Breast Augmentation Risks
All surgical procedures, including breast augmentation, have potential risks. The decision to have breast augmentation is extremely personal. You will have to decide if the procedure will achieve your goals, and whether or not the risks and potential complications are acceptable. In this section, you will find further information regarding the potential risks associated with breast surgery.
Hematoma: Some post-operative bleeding into the pocket containing the breast implant occurs in 2-3% of women. If the bleeding is minimal, the body will absorb it with time. Marked swelling will probably require surgical removal of the blood in the operating room.
Infection: Post-operative breast augmentation infection is uncommon, but possible. We reduce this to a minimum by giving intravenous antibiotics during breast enlargement surgery and oral antibiotics after surgery. Most infections are mild and resolve without incident. If a serious infection develops, the breast implants will probably need to be removed, and cannot be safely replaced for several months after healing.
Capsular contraction: Capsular contraction is the most common complication, or side effect, of breast implant surgery. During surgery, a pocket is created for the breast implant. During healing, a fibrous membrane called a capsule forms around the device. Under ideal circumstances, the pocket maintains its original dimensions, and the breast implant rests inside, remaining soft and natural. For reasons still largely unknown, however, the scar capsule shrinks or contracts in some women and squeezes the implants, resulting in various degrees of firmness. This contraction can occur soon after breast enlargement surgery or many years later. It can appear in one or both breasts. Current theories suggest that a low grade infection may “trigger” some contraction. The use of a textured surface on the breast implants seems to alter the way in which the scar capsule develops. Although use of textured breast implants has not eliminated capsular contraction, it appears to have reduced this risk to the 5-10% range.
Capsular contraction is not a health risk, but it can detract from the quality of the breast augmentation results and cause discomfort or pain. It may also cause distortion of the breast contour. In cases of minor contraction, we usually do not suggest surgical correction. Cases of very firm contraction may require surgical intervention. Rarely, if the contraction recurs and cannot be eliminated, the occasional patient may choose to have the breast implants long-lastingly removed.
Loss of sensation to skin or nipples: Nerves that supply skin or nipple sensation may be cut or damaged while the pocket, or space, for the breast implant is being created. Although this does not happen routinely, it can happen no matter how carefully the breast augmentation surgery is performed. If sensory loss occurs, the nerves slowly recover over a period of 1-2 years in about 85% of cases.
Exposure or extrusion of implant: Thin skin, inadequate tissue coverage, capsule formation, infection, or severe wrinkling may all contribute to the erosion of an implant through the skin or scar. Should this very rare complication occur, breast implant removal would probably be indicated (at least temporarily).
Wrinkling: With the use of textured breast implants, visible wrinkling under the skin has been more noticeable. Occasionally, the edge of the breast implant can be felt. These problems are usually mild and require no treatment. Experience has shown that the wrinkles frequently improve or even disappear within a year.
Asymmetry: If your breasts had slightly different shapes before breast enlargement 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.
Subpectoral placement of the implant (under the muscle): During contraction of the muscle, the breast implants will temporarily be flattened and/or pulled upward. Occasionally, the breast implants may “ride” higher than their original position because of the muscular contraction.
Deflation: If for any reason the valve or implant covering fails, saline will leak and be absorbed by the body. This causes no medical harm, but the breast implant will need to be replaced in a secondary breast augmentation procedure. The rate of saline-implant leakage is quoted at about 1% over many years.
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 may be needed.
Interference with breast feeding: Many women with breast implants have nursed their babies successfully. Nevertheless, any breast surgery can theoretically interfere with your ability to breastfeed.
Calcium deposits in the tissue or around the implant: In some patients, a thin layer of calcium will develop within the scar capsule surrounding the implant. This usually occurs several or more years after the breast implants have been inserted. In these patients, 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.
Breast Cancer: There is no evidence linking breast implants and breast cancer. The only clinical studies available show that the prevalence of breast cancer in women with implants is the same or even slightly lower than that in women without breast implants. Furthermore, two studies have shown, to date, that the stage of breast cancer detection in women with breast implants appears to be identical to that found in the overall population.
Synmastia (loss of cleavage): This is a very unusual problem that occurs after 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. In the more minor form, the pockets remain separate, but the skin tents upward. In its more serious form, the pockets on either side merge to form a single pocket. If the problem develops, correction will require secondary surgery.
Interference with mammography: You should alert the technician to the fact that you have breast implants. Special techniques will be used and extra views may be needed in order to see as much of the breast tissue as possible. Even under the most ideal circumstances, some breast tissue may remain unseen. Because the breast is compressed during mammography, it is possible, but rare, for an implant to rupture.
Immune disorders: Some women have claimed that silicone gel prostheses have contributed to or stimulated connective tissue disorders such as systemic lupus erythematosis, scleroderma, rheumatoid arthritis, etc. Other complaints involving the nervous system, skin, and immune systems have been reported. Reports claiming a causal relationship between silicone gel and such symptoms have been published in medical literature and reported in the press. Presently, no such relationship has been established scientifically, and the gel implants have been cleared for breast enhancement by the FDA. The saline used to fill saline breast implants is harmless, and is excreted in the urine should the breast implant leak or rupture.
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