An estimated 40,000 PIP breast implants have been used for breast reconstruction and/or breast enlargements in the UK, in operations performed between 2001 and 2009. At the time of writing this book, news emerged in the UK of further cases of faulty implants having been inserted in women prior to 2001. In response to questions from the UK regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), the French authorities have now said the use of defective PIP implants began earlier than 2001, potentially affecting 7,000 more women in Britain.
Finding out if you have PIP implants
The government is advising women to take the following steps to reassure themselves if they have PIP implants, or if they need to find out if they have PIP implants:
Find out if you have PIP implants by checking your medical notes. You can get this information for free from your clinic or through your GP. If you had PIP implants on the NHS, you should receive a letter, however if you do not receive one contact your GP.
Speak to your clinic or cosmetic surgeon if you had them done privately; ask for information directly if you prefer. You can do this by requesting information from the supplier of the implants i.e. from the clinic which did the surgery or from the surgeon. Address the letter to the designated holder of the record. (This could be the clinic where the operation took place.) Include information so that they can identify your records – i.e. your name and address. (Further to this you may be sent an application form so you can access your records.) Specify exactly what you want to see. The person with this data must reply to your request within 40 days. They must reply within 21 days if the records have been added to in the last 40 days.)
If only requesting to view the records this could cost £10, as opposed to receiving copies which could cost up to £50. You will need to identify this when requesting. When viewing your records, you will need to look at the operation records page. This allows you to view stickers which will identify the makers of your implant. Those with PIP breast implants will see stickers reading ‘PIP’ or ‘Cloverleaf Medical Implants’.
If a private clinic no longer exists, the government is advising women to speak to their GP.
Once you have confirmed that your implants are PIP what to do next:
Scans
If you have PIP implants we would suggest that you contact your GP or the clinic where the operation took place to request a scan. This will enable the medical practitioner to assess whether your implants pose an immediate risk, i.e. if they are ruptured. You must be persistent in this if your request is denied.
The scan for breast implant review is either an ultrasound or an MRI. Ultrasound is reasonably available and cheap but it is not that accurate and depends on how experienced the person is who does it.
The MRI scan is more reliable but not as easily available and very expensive.
Since you often can’t see a difference in your breast when a silicone gel implant breaks, it is important to have an MRI. A mammogram is not reliable enough for detecting a broken silicone gel implant, and the squeezing could make the contents of the implant leak outside the scar capsule.
MRI is the most sensitive imaging modality, as it is in most areas of diagnosis, but it also comes at a premium price. Good quality high resolution ultrasound is deemed by most doctors an accurate tool to detect implant rupture. The key in all of this though is the skill and experience of the reporting consultant radiologist.
When making an appointment to have your MRI scan you should check if the provider has a dedicated breast coil, as not all MRI providers have dedicated breast coils. Your MRI scan must also be provided by a specialist radiologist.
MRI providers will be able to provide you with detailed information regarding the scan and what the use of a breast coil involves.
It is important to note that you can currently take a request form for a diagnostic imaging service to any accredited diagnostic imaging provider. You may also wish to discuss your concerns with your specialist or GP at the time the diagnostic imaging request is made.
Once you have had the scan there are two outcomes:
If your scan shows that your implants are ruptured and you would like them removed you would need to contact the clinic or surgeon to see what your options are.
If your scan shows that there is currently no sign of any problems with the implant you will need to make the decision as to whether you would like them removed/replaced, or continue to monitor them.
Symptoms and signs of a ruptured breast implant
When a silicone gel breast implant breaks, the contents usually leak very slowly. A ruptured silicone gel implant can go completely unnoticed for many years. Sometimes the rupture is discovered only when the implant is removed.
A rupture is a split that occurs in the implant’s casing. A rupture can be caused if:
The implant’s shell (that holds the silicone or saline) gets weaker over time.
The implant is damaged during the operation.
There is a flaw in the implant.
The breast is injured.
When a silicone implant breaks, one of two things can happen to the leaking silicone gel. One possibility is that the leaking silicone can be contained within the scar tissue capsule, which is the thick layer of scar tissue that naturally builds up around the implant. When this happens, the silicone stays where it is. However, the silicone can leak outside of the scar tissue capsule. When this happens, silicone can migrate to other parts of the body, including the lymph nodes under the arm and major organs such as the lungs, where it is impossible to remove. The longer a woman waits to have a ruptured silicone gel implant removed, the more time the silicone has to travel in her body.
If your silicone gel implant ruptures, you could notice a change in the size or shape of your breast, pain or tenderness, swelling, numbness, burning or tingling. It is also highly possible to have a ‘silent rupture’, where you would not experience any of these symptoms. In this case, you would not know that your implant has broken.
Other symptoms include sudden swelling breasts; new discomfort; dragging pains; breast discomfort; warm, red, inflamed, tender to touch breasts, colour change; lumps around the implant; painful or non-tender lumps in the axilla; generally feeling unwell; and a broad spectrum of symptoms from ‘not right’ through to a tendency to be prone to infection, arthritis, dry eyes, general lethargy, renal and hepatic problems.
Other symptoms include a sensation of tingling under the nipple (followed by a complete loss of sensation, which over the years affects the entire breast), chronic back pain and ‘pins and needles’ down the arm on the side of the affected breast.
Many patients experience extreme fatigue, numbness and tingling, nausea, dizziness, heart palpitations, hair loss, depression, severe insomnia, ringing ears, weakness, stomach/headaches and anxiety.
Some patients experience discomfort in the armpit; also where an implant has ruptured the breast will lose the slight ‘ridge’ look that you get with implants; it may also feel a lot softer than the healthy breast, and look a lot ‘flatter’, which clearly signals a problem with the implant.
Do I need an MRI even if I just want them removed and replaced?
Scanning by ultrasound or MRI may be useful in helping to confirm whether or not the implant has ruptured. However, if a patient has already decided (after clinical advice) to have the implant removed, scanning is usually unnecessary.
Summing Up
To find out if you have PIP implants, the government advises checking your original medical notes. This can be done by either obtaining them from the clinic or your GP. If the procedure was performed at a private clinic you can send a written request direct to the clinic or surgeon for the information.
If it is confirmed you have PIP implants, you should contact your GP or the clinic the surgery took place. An MRI scan can determine the condition of the implants.
There are many signs and symptoms associated with a ruptured breast implant, so it is important you are aware of them and can recognise them so you can seek medical help if necessary.
