The Surgery: Risks Associated with Breast Augmentation

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The specific risks and suitability of this procedure for any given patient can only be determined at the time of consultation. As with all surgical procedures, however, there is some degree of risk. There are certain factors which may put you at an increased risk for complications. Be sure to advise your doctor if you have any medical problems or conditions, if you are on any medications, if you smoke, or if you have previously had surgeries on or near the areas to be treated. It is important to avoid certain drugs before and after surgery, such as aspirin, which interferes with the normal clotting of blood. You can reduce your risks by selecting a qualified plastic surgeon, and by carefully following his or her instructions both before and after surgery.

Possible risks or complications associated with breast augmentation surgery may include the following:

• Additional surgeries. Breast augmentation surgery can carry with it a high chance for the need of future additional surgeries to replace or remove the implants. There are several complications which can require removal of the implants including capsular contracture, calcium deposits, deflation, infection, and shifting. While some women requiring removal of implants choose to have them replaced, others do not. By removing and not replacing implants, women may acquire unacceptable amounts of dimpling and/or puckering.

• Anesthesia reactions.

• Breast Feeding Complications. Incisions placed around the nipple, or periareolar, are associated with an increased inability to breast feed following surgery. In addition, it is not yet known whether small amounts of silicone are able to pass through the implant shell and enter into the breast milk, or what this effect may have on nursing infants.

• Breast Tissue Atrophy, or chest wall deformity. Occurring either when the implants are still in place or following their removal, breast tissue can shrink and become thin as a result of the pressure of the breast implant.

• Calcium Deposits. Calcium deposits can form in the tissue surrounding the implant. Because they can be visible on mammograms, they may be mistaken for possible cancer. This can lead to subsequent surgery for biopsy and/or implant removal in order to distinguish the calcium deposit from cancer.

• Capsular Contracture. Capsular contracture occurs when the scar tissue that normally forms around the implant, creating a sort of capsule, tightens and squeezes the implant. If pain or firmness become severe, surgery may be required to remove the scar tissue or to remove and possibly replace the implant itself. However, capsular contracture can reoccur following additional surgery. Capsular contracture is more likely to occur when the implant is placed between the breast tissue and chest muscle, or subglandular, or following other complications such as infection, seroma, or hematoma. Symptoms can include mild discomfort and firmness, though they can be more severe and involve intense pain, implant shifting, implant palpability, and/or distorted shape.

• Changes in Nipple and Breast Sensation. Following surgery, sensitivity of the nipple and breast may increase or decrease, ranging from intense sensitivity to a lack of feeling. While these changes are usually temporary, tending to disappear within several weeks following surgery, they can be permanent and possibly affect your ability to breast feed, as well as your sexual response.

• Deflation/Rupture of the Implant. This typically occurs when the implants tear and/or leak. Leakage may occur as the result of an unsealed or damaged valve, or a break in the implant shell. Other causes may include damage from surgical instruments during surgery, capsular contracture, closed capsulotomy, overfilling or underfilling of implants, excessive compression during mammogram imaging, trauma or intense physical manipulation, or navel or belly button incision placement (umbilical/endoscopic). In addition, implants may possibly wear out over time and lead to deflation/rupture. Implant deflation/rupture can occur at any time within the first few months following surgery or even after several years, and the rate of deflation can occur immediately or more slowly over a period of several days. Deflation/rupture is typically noticed by a loss in shape or size, and will require subsequent surgery to remove and possibly replace the implant.

• Delayed Wound Healing. As with many surgeries, the incision site can, in some instances, take longer to heal than normal.

• Dissatisfaction with Cosmetic Results. Dissatisfaction may include asymmetry, implant palpability, implant shifting, incorrect size, scar deformity including hypertrophic or irregular and raised scarring, sloshing, unanticipated shape, and/or wrinkling.

• Excessive bleeding. Prior to surgery, patients should avoid certain drugs, such as aspirin, which interfere with the normal clotting of blood. Even vitamin E, red wine, and some herbal remedies can lead to excessive blood loss. If you have any concerns, ask your surgeon for further information.

• Extrusion. The breast implant may come out, or extrude, through the skin, sometimes occurring when the healing of the wound is interrupted or if the tissue covering is compromised or unstable.

• Hematoma/Seroma. A hematoma is a collection of blood, or blood clot, beneath the skin, while a seroma is a collection of the watery portion of the blood, occurring with breast augmentation either around the implant or incision. Though hematomas typically occur soon after surgery, they can also form following an injury to the breast. Pain, swelling, and bruising may result, along with further complications such as infection or capsular contracture. While the body can absorb smaller hematomas and seromas, larger ones may require the insertion of a drain or possible surgery. Surgical draining can potentially lead to scarring and/or implant deflation/rupture.

• Infection. As with all surgical procedures, there is the risk of infection. However, infections occurring with an implant present are generally more difficult to treat than those infections in the normal body tissues. Antibiotics may be prescribed and, failing that, subsequent surgery may be required to remove the implant and possibly replace it once the infection has been resolved.

• Mammogram Interference. Interference with mammogram readings can occur with augmented breasts. Calcium deposits forming in the surrounding tissue can be visible on mammogram readings and possibly mistaken for cancer. Subsequent surgery and/or removal of the implant can result in order to distinguish any irregularities from cancer.

• Necrosis. Necrosis involves the formation of dead tissue surrounding the implant, and may prevent proper wound healing. Subsequent surgery may be required in order to correct the problem and/or remove the implant. In addition, necrosis can lead to permanent scar deformity. There are several factors which may increase the risk of necrosis, including smoking, infection, the use of steroids in the surgical pocket, excessive heat or cold therapy, and radiation or chemotherapy treatment.

• Pain. Breast augmentation surgery can result in pain of varying intensity and duration. While most pain will gradually disappear within several weeks following surgery, it possible for pain to persist. Pain may vary according to surgical technique and implant size and placement, and may be associated with other complications such as capsular contracture. Any severe pain should be immediately reported to your surgeon.

• Rippling. The breasts can acquire rippling, or indentations, along the surface. This may be caused by several factors, including implant shifting.

• Shifting of the Implant.

• Toxic Shock Syndrome. Though a very rare occurrence, toxic shock syndrome can prove life-threatening. Symptoms may include vomiting, fainting, sudden fever, dizziness, diarrhea, and/or the appearance of a sunburn-like rash.

There may be other, more rare complications associated with implants, which have yet to be studied and determined. Some concerns have been raised about the association of breast implants with the development of both cancer and autoimmune or connective tissue diseases such as rheumatoid arthritis, lupus, and scleroderma. Other concerns have been raised about the potentially damaging effects on children born of mothers with implants. The long-term effectiveness and safety of implants has yet to be determined. For further information about breast augmentation and potential complications, click here: www.fda.gov/oca/breastimplants/bitac.html

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A Note On Smoking-Associated Risks:

If you’re a smoker, it’s particularly important that you stop smoking for at least two weeks before and after surgery. Because smoking significantly reduces your body’s circulation and vascularity, smokers generally heal slower and increase their risk of other complications such as necrosis (skin death), scarring, and skin loss.

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SCARRING:

Surgical scars are permanent. Because breast augmentation surgery requires that a small incision(s) be made on the skin, patients will have a resulting scar(s). Incision placement can help determine the visibility of these scars.

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