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Breast Implant Complications
While breast implants are safe in the hands of a trained plastic surgeon and appropriately selected patients, it is important to understand and monitor for complications that can occur.
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​Breast implant complications encompass a range of responses including capsular contracture, malposition, seroma and implant rupture, and they are approached through careful assessment and evidence-based management tailored to each patient’s anatomy and goals
​My Approach
In Singapore, the Health Sciences Authority (HSA) warns that textured implants appear to be associated with a higher risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). There is also emerging evidence of Squamous Cell Carcinoma (SCC) arising in association with textured implants.
Meanwhile, capsular contracture - firmness around the implant after placement - remains one of the most common reasons for revision surgery following augmentation. Despite claims by various implant companies, it is not if but when contracture occurs. What truly matters is whether intervention is necessary, as some patients may develop pain, tightness, or visible distortion while others remain comfortable and unaffected, regardless of implant brand, type or time since implantation.
My practice emphasises full informed consent, meticulous surgical technique, careful implant selection and handling, and diligent follow-up so that any early signs of complications are recognised and managed appropriately.
Planning & Technique
BIA-ALCL is a rare lymphoma of the immune system that develops in the capsule or fluid surrounding a breast implant, most commonly in textured implants. Symptoms include persistent swelling, a new lump in the breast or armpit, or a fluid collection that occurs usually a year or more after surgery. If these signs appear, prompt investigation is critical - typically including ultrasound or MRI imaging, fluid aspiration for cytology, and surgical removal of both the implant and capsule for tissue sampling and laboratory confirmation.
Capsular Contracture occurs when the natural scar tissue around the implant becomes abnormally thick or tight. Early signs include firmness, asymmetry, or discomfort. Treatment may involve capsulectomy, implant exchange, or implant removal depending on severity and patient goals.
Ultimately, surgeon technique matters - sterile handling, pocket selection, and incision choice all influence risk. Each patient’s surgical plan is designed to minimise complications while maintaining long-term comfort and symmetry.
Recovery & Expectations
In confirmed cases of BIA-ALCL, surgical excision is the cornerstone of treatment. If the disease has spread, chemotherapy or immunotherapy may be required in collaboration with oncologists in a multidisciplinary setting.
For capsular contracture, management depends on individual goals. Some patients may choose implant removal with total capsulectomy, others may pursue Simultaneous Implant Exchange with Fat Grafting (SIEF) or implant exchange with mastopexy for aesthetic restoration.
Follow-up visits remain essential for all patients. You will be guided on what to monitor, when to return, and how concerns are escalated promptly should they arise.
Post-operative care extends beyond routine reviews - it is an integral part of Dr Ng’s surgical philosophy. Through Doctor Stitch, an aftercare service founded to ensure seamless continuity and comfort, every patient is followed up personally by Dr Ng. Whether at home or in clinic, he provides attentive, discreet, and consistent care throughout the recovery journey.
Frequently Asked Questions
1. What is capsular contracture and how common is it?
Capsular contracture is the abnormal tightening of the fibrous capsule that forms around a breast implant. While the body normally forms a capsule, contracture occurs when the capsule thickens and tightens. Its incidence varies but is one of the more commonly recognised long-term implant responses.
2. How is capsular contracture treated?
Mild contracture may be observed initially, but progressive or symptomatic contracture is often addressed surgically with capsulectomy (partial or complete), implant exchange and sometimes pocket change. The approach is guided by severity, anatomy and patient goals.
3. What causes seroma around implants and when does it appear?
Seroma refers to fluid accumulation around an implant. Early seromas relate to surgical trauma and dead space; late seromas can be associated with friction, surface textures, or very rarely immunological responses. Evaluation involves clinical assessment and ultrasound to guide management.
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4. How is implant rupture identified?
Implant rupture can be internal (silent) or external. Saline implant ruptures are often clinically obvious due to volume loss. Silicone implant ruptures may require imaging (MRI/ultrasound) for confirmation. Management is typically implant removal/exchange based on symptoms and goals.
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5. What is malposition and how is it corrected?
Malposition refers to implants sitting in an unintended position (high, low, lateral). Surgical correction involves adjusting the pocket boundaries, capsulorrhaphy, or pocket repositioning to achieve symmetry and appropriate implant position.
6. Are infections around implants common?
Acute infections are relatively uncommon but are taken seriously when they occur. Early postoperative infections are usually managed with antibiotics and drainage; persistent or severe infections may necessitate implant removal and delayed reconstruction.
7. Can breast implants cause systemic symptoms?
Some patients report systemic symptoms they attribute to implants. While large-scale evidence does not establish a direct causal link in most cases, thorough clinical assessment is important. We investigate symptoms carefully and discuss evidence-informed options.
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Related Reading
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Breast Augmentation - choosing the right implant safely
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Natural Breast Lift - reshaping using one’s own tissues
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Breast Fat Grafting - implant removal and replacement with fat transfer
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Swelling after breast implants done abroad - Dr Ng's blog on what to do when this happens after returning from overseas
