Understanding Augmentation Risks

Although breast augmentation is a very common operation with a high level of success, it is incumbent upon every patient to understand the natural course of events and potential complications for any breast that has an implant placed under it. Patient understanding of limitations, tradeoffs, and complications is critical. Complications can be due to a number of factors. There are complications due to the patient’s underlying health, complications of anesthesia, complications due to surgical trauma, and complications due to the implants. There is often a fine line between what is considered a side effect of surgery and what a true complication is.

One of the limitations of breast augmentation is that stretch marks on the breast will not be eliminated by implants. Also, the skin may be too tight to accommodate a very large implant. If there is severe sagging of the breast a lift may be required either at the same time or at a later date. Breast implants do not prevent the natural aging of the breast. Many asymmetries may persist and actually be aggravated by breast implants.

A breast augmentation patient will also have to accept certain tradeoffs. Where incisions are made there is always a scar. Every effort will be made to make this scar as inconspicuous as possible. Most of the time, the patient will be able to feel the implant under the skin. The less breast tissue you have the more likely you are to feel the implant. A saline breast implant is also slightly firmer than natural breast tissue, though many women actually prefer the firmer feel. One of the most important tradeoffs is the anticipation of future operation. Breast implants are not lifetime devices.

Most complications due to poor underlying health can be avoided by restricting the operation to healthy patients. Likewise many of the potential anesthetic problems can be avoided by operating only on healthy women.

SURGICAL COMPLICATIONS

Breast implants are not considered lifetime devices. You should anticipate additional surgery and doctor visits over the course of your life. Even though the implants are covered by a lifetime replacement policy, you should anticipate additional expenses related to future implant surgery.

DEFLATION

Breast implants deflate when the saline solution leaks out of the implant due to the development of a defect in the implant shell. It may deflate rapidly or progressively over the course of several days and is noticed by a loss of size and shape of the implant. The rupture rate is less than 4% in the first seven years. They may deflate due to some type of trauma but usually they just wear out over time and deflate. Deflated implants require additional surgery to replace the implant.

CAPSULAR CONTRACTURE

The scar tissue or capsule that normally forms around the implant may tighten and squeeze the implant and is called capsular contracture. Capsular contracture is more common following infection, hematoma, and seroma. It is also more common with placement above the muscle. Symptoms range from firmness and mild discomfort, to pain, distortion, palpability of the implant, and/or displacement of the implant. Additional surgery is needed in cases where pain and firmness are severe. My recommended treatment of capsular contracture is implant removal with removal of the scar tissue, followed by re-augmentation 3 months later. Capsular contracture may happen again after these additional surgeries. Capsular contracture may occur on one or both sides.

PAIN

Pain of varying intensity and duration may occur and persist following any surgery. In addition, excessively large size, improper placement, surgical technique, or capsular contracture may result in pain associated with nerve entrapment or interference with muscle motion.

DISSATISFACTION WITH COSMETIC RESULTS

Dissatisfying results such as wrinkling, implant displacement (shifting), incorrect size, unanticipated shape, implant palpability, scar deformity, or hypertrophic (irregular, raised scar) scarring may occur. Asymmetry in implant position, nipple location, or size may occur. Unsatisfactory surgical scar location may occur. Results of surgery are unpredictable for any individual patient. You may be disappointed with the results of your surgery.

REOPERATIONS

Some complications may require additional surgery or other treatment to correct them and will result in additional expense to you. In rare cases, a satisfactory solution may not be possible.

INFECTION

Infection can occur with any surgery. Infection may occur even though special precautions are taken, and despite the administration of antibiotics. Most infections resulting from surgery appear within a few days to weeks after the operation. However, infection is possible at any time after surgery. Infections with an implant present are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the implant must be removed. Another implant may be placed 6 months after the infection is resolved.

HEMATOMA / SEROMA

Hematoma is a collection of blood inside a body cavity, and a seroma is a collection of fluid. Hematoma and seroma may contribute to infection and/or capsular contracture. Swelling, pain, and bruising may result. If a hematoma occurs, it will usually be soon after surgery. However, it can also occur at any time after injury to the breast. Seroma may occur soon after surgery or, rarely, years later. While the body absorbs small hematomas and seromas, large ones will require surgery for proper healing.

CHANGES IN NIPPLE AND BREAST SENSATION

Feeling in the nipple and breast can increase or decrease after implant surgery. The range of changes varies from intense sensitivity to no feeling in the nipple or breast following surgery. Changes in feeling can be temporary or permanent and may affect sexual response or the ability to nurse a baby.

BREAST FEEDING

At this time it is not known if a small amount of silicone may diffuse (pass through) from the saline filled breast implant silicone shell and may find its way into breast milk. If this occurs, it is not known what effect it may have on the nursing infant. Although there are no current methods for detecting silicone levels in breast milk, a study measuring silicon (one component in silicone) levels did not indicate higher levels in breast milk from women with silicone-filled gel implants when compared to women without implants. (Most modern day pacifiers and baby bottle nipples are made from silicone.) The periareolar incision site may significantly reduce the ability to successfully breast feed.

ASYMMETRY

No one has perfectly symmetrical breasts. Implants can correct volume asymmetry but may make nipple asymmetry more obvious. The breasts usually heal at different rates and some degree of asymmetry is expected during healing. If the implants heal in asymmetric positions (too high, too low), a second surgery may be needed.

WRINKLING

Visible and palpable wrinkling of implants can occur. Some wrinkling is normal and expected. This may be more pronounced in patients who have saline-filled implants with textured surfaces or thin breast tissue. It may be possible to feel the implant fill valve. Some patients may find palpable valve and wrinkles cosmetically undesirable. Palpable valve, wrinkling and/or folds may be confused with palpable tumors and questionable cases must be investigated.

SYNMASTIA

This can develop with implants above or below the muscle. The skin over the breastbone can pull away and the implants can slide closer together, reducing or eliminating cleavage. The degree can vary from mild to severe. Secondary surgery may be required and correction may be extremely difficult to accomplish.

DISSATISFACTION WITH SIZE

Every effort is made to help the patient select an appropriate size implant. We never guarantee a particular cup size as there is too much variability among bra manufacturers.

BREAST TISSUE ATROPHY/CHEST WALL DEFORMITY

The pressure of the breast implant may cause the breast tissue or chest wall tissue behind the implant to thin and shrink. This can occur while implants are still in place or following implant removal without replacement. This is more likely to occur with high profile implants.

CONNECTIVE TISSUE DISEASE

Concern over the association of breast implants to the development of autoimmune or connective tissue diseases, such as lupus, scleroderma, or rheumatoid arthritis, was raised because of cases reported in the literature of small numbers of women with implants. A review of several large epidemiological studies of women with and without implants indicates that these diseases are no more common in women with implants than those in women without implants. The effects of breast implants in individuals with pre-existing immune system and connective-tissue disorders are unknown. There is the possibility of unknown risks associated with silicone breast implants and tissue expanders.

SECOND GENERATION EFFECTS

There have been concerns raised regarding potential damaging effects on children born of mothers with implants. A review of the published literature on this issue suggests that the information is insufficient to draw definitive conclusions.

REMOVAL / REPLACEMENT OF BREAST IMPLANTS

Future revision, removal, or replacement of breast implants and the surrounding scar tissue envelope involves surgical procedures with risks and potential complications. There may be an unacceptable appearance of the breasts following removal of the implant.

LONG TERM RESULTS

Subsequent alterations in breast shape will occur as the result of aging, weight loss or gain, pregnancy, or other circumstances not related to augmentation mammoplasty. Sagging of the breast may normally occur.

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