Breast Augmentation Surgical Risks

The decision to undergo breast augmentation should be made after carefully weighing the risks versus the benefits. You should decide independently, with the understanding that there are limitations to what can be achieved. Breast implants will not improve depression, personal relationships, and other personal problems and should not be done for any of these reasons.

The following are some of the risks involved with surgery.

Swelling

Some breast swelling is expected after surgery. Most of the swelling subsides over the first 10-14 days although minor swelling may last slightly longer.

Bruising

Some breast bruising is expected after the surgery. Most of the bruising subsides over the first 10-14 days although minor bruising may last slightly longer.

Hematoma

A hematoma is a collection of blood within the pocket surrounding the implant. If the bleeding is minimal, the body will absorb it with time. However, significant bleeding accompanied by marked swelling, bruising, and/or pain will require a return to the operating room for the surgical removal of the blood at an addition cost to you. While a hematoma can happen under the best of circumstances, you can minimize your risk by following our pre and post operative instructions. Hematomas increase your risk of capsular contracture and infection, and prolong healing time. Smoking can be a cause of bleeding, hematoma, and excessive bruising.

Infection

Postoperative infection is very uncommon. Most infections are mild and resolve without incident. However, if a serious infection develops, the implant may require temporary surgical removal and cannot be safely replaced for at least 3 months after resolution of the infection and subsequent healing. In rare cases, hospitalization may be required. All additional treatment will be an added expense to you, including hospitalization. It is important that you take the oral antibiotics as directed before and after your procedure and to follow all other pre and postoperative instructions. A superficial infection may require something as simple as a topical antibiotic ointment. Deeper infections require treatment with oral, injection, or IV antibiotics. Development of an abscess (a pus filled pocket) requires surgical drainage. In unusual cases, infection may lead to wound disruption or skin loss resulting in a permanent scar and/or need for a skin graft.

Loss of Sensation to Skin or Nipples

Some loss of sensation to areas of the skin overlying the breasts as well as the nipple area is normal and expected following surgery. Nerves that supply skin or nipple sensation may be stretched, cut, or damaged while the pocket or space for the implant is being developed. It can happen in any part of the breast no matter how carefully the surgery is performed. Sensory loss is usually temporary with gradual recovery over 6 to 24 months. During that time, you may experience momentary sharp electrical sensations, tingling, burning, itching, and nipple/breast hypersensitivity that may be different on one side compared to the other. It is possible to have permanent numbness in some areas including the nipple. It is also possible for the nipple to lose its ability to become erect.

Stretch Marks (Striae)

Stretch marks represent a break or crack in the dermis (deep layer) of the skin overlying the breast. They usually arise from sudden enlargement of the breast with rapid stretching of the breast skin, such as with pregnancy or rapid weight gain. These striae cannot be removed without removing the skin bearing them. Striae may appear to be worse after surgery due to skin swelling that makes them appear more prominent but this is usually temporary and resolves once the swelling subsides. Striae can be caused by and made permanently worse with augmentation surgery.

Implant Deflation

Breast implant deflation is not common after surgery. If, for any reason, the valve or implant shell fails, the saline will leak and be absorbed and excreted by your body. This results in a painless, visible, and usually rapid and dramatic change in the shape of the involved breast. This causes no medical harm, but the implant will need to be replaced in a secondary procedure. You will incur some additional expense, but the manufacturer will replace the implant at no charge and will pay a portion of the replacement surgery if the leak is due to implant failure and not due to trauma. A warrantee booklet will be provided to you that will explain coverage provided by the company. The rate of saline-implant leakage is quoted at about 1% per year. (1 out of 100 patients.)

Loss of Skin, Breast Tissue, or Nipple

This is an extremely rare complication of breast enlargement. It usually develops from an infection that has gotten out of control and results in the death of the involved tissues. This very rare complication will usually involve only small areas that will eventually heal with good wound care. Secondary surgery is a possibility. Cigarette smoking may lead to this complication due to interference with blood flow to the nipple or breast tissue because of nicotine in the blood stream.

Scarring

Genetic predisposition, your general health, and other factors effect the way wounds heal. Scarring can be estimated from other scars that you may have incurred. No matter where the incision is made for your augmentation, a scar will result. If the scars are unacceptable to you, treatments can usually be done to improve them but will not take them away. 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 you can expect.

Skin loss

Skin loss can also be called skin slough, ischemia or necrosis. It usually leads to the development of an open wound which may require further surgery often with significant scarring effects. It may need to heal on its own with scar tissue and require later surgery for improvement.

Wound Dehiscence

This refers to the incision line breaking open during healing and is usually due to mechanical stretching or to infection. It will usually heal without treatment, but may require surgery later to refine the result.

Palpability of Implant

Saline implants do not feel like natural breast tissue. During your consultation, you will be able to hold a saline implant in your hand during a consultation to give you an idea of how they feel.

Breast Feeding

Many women with breast implants have nursed babies successfully. Any breast surgery can theoretically interfere with your ability to nurse. Also, some women are unable to breast feed for reasons unrelated to breast surgery. If you were able to breast feed before surgery, you are more likely to be able to breast feed after enhancement surgery.

Breast-feeding usually results in even greater breast swelling and skin envelope expansion than pregnancy alone. The breasts are then more likely to settle, drape over and fall beyond the underlying implant after breast-feeding has been completed. Pregnant and post-partum patients are probably more likely to develop a breast infection that can affect your implants.

Breast Cancer

There is no evidence linking implants and breast cancer. Some clinical studies have shown that the prevalence of breast cancer in women with implants is the same or even slightly lower than in women without breast implants. Furthermore, two studies have shown that the stage of breast cancer detection in women with implants appears to be identical to that found in the overall population. In other words, it does not appear that breast implants, although they may interfere somewhat with mammography, lead to a delay in detecting breast cancer.

Mammography

You must immediately tell the technician that you have breast implants. Special techniques can be used and extra views may be needed in order to see as much of the breast tissue as possible. As a result, the mammography may be more expensive. Even under the most ideal circumstances, some breast tissue may remain unseen and a suspicious lesion missed. However, the stage of breast cancer detection in women with implants appears to be identical to that found in the overall population. However, you should recognize that IN YOUR CASE, if a breast implant delays detection of a breast cancer, it may prevent timely treatment, and you may die from a cancer which would otherwise have been curable. Because the breast is compressed during mammography, it is possible for an implant to rupture.

Symmastia (Loss of Cleavage)

This is an unusual problem that can develop after typical breast augmentation either above or below the muscle. The skin over the lower sternum (breastbone) pulls away from the bone, and normal cleavage is reduced or eliminated. This is also called a “unibreast” deformity. In the more minor form, the pockets remain separate, but the skin tents upward. In the more advanced form, the pockets on either side merge to form a single pocket. Reduced fibrous or elastic "strength" in the subcutaneous tissues may be contributory but is difficult to predict. If the problem develops, correction will require secondary surgery. This problem appears to be less likely to occur when the implants are placed in the subpectoral plane since the muscle attachments will reduce the tension placed upon the overlying skin. It is possible you will have your implants removed and not replaced until a later time.

Presence of Silicone Polymer Shell

The shell of saline-filled implants is made of silicone polymer (inert, vulcanized, silicone material). Although silicone polymer has not been implicated in any diseases and has been used in many types of implants, it is still being investigated.