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Breast Implant Related Issues
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.
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 BIA-Squamous Cell Carcinoma (BIA-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.
The association between textured implants and BIA-ALCL is well-documented. A 2024 literature review found that 13 of 17 analysed studies supported a potential association, with over 70% of reported cases linked to textured devices and 64 deaths recorded in the FDA's Medical Device Reports as of mid-2024. No epidemiological study or regulatory agency has reported a case of BIA-ALCL occurring exclusively with a smooth implant. A systematic review including local authors from SGH and NUH found that the majority of BIA-SCC patients presented with extracapsular spread at diagnosis, with a median time from augmentation to diagnosis of 20 years
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 with implant removal or implant exchange, depending on severity and the patient's goals.
Implant Exchange - For patients who wish to retain the aesthetic outcome of breast augmentation but address implant-related concerns such as implant ageing, pocket size change, or a desire to switch to a newer generation of implants, this is a well-established option. This may be performed as a straightforward exchange by utilising the same tissue plane, or combined with capsulectomy, pocket and plane adjustment, mastopexy, or fat grafting depending on the individual's anatomy and goals. Where the patient wishes to avoid new implants entirely, Simultaneous Implant Exchange with Fat Grafting (SIEF) offers a natural alternative using autologous tissue.
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 or without 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 for 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. Studies suggest up to half of patients develop some degree of capsular contracture over time, with approximately 30% developing clinically significant Baker Grade III-IV contracture following implant-based breast reconstruction.
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.
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.
5. How do I know if I need an implant exchange rather than just removal?
It depends on your goals. Patients who are happy with having implants but have concerns such as capsular contracture, rupture, size change, or ageing implants, are usually candidates for exchange. Patients who want to move away from implants entirely can consider SIEF or removal alone with or without mastopexy. There is no single right answer. The decision is guided by what you want to achieve, your anatomy, and the condition of the existing implant and capsule. This is discussed fully at consultation.
6. 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.
7. 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.
8. Can breast implants cause systemic symptoms?
Some patients report systemic symptoms they attribute to their implants such as fatigue, joint pain, cognitive difficulties, and others. The evidence is genuinely evolving and contested. A 2022 expert review concluded there is a causal association between silicone breast implants and systemic symptoms in certain patients, while a 2025 systematic review and meta-analysis found that no definitive causative link has been established and that mechanisms remain unclear. What is consistently reported is that explantation leads to symptom improvement in a meaningful proportion of patients. We take these concerns seriously, investigate symptoms carefully, and discuss options based on the current evidence rather than dismissing or overstating the association.
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
References
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Muntean M, Ilies RA, Pop IC, Urian L, Vlad IC, Achimas-Cadariu P. Unveiling the Controversy: A Literature Review on the Link Between Textured Implants and Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). J Clin Med. 2025 Jun 1;14(11):3902. doi: 10.3390/jcm14113902. PMID: 40507664; PMCID: PMC12156254.
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Lynch EB, DeCoster RC, Vyas KS, Rinker BD, Yang M, Vasconez HC, Clemens MW. Current risk of breast implant-associated anaplastic large cell lymphoma: a systematic review of epidemiological studies. Ann Breast Surg. 2021;5:30. doi: 10.21037/abs-20-96. Epub 2021 Sep 30. PMID: 35415602; PMCID: PMC9000366.
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Yeow M, Ching AH, Guillon C, Alperovich M. Breast implant capsule-associated squamous cell carcinoma: A systematic review and individual patient data meta-analysis. J Plast Reconstr Aesthet Surg. 2023 Nov;86:24-32. doi: 10.1016/j.bjps.2023.08.002. Epub 2023 Aug 18. PMID: 37666057.
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Luvsannyam E, Patel D, Hassan Z, Nukala S, Somagutta MR, Hamid P. Overview of Risk Factors and Prevention of Capsular Contracture Following Implant-Based Breast Reconstruction and Cosmetic Surgery: A Systematic Review. Cureus. 2020 Sep 9;12(9):e10341. doi: 10.7759/cureus.10341. PMID: 33062465; PMCID: PMC7549852.
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Cohen Tervaert JW, Mohazab N, Redmond D, van Eeden C, Osman M. Breast implant illness: scientific evidence of its existence. Expert Rev Clin Immunol. 2022 Jan;18(1):15-29. doi: 10.1080/1744666X.2022.2010546. Epub 2022 Jan 5. PMID: 34882509.
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Ferreira S, Barros AS, Marques M. Breast Implant Illness: Symptoms, Outcomes with Explantation and Potential Etiologies-A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2025 Dec;49(23):6600-6620. doi: 10.1007/s00266-025-05142-x. Epub 2025 Aug 11. PMID: 40788544; PMCID: PMC12738613.
