Possible Risks & Complications

Any surgical procedure has potential risks and complications. In addition to these, there are several complications unique to breast augmentation:

Infection

Infection is a risk with any surgery and is most often seen within the first week. Nevertheless, it can manifest itself later. In rare cases, infection can escalate to Toxic Shock Syndrome. Watch for symptoms such as sudden fever, vomiting, diarrhea, fainting, and/or a sunburn-like rash. In extreme cases, the implant might need to be removed until the infection is gone. A new implant can then be reinserted.

Hematoma/Seroma

Hematomas occur when blood pools inside a body cavity or the wound. A seroma is a collection of the watery part of the blood. The result is swelling, pain and bruising. Small hematomas and seromas can be absorbed into the body, but larger ones might require surgical drains.

Capsular Contracture

The most common complication of breast augmentation surgery is capsular contracture. When any foreign object is placed in the body, a scar capsule forms around it. This is part of the natural healing process. The problem arises when the capsule tightens and compresses the implant. This may cause breast firmness, discomfort, pain, a change in the appearance of the breast, displacement or palpability of the implants. In severe cases additional surgery is necessary to either remove or score the scar tissue or remove or replace the implant. One recent study shows that if the implants are treated with antibacterial agents during surgery, the risk of capsular contracture is reduced. Submuscular placement also reduces the likelihood of capsular contracture.

Deflation/Rupture

Deflation and rupture of an implant can happen for several reasons and it can occur instantly or slowly over time. The shell could burst due to capsular contracture, intense physical manipulation, or extreme compression during mammograms. Other reasons for deflation might include an unsealed or damaged valve on the implant. If a shell does rupture, the saline is just absorbed into the body with no health risks.

Changes in Nipple and Breast Sensation

Nipple and breast sensation can be altered with breast implants. These alterations can affect sexual response and ones ability to nurse a baby. Post surgery nipple sensation can range anywhere from extreme sensitivity to numbness. A higher likelihood of this is associated with a periaerolar incision.

Aesthetic Dissatisfaction

Although most patients are happy with the results of their breast augmentation surgery, there are a small number of women who are not. Wrinkling, asymmetry, shifting, incorrect size, unanticipated shape, implant palpability, or scar deformity are some of the causes of cosmetic dissatisfaction.

Double-Bubble

If an implant is inserted submuscularly into a naturally sagging breast a double-bubble could occur. The implant would likely sit higher on the chest as the natural breast tissue sags below giving the appearance of two breasts in one. This undesirable effect can be avoided with a breast lift in conjunction with the breast augmentation. The double-bubble could also occur over time as the natural breasts sag due to age, gravity, or pregnancies, but the implants do not. A breast lift might be needed later.

Symmastia

Symmastia, or breadloaf, is caused when the implants move to the center of the chest, cross the breastbone, and touch each other where cleavage would normally be seen. This creates the appearance of one continual implant across the chest; hence the name breadloaf. This complication happens during a submuscular placement, when the surgeon unknowingly cuts the muscle that helps hold the implants in place. This particular muscle is attached to the sternum and goes horizontally across the implants. Symmastia can be repaired, but it does require additional surgery. First, the implants are removed; then the muscle must be reattached with permanent sutures. This repair should be done internally to avoid any additional scarring in the cleavage area.

Bottoming Out

Bottoming out is also known as implant displacement. This occurs when the pocket created by the surgeon for the implants fails meaning there is a loss of tissue support at the bottom half of the breast. Consequently, the implants drop and end up too low on the chest. The nipples will then be higher on the breast. This complication can be avoided with a complete submuscular placement. Bottoming out is remedied by recreating or restoring the pocket with permanent sutures.

Extrusion

Extrusion is when the breast implant comes through the skin. This complication can be caused by unstable or compromised tissue or improper healing of the wound.

Necrosis

When dead tissue forms around the implant, the wound may be unable to heal. This is referred to as necrosis. Implant removal or other surgical corrections may be required. Infections, use of steroids in the surgical pocket, smoking, chemotherapy, radiation, or excessive heat or cold therapy increase the chances of necrosis.

Calcium Deposits

Calcium may deposit in the tissue capsule around the implant. These deposits can be mistaken for cancer on a mammogram. Subsequently a biopsy might be ordered which would require additional surgery.

Additional Surgeries

According to a study by Mentor about one in every seven women had at least one additional surgery within the first three years.

Reasons for Additional Surgeries

Replace implant 32%

Capsular Contracture 22%

Scar or wound revision 19%

Repositioning 8%

Size adjustment 8%

Sagging 6%

Removal without replacement 3%

Biopsy or cyst removal 2%

Because implants are not meant to last a lifetime, it is highly probably that additional surgery in the future will become necessary to either remove or replace the implants. It should be noted that if you choose not to replace your implants, unsightly puckering or dimpling of the breast tissue is possible. Other severe complications such as deflation, rupture, capsular contracture, infection, or calcium deposits might warrant further surgeries as well. Due to the natural aging process, breasts may continue to sag over time, and a breast lift might be desired.

Interference with Mammogram Readings

Breast tissue is obscured by implants. When implants are placed over the muscle, approximately 25% of the breast tissue is hidden. Only 10% of breast tissue cannot be seen on the mammogram when the implant is placed under the muscle. Additional mammogram views are necessary to see the hidden tissue. Obviously this takes more time and radiation, and the early detection of breast cancer could be impeded. Therefore, it is imperative to have a skilled radiology technician experienced with breast implant readings perform the mammograms.

Difficulties with Breast Feeding

If glands and milk ducts are untouched during surgery, postoperative breast feeding is possible. However, one study reported that up to 64% of women with implants were unable to breast feed compared to 7% without implants. Moreover, there is a possibility that breast implants may decrease ones ability to produce milk. A higher incidence of this is associated with insertion through the areola. There has also been some concern as to whether saline leaks out into the breast milk and if it is harmful in any way. As of yet, there is no evidence that saline finds its way into breast milk. Patients whom have breast fed within the year before their surgery, may produce milk for a few days after surgery.

Connective Tissue Disorder

In the media, implants have been associated with autoimmune and connective tissue diseases with symptoms such as joint pain or swelling, fever, fatigue, or breast pain. Although some women with implants have reported these symptoms, there is no definitive research to suggest that there is a correlation. The FDA has requested more research.

Reported Percent

Wrinkling, asymmetry, sagging or scarring 32%

Nipple changes 15%

Additional surgery 13%

Severe Capsular Contracture 10%

Implants removed 8%

Breast pain 5%

Leakage or deflation 3%

Infection 2%

Implant palpability 2%

Although this is the majority of possible complications, it is not a comprehensive list. According to a study by Mentor of 1,264 women, 43% of augmentation patients reported at least one complication within three years. The percentage of women having complications may be higher than reported here because 24% of women dropped out of the study, but the percentages were figured according to the original number of women participating.