Hyaluronic acid injection is another procedure for augmentation mammaplasty. However, this is an absorbable material, and it is necessary to repeat the injection to maintain breast volume. Also, any kind of breast filler injection is prohibited in France due to the possible hindrance posed in identifying breast cancer.

Many reports have also addressed the relationship between breast cancer and augmentation mammaplasty using implants. Most of them report that there is no increased rate of breast cancer in patients with augmentation mammaplasty [5,6]. On the contrary, several studies have reported that the rate of breast cancer is actually lower in patients with augmentation mammaplasty [7,8]. These studies argue that the lower incidence rate of breast cancer is probably due to the lower calorie intake of patients who wish to have augmentation mammaplasty. These patients, being on the thinner side, do not have a tendency toward breast cancer.

One of the recent issues regarding breast cancer is anaplastic large cell lymphoma (ALCL), a very rare type of peripheral T-cell lymphoma. The first three cases were reported by Duvic et al. [9]. Other reports showed that ALCL occurred after using both silicone implants and saline implants which have a silicone outer shell [10,11]. In total, 22 cases have been reported.

The odds ratio of ALCL in the breast associated with silicone implants was reported to be 18.2, although the absolute risk was exceedingly low due to the rare occurrence of ALCL [12]. Also, the fact that ALCL was found just at the surface of the implant in most reported cases suggests that the ALCL was caused by the silicone implant [10,11].

Silicone implants have been used in about 500 million patients worldwide and about 100 cases of imunological disease have been reported. In the US, silicone implants have been used in about 200 million patients, and 28 cases of immunological disease have been reported. However, these incidence rates are at the same level as those for women without augmentation mammaplasty, and there is no statistical relationship between augmentation mammaplasty and immunological disease [14,15].

Brody et al. [16] reported that silicone implants do not induce immunological disease and as the human adjuvent disease does not exist, he recommends not using this medical term. However, several recent studies have demonstrated multiple proinflammatory serum proteins adhering to the surface of silicone implants, and this suggests that they are correlated with the development of massive capsular fibrosis and contracture, and perhaps also with the onset of autoimmune disease [17,18].

The author agrees that the textured surface implant provides better anti-capsular contracture results and recommends the use of textured surface implants for augmentation mammaplasty [24-27]. The author also recommends against breast massage for three months after surgery. Relatively new phenomena regarding capsular contracture are double capsule and late seroma [28].

When a saline implant is used, leaks or ruptures of the implant will cause decreased volume of the breast. Patients who have saline breast implants should be informed that they must have a leaking implant replaced with a new implant within several days after noticing a volume change of their breasts. This is to prevent a change in the breast volume.

Otherwise, the capsule may shrink and replacement surgery will become difficult. If the patient does not want to have new implants and just wants to remove the ruptured saline implant, she can have surgery any time after noticing the problem.

When a rupture or leak of silicone implants takes place, the patient does not notice the problem in most cases. Therefore, patients with silicone implants should be advised to examine their breast implants together with the breast tissue once every year following the surgery.

Rupture or leak of the silicone implant may be caused by closed capsulotomy, mammography, or by accident. Also aging or weakness of the outer shell of the implant may cause the problem [29-31].

When the rupture or leak of the silicone implant occurs, it will often occur only inside the capsule. In some cases, however, it may spread to the surrounding tissue through the capsule. The leaked silicone may cause cyst formation, inflammation, pain of the shoulder or upper arm, firmness of the skin, erythema, and/or edema [30,32].

Silicone implants can hinder X-ray examinations due to their low transparency. In some cases, calcification around the implant may be found and this can stand in the way of a thorough examination of the breast tissue [33].

However, there are several reports that well-experienced doctors do not have any problems detecting breast cancer in implant augmented breasts [7,34,35].