throughout your entire life. Immediate results are usually positive for girls, but it’s important to remember that this decision will be with you forever, so choose wisely.

What To Ask Your Friends, Relatives, and Plastic Surgeon.

Sometimes it’s hard to know what questions to ask, and who to ask them of. Here are some of the questions you may want to ask the people who are closest to you. And, important questions to ask a plastic surgeon if you are seriously considering breast implants.

Questions for your friends:

• Do you think implants look real?

• Will other people notice if I get implants?

• Do you think it would affect my reputation or how people think of me?

• Are implants worth it – the money and additional surgeries?

• Will I look better with implants?

• Do you know anyone else who has implants?

• Could you help me come up with other ways to help me feel better about myself?

What to ask your friend who has implants:

• What was the surgery like?

• What exactly did you have done?

• Did your doctor show you pictures of what can happen if things go wrong?

• Were there any complications?

• How much did it cost? Have you had to pay more after the surgery?

• Were you satisfied with the result? Has that satisfaction changed over time?

• If you could, would you do it again? Would you have gotten bigger, smaller,
or the same size implants if you did it over again?

• Do they hurt? Did it influence how sensitive your breasts or nipples are?

• How long have you had implants? Have you experienced any side effects yet?

• How has your daily life been affected by the implants?

If you want to get a true picture of how implants can affect your life, and still want that personal contact and advice, you should talk to a woman who has had her implants for more than ten years. If you don’t know anyone, read some personal stories about girls and women who got implants in their teens.

It’s probably going to be scary asking your parents either for or about breast implants, but it’s best to have their advice before you either ask them to pay for it, or pay for it yourself. Even though they may seem out of date on a lot of things that are important to you, they still have had the experience of growing up and could be helpful to you.

• What do you think about me getting breast implants?

• How could I pay for them? Would you help pay for any problems that might happen?

• Do you think that is a good choice for me?

• If you do not want me to get implants, can you suggest any alternatives to feel better
about myself and how I look?

What to ask your mom specifically

• Did you want to get breast implants when you were my age?

• If yes…Now that you are older, do you regret not getting implants,
or are you happy with your decision?

• How did you feel about your breast size growing up?
Did this feeling change at different ages?

What to ask your doctor

When you visit your doctor for the first time to talk about implants, here are some things to ask about:

• If you decide to get breast implants, make sure you only use
a board-certified plastic surgeon.

• If your doctor shows photographs of patients, ask if they were his or her own patients.

• Ask to see photographs of how the women looked a few years later
and ask to see photos of what they would look like if there are complications.

• Ask if you can speak to any patients who have had implants for at least 7-10 years,
preferably one who had implants at a young age.

• Ask your doctor for written information about the risks of breast implants
and read that information at least one week before surgery,
so you have time to ask questions or gather more information.

• Any woman who considers silicone gel implants should ask for
the informed consent form at least one week before surgery.

• Ask the doctor how many breast implant surgeries he has performed on girls your age.

• If there is a paid warrantee on the implants, what exactly is included in that warrantee?
What isn’t included?

• Will the doctor remove them for free if you have any serious problems?
What if you want them removed but the doctor doesn’t think it is necessary?
Will the services of the nurses and anesthesiologist and other costs also be free?