Risks and Possible Complications

Breast Augmentation Risks

In general, the least serious problems occur more often and the more serious problems occur rarely. Most complications involve an extension of the recovery period rather than any permanent effect on your final result.

Once you have reviewed this section, be sure to discuss your personal situation with your plastic surgeon to determine if you may be at increased risk for any of these potential complications. Your doctor and his or her staff will use their knowledge and expertise to avoid complications as much as possible and attempt to quickly solve any problems that arise.

Capsular Contracture

Capsular contracture is the most common complication of surgery involving breast implants and can cause discomfort, pain or distortion of the breast contour. This complication can occur soon after surgery or many years later and can appear in one or both breasts.

When breast implants are inserted, the body forms a fibrous membrane, or "capsule," around the device. This is part of the natural healing process and occurs when any foreign object is placed into the body, such as a pacemaker, artificial joint or accidental wood splinter.

Under ideal circumstances, the pocket created for the implant maintains its original dimensions and the implant "rests" inside, remaining soft and natural. However, the scar capsule shrinks or contracts in some women and squeezes the implant, resulting in various degrees of firmness, and can take on a "ball-like" look.

The level of severity of capsular contracture is measured by a system known as the Baker grading system:

• Baker Grade I — The breast is normally soft and natural looking.
• Baker Grade II — The breast is a little firm but is normal in appearance.
• Baker Grade III — The breast is firm and is beginning to take on an abnormal appearance.
• Baker Grade IV — The breast is hard, painful and has an abnormal appearance.

Surgical correction is usually not suggested in cases of minor contraction, but cases of very firm contraction may require surgical intervention. Rarely, the implant may be permanently removed if the condition recurs and cannot be eliminated.

Capsular contracture occurs for reasons still largely unknown. However, higher rates of this condition are associated with placement of the breast implants above the muscle (subglandular implant placement) versus placement behind the muscle (submuscular implant placement) and with incidences of hematoma/seroma and infection.

A Mentor Corp. study found that 5% of breast augmentation patients experienced capsular contracture at some point within 1 year of surgery.

Deflation/Rupture

Breast implants are not considered to last a lifetime and may rupture or deflate at some point. This occurs when saline solution or silicone gel leaks from the implant due to a break in the implant covering. The rupture of silicone gel implants may not be as easily noticeable as saline implants because the thicker silicone gel usually stays within the scar capsule that forms around the implant. An MRI to screen for rupture is recommended three years after implantation and every two years thereafter.

Deflation or rupture is evidenced by a loss of size or change in shape of the affected breast, and surgery may be required to replace or remove the implant. If saline breast implants were used, the saline leakage is not a health risk and is harmlessly absorbed by the body. Similarly, studies have failed to link the leakage of silicone gel with an increased incidence of breast cancer or other illnesses.

The causes of implant deflation include wearing out of the implant over time, damage to the implant during surgery, overfilling or underfilling of the implant, physical trauma to the breast and excessive compression of the breast during a mammogram.

A Mentor Corp. study determined that leakage/deflation occurred in 1% of patients within 1 year or surgery and in 3% of patients within 3 years.

Hematoma/Seroma

Hematoma is a small collection of blood under the skin, and seroma is an accumulation of fluid around the implant or incision. When hematoma is experienced, blood escapes from the blood vessels and flows into a space under the skin, forming a mass that may cause swelling, pain and bruising. Incidence of hematoma may also contribute to infection and/or capsular contracture.

Hematoma usually occurs shortly after surgery but can occur at any time if the breast is injured. Your body will absorb small hematomas and seromas, but larger ones may require aspiration, drainage or even surgical removal to achieve best results.

Your chances of developing hematoma or experiencing excessive bleeding are decreased if you avoid taking anything that thins the blood prior to surgery, including aspirin, ibuprofen or vitamen E. Be sure to discuss all medications you are currently taking with the plastic surgeon and his or her staff at your consultation.

Infection

Post-operative infection with breast implants is uncommon, but possible as with any surgery. Intravenous antibiotics administered during surgery and oral antibiotics prescribed for afterward reduce the risk of infection to a minimum. Most infections that do occur are mild and easily treated with antibiotics.

Serious infections may develop in approximately 1 of 300 patients. Typical symptoms of an infection include swelling, fever, redness, drainage and tenderness in the breast area. If you experience any of these symptoms, call your doctor's office immediately.

The implant may be temporarily removed in cases of serious infection or infections that don't respond to antibiotics.

Discomfort/Pain

Most women who undergo breast augmentation experience some degree of discomfort or pain in the breast and chest area. This pain is usually mild and subsides rapidly during the healing process. Be sure to call your doctor's office if you experience pain that is severe or persisting after the surgery.

Asymmetry

If your breasts had slightly different shapes before surgery, they may remain slightly different after surgery. Rarely, in spite of careful attention to detail, the dissected pockets may end up slightly different in shape or height. If this is not noted while you are in surgery, but becomes a problem after healing, you may later need a small adjustment procedure.

Bottoming Out

Bottoming out occurs when the breast implant is positioned too low on the chest and the nipple rides too high, resulting in an unnatural look. This condition is usually due to over-dissection of the pocket created for the implant. It can also be caused by the weight of the implant in women with thin skin and is more common when the implant is placed above the muscle (subglandular implant placement).

Bottoming out is corrected by rolling up the scar tissue at the bottom of the pocket to create a higher crease.

Breast Tissue Atrophy/Chest Wall Deformity

Breast tissue can become thin and shrink from the pressure of the breast implant. Atrophy and/or deformity can occur while the implant is in place or after an implant is removed and not replaced.

Calcium Deposits

A thin layer of calcium may develop within the scar capsule surrounding the implant, usually several years or more following surgery. The added density of the scar may reduce the detectability of lesions close to the scar on mammograms. Breast cancers may still be visible and detectable when specialized techniques are used.

Changes in Sensation

Feeling in the breast skin or nipples may decrease or increase following breast surgery. These changes in sensation usually disappear after a few weeks, but can take up to a year. Feelings of numbness or over-sensitivity can be permanent in some cases.

Delayed Wound Healing

Incisions may separate or heal unusually slow for reasons including inflammation, infection, wound tension, decreased circulation, smoking or excess external pressure.

Displacement

Breast implants can move out of position at any time after surgery. They can move up, down, left or right. You will probably not even notice a small displacement, but larger movements may require corrective surgery. Fortunately, this is not a common problem. Women with large implants stand a greater chance of downward displacement.

Dissatisfaction with Results

Breast augmentation performed by a qualified plastic surgeon is a safe and popular cosmetic procedure. However, disappointments do occur and results are not always acceptable to the patient or the plastic surgeon. Revisional procedures or treatments may be necessary for dissatisfying results such as asymmetry, wrinkling, implant displacement, incorrect size, unanticipated shape or scar deformity. Rarely, problems may occur that are permanent.

To avoid dissatisfaction with your results, think carefully about your goals and expectations and discuss all of your options with your plastic surgeon. Visit our section Are You a Candidate for Breast Augmentation? for help in determining if breast augmentation is right for you.

Extrusion

Thin skin, inadequate tissue coverage, capsular formation, infection or severe wrinkling may all contribute to the erosion of an implant through the skin or scar. This very rare complication usually results in implant removal, at least temporarily.

Immune Disorder Symptoms

A possible relationship between breast implants and connective tissue diseases such lupus, sclerderma and rheumatoid arthritis has been studied because of symptoms experienced by some women. Studies have found that these conditions are no more prevalent in women with implants than those without implants, and there is no conclusive evidence linking breast implants with the symptoms of these disorders.

Interference with Mammography

At age 40, all women should begin receiving annual mammograms. Breast implants can interfere with the detection of early breast cancer during a mammogram, which is a low-dose x-ray examination of the breast. For this reason, women with breast implants should always alert the technician as to the presence of their implants.

Technicians experienced in performing mammograms on women with implants use a special technique called "implant displacement views" that require more x-ray views to see as much of the breast tissue as possible. Still, implants may hide some breast tissue from the x-rays. A study funded by the National Cancer Institute found that mammograms missed 55% of breast cancers in women with implants as compared to 33% in women without implants.

In rare instances, a breast implant can rupture due to compression of the breast during a mammogram. Your technician should exercise special care to avoid rupture when the breast is compressed.

All women over 40, including those with breast implants, should get regular mammograms. Mammograms are the best method for early detection of breast cancer.

Mondor's Cord

Occasionally following breast augmentation, a blood vessel beneath the breast becomes inflamed. Mondor's Cord is the small vein that becomes visible and usually runs vertically. One or more of these veins may be visible.

Mondor's Cord heals on its own, usually within a couple of weeks, and does not cause permanent damage. Discomfort is usually minor and is treated with warm compresses and aspirin or ibuprofen. The condition is named for French surgeon Henri Mondor (1885-1962).

Nausea/Vomiting

Patients may experience nausea and vomiting as a reaction to the anesthesia used during surgery. It usually lasts less than 24 hours and is treated with lots of fluids, rest and over-the-counter medications. Contact your doctor if you experience severe vomiting or if nausea lasts longer than a couple of days.

After your surgery, drink clear liquids and avoid caffeinated drinks, which promote the production of stomach acid. Foods that can absorb stomach acids include crackers and bread without butter. Eat small, frequent meals and avoid spicy or fried foods.

Necrosis

Formation of dead tissue around the implant can prevent wound healing and require surgical correction and/or implant removal. Increased risk of necrosis is associated with infection, use of steroids in the surgical pocket, smoking, chemotherapy/radiation and excessive heat or cold therapy. Necrosis can leave permanent scars, but is not a common problem. Contact your doctor immediately if you notice that an incision is reopening.

Repeat Surgery

You should be aware that breast implants are not considered to be lifetime devices and wear out over time. You will probably need at least one additional surgery to replace or remove the implants. Some of the potential complications described in this section can also result in additional surgeries.

The life expectancy of breast implants can be affected by the level of physical activity and other factors, such as an injury to the breast. Studies have found that the risk of experiencing problems with implants increases 8 to 10 years following surgery. If implants are removed without replacement, you may experience undesirable cosmetic changes such as dimpling, puckering, wrinkling or sagging.

Sensitivity or Allergy to Dressings or Tape

Occasionally, allergic or sensitivity reactions may occur from soaps, ointments, tape or sutures used during or after surgery. Such problems are unusual and are usually mild and easily treated. In extremely rare circumstances, allergic reactions can be severe and require aggressive treatment or even hospitalization.

Synmastia or "Breadloafing"

This very unusual problem occurs when the skin over the sternum, or breastbone, is pulled from the bone and tents upward. Normal cleavage is eliminated as the breasts appear to merge. Synmastia is usually caused by over-dissection of the cleavage area between the breasts.

Synmastia can appear from several days to a few months after surgery and is more prevalent in women who are thin. It is corrected by surgically reattaching the tissues in the cleavage area to the breastbone.

Thick, Wide or Depressed Scars

Abnormal scars may occur even with the most modern surgery techniques. Injection of steroids into the scars, placement of silicone sheeting onto the scars or further surgery to correct the scars is occasionally necessary. Some areas on the body scar more than others, and some people scar more than others. Your own history of scarring should give you some indication of what to expect.

Wrinkling/Rippling

Visible wrinkling under the skin is more noticeable with the use of textured implants. Occasionally, the edge of the implant can be felt. These problems are usually mild and require no treatment. Wrinkles frequently improve or even disappear within a year. Ripples are indentions on the breast and are often caused by movement of the implant.