Breast Augmentation Risks and Complications

Anyone considering surgery should approach the decision with a healthy amount of respect and caution especially when the surgery is elective (or planned) and is non essential surgery (as aesthetic or cosmetic surgery generally is). All surgical procedures have limitations in terms achievable outcome and it is important that your expectations match what is possible through surgery. The choice to go ahead with surgery is always (or should always be) taken after due consideration of the risk benefit balance for the procedure. Although the majority of patients do not experience problems, it is important that you fully understand all the potential risks and complications of breast augmentation surgery. It is important that you take the time to read over them again prior to your next consultation.

Implants and implant failure

Like any biomedical implant, breast implants have a finite life span and after a given time the implant will lose integrity of its outer shell and the inner cohesive gel structure will become exposed. The current cohesive gel implants are designed to maintain shape even with the loss of structure in its outer coating or shell. Usually, the gel is core of the implant is contained inside the capsule or scar tissue that forms around the implant, though it can escape in some cases beyond the capsule into the breast tissue itself. This may result in localized firmness within this area of the breast. Implants can rupture or fail as the result of trauma, mammograms or due to the natural lifespan of the implant. Implants that have degraded from whatever cause are not repairable and need to be replaced. Breast implants will need to be replaced over the course of a patient’s lifetime.

Capsular contracture

The scar tissue that forms around a breast implant (known as a capsule) can thicken and distort and potentially be painful. Timing of the development of capsular contracture is unpredictable and can occur early after surgery or many years later. The formation of capsular contracture can affect one or both breasts. The treatment of symptomatic capsular contracture requires surgery to modify or remove the capsule and removal and replacement  (or removal without replacement) of the breast implant(s). It is possible for capsular contracture to reoccur even after previous treatment for the condition.

Implant Extrusion

Wound breakdown or infection can result in exposure of the implant through the incision or other part of the skin of the breast. If it becomes exposed a breast implant will need to be removed and there may be associated scar formation visible on the surface of the breast or deformity of the breast tissue and skin contour.

Calcification

Within the scar tissue or capsule surrounding the breast implant calcium salts can be deposited by the body. This can result in the capsule appearing rippled or solid and cause the breast to feel firm or even hard.

Implant Rotation

Anatomic or teardrop shaped implants have a definite upper and lower pole which must be correctly orientated in order for the implant appear as it should. In order for the implant to stay in the correct position in which it is placed at the time of surgery the implant capsule has to form around it and be strong enough to prevent implant movement. It is essential that for the first 8 weeks following surgery exercise is avoided and no lifting of heavy objects is performed. Implant rotation is still possible even once the capsule has formed.

Pregnancy and Change of Breast Shape and Size

If you become pregnant this will affect the size and shape of your breasts and it may change how your breast implants look and the position of the breast and nipple on top of the implant.

Inferior Displacement of the Implant

Breast implants increase the weight of your breasts and the amount of stretch that is placed on the soft tissues of the breast. With time the supporting tissue under the breast can give way and the breast implant can drop from the pocket in which it was placed causing the shape of the breast to change.

Double Bubble Formation

Double bubble formation is the term given to the appearance of the breast when the bottom edge of the implant is visible below the bottom edge of the breast. Your breast has a natural footprint where it sits on the chest wall. There is a limit to the size of implant that can be put in this footprint without the bottom edge of the implant being visible beneath the bottom edge of the breast. The larger the implant you chose the greater the risk of double bubble formation. If your breasts are at unequal heights there is a risk of double bubble formation when matching the implant positions (the breast sitting higher on the chest wall being at increased risk).

Nipple Asymmetry and Malposition

Any pre-existing asymmetry of nipple position will be present or even accentuated following breast augmentation.

ALCL

Anaplastic large cell lymphoma (ALCL) is a known occurrence following breast augmentation. It is not currently fully understood either in terms of what causes it, rates of incidence and subsequent prognosis. Current treatment consists of implant removal together with excision of the implant capsule. Some patients may need to be treated with chemotherapy. The knowledge relating to ALCL is changing and you understand that current recommendations and accepted practice relating to breast augmentation may change in the future.

Changes in Sensation   

Patches of numbness or decreased sensation over the breast and including the nipple are possible following breast augmentation surgery however these usually resolve with time. It is possible that these changes can be permanent. Very infrequently pain or uncomfortable sensations may be caused by nerve entrapment within scar tissue.

Contour Irregularities of the Skin 

Following breast augmentation surgery it is possible to get loss of smoothness of the surface of the skin (depressions or irregularities of the contours of the skin). It is also possible to get corrugation or pleating of the scar, tethering of the scar to underlying tissues and ‘dog ear’ formation at the ends of the scar. Such problems may respond to massage and maturation of the scar with time, though may require additional surgery to correct them.

Fat Necrosis

Fat cells in the subcutaneous tissue (under the skin) have a relatively poor blood supply and are quite susceptible to traumatic damage. With the effects of surgery it is possible for some of the fatty tissue to die and form scar tissue (which can be felt a lumpiness beneath the skin). If there are large areas of fatty tissue that suffer from necrosis this may require removal, or can result in prolonged discharge from the incision. If an area of fat necrosis became infected this would cause and abscess, which would require surgical drainage. It is possible that skin contour abnormalities can be caused by fat necrosis.

Seroma Formation

A seroma can be best thought of a collection of fluid beneath the skin at a surgical site. The composition of a seroma is much the same as that of blood but without the actual blood cells (it contains similar proteins and salts to blood) and is usually the result of lymphatic fluid accumulation (this is the 10% of the fluid that escapes from capillaries within tissues but does not return back to the veins via the small blood vessels but rather by the lymphatic drainage vessels) or by direct production from inflamed tissue (think of the tissues ‘sweating out’ the fluid). If this occurs there is the possibility it will need to be drained (often by simple aspiration with a needle or syringe, though in rarely can require a further operation to remove completely).

Asymmetry       

Skin tone, skeletal shape, muscle size and tone together with fatty deposits will all result in normal differences in shape between the sides of the body and it is normal for there to be asymmetry between both breasts in terms of size shape and position on the chest wall. There is no guarantee that the scar position will be symmetrical following breast augmentation surgery. It is possible further surgery may be required to attempt to improve symmetry.

Risks and Complications of Surgery in General

Anyone considering surgery should approach the decision with a healthy amount of respect and caution especially when the surgery is elective (or planned) and is non-essential surgery (as aesthetic or cosmetic surgery generally is). All surgical procedures have limitations in terms achievable outcome and it is important that your expectations match what is possible through surgery. The choice to go ahead with surgery is always (or should always be) taken after due consideration of the risk benefit balance for the procedure. Although the majority of patients do not experience problems it is important that you fully understand all the potential risks and complications of breast augmentation surgery. Mr. MacQuillan will have discussed these with risks and complications with you during your consultation however it is important that you take the time to read over them again prior to your next consultation.

Bleeding

It is possible, though unusual, to experience a bleeding episode during or after surgery. Drains are often used to reduce the risk of haematoma formation (a collection of blood within the surgical site beneath the skin) post operatively Significant post-operative bleeding will require a return to theatres to remove the collection of blood and seal (coagulate) any bleeding points. Avoid the use of Aspirin for 2 weeks prior to surgery as this increases the propensity to bleed, as can certain other medications (particularly non-steroidal anti-inflammatory medications, if in doubt please ask Mr. MacQuillan). Significant bleeding is unusual with breast augmentation surgery but if this occurs a blood transfusion may be required.

Blood Transfusion

If blood transfusions are needed to treat blood loss, there is a risk of blood-related infections such as hepatitis and HIV (AIDS). Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets.

Infection

Whenever the skin is cut there is always the risk of infection. With breast augmentation surgery the risk of  infection is low, but if it occurs it may require removal of the implant on the affected side and full resolution of the infection and subsequent recovery of the soft tissues is necessary prior to re insertion of the another implant  (this period of time is usually in the region 3 months).For more superficial infections limited to the skin and not involving the prosthesis further treatment ranging from specialist dressings, to antibiotics or hospitalization may be necessary.

Delayed Healing

Wounds can break down following surgery (wound dehiscence) or after suture removal or may be slow to heal. If this occurs dressings may be required for a prolonged period of time (weeks to months) prior to wound healing and in occasional cases a further operation may be needed. Scar revision may be necessary in cases of delayed wound healing.

Major Wound Dehiscence          

If the sutures holding the wound together pull out or the tissue in which they are placed loses its structural integrity the incision may open partially or completely. This may require further surgery or a prolonged period of dressings.

Skin Necrosis

If the blood supply to the skin is insufficient following surgery (which can be for a variety of reasons) the skin, particularly at the incision site, can necrose (die). If this happens the skin will form an eschar (scab) which may need to be removed surgically. Dressings are likely to be required for a period of time and further surgery may be needed.

Sutures

Most operations involve the routine use of deeply placed sutures (stiches) within and beneath the skin. Such sutures are usually designed to be dissolving however in some individuals they make take longer to dissolve than intended or may provoke a reaction from the body. In such instances they may form small pockets of inflammation (stitch granulomas or abscesses) which resemble an infection but are in fact due to the underlying stitch. Similarly the stitch may poke through the skin and become uncomfortable. In such cases the stitches will require removal.

Damage to Deeper Structures

With any surgery there is always the risk of damage to underlying structures. This is highly unusual but if it occurs the structures that could be involved include nerves, blood vessels, muscles, lungs or heart. Such injuries could result in temporary or permanent problems including pain, numbness, well as the need for  further surgery.

Allergic Reactions

In rare cases, local allergies to tape, suture material and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription medications. Allergic reactions may require additional treatment.

Pain     

You will have pain following surgery. The intensity and duration of the pain varies from individual to individual following breast augmentation surgery. Very infrequently chronic pain due to nerve damage or nerve entrapment in scar tissue may arise following breast augmentation surgery.

Deep Vein Thrombosis, Cardiac and Pulmonary Complications

Any procedure requiring general anaesthesia and immobilization for a period of time increases the risk of the formation of blood clots in the legs. Such clots can dislodge and move to the lungs, causing shortness of breath and strain on the heart. Air travel, inactivity and other factors (medications such as the oral contraceptive pill) can increase the risk of clot formation. It is important you tell Mr. MacQuillan of any previous history of swollen legs or blood clots prior to surgery. If you experience shortness of breath, chest pains or feel palpitations (abnormal heart beats) following your surgery it is important you seek medical advice immediately.

Unsatisfactory Result

Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of breast augmentation surgery. This would include risks such as asymmetry, unsatisfactory or highly visible surgical scar location, unacceptable visible deformities, capsule formation, bunching and rippling in the skin near the suture lines or at the ends of the incisions (dog ears), poor healing, wound disruption and loss of sensation. It may not be possible to correct the effects of surgical scars. Additional surgery may be required to improve results.

Long Term Outcomes    

The appearance of your breasts may change with future alterations in body weight, pregnancy, aging, sun exposure and hormonal changes (such as medication and the menopause) together with other circumstances not related to your surgery.

Alternatives to breast augmentation include the use of external devices to pad the chest, fat grafting, saline filled implants or not having any treatment.

Recommendations Around the time of Surgery

  • Clothing to wear to hospital – we recommend you wear a button or zip top for ease and comfort (such as a tracksuit top).
  • Keeping your skin clean – we recommend regular washing before and after surgery with tea tree wash.
  • Good supporting post-operative bra – a good bra is essential after breast surgery. We can provide Lipoelastic bras, which you can purchase from us prior to your surgery. They offer good support and have stretchy cups, meaning that they can accommodate your breasts during any post-operative swelling you may experience. They are also front-fastening, which makes things easier after surgery. Another good alternative is Parks & Spencer post surgical range. We would also suggest you purchased two bras, so one can be in the wash whilst wearing the other one. It is important to ensure that the bra fits comfortably around your chest. The post-surgical bra should be worn day and night (apart from showering) for 6- weeks unless otherwise advised.
  • Sleep for a few days with an extra pillow after surgery – this should help swelling to reduce.
  • Looking after your dressings – your wounds will be dressed in brown tape that stays on for two weeks. You can shower with the dressings on, but please have your back to the shower hose, so the tapes don’t come off. It is essential that the dressings are dry prior to getting dressed – dab of excess water with a towel, then use a hair dryer on a cold setting to dry the tapes.
  • Post-operative follow-up – you will have a check up with the nurse one week after surgery, and then a further appointment for the removal of tapes at 2-weeks. Later follow-up will be arranged subsequently.
  • Take things easy & slowly after surgery. Gentle pottering about, no heavy lifting or jumping up and down for first 2-3 weeks.
  • After 6 weeks you can get back to normal exercise with round implants, though you will require 8 weeks of abstinence from exercise for anatomic (tear drop) implants.
  • Scar management – this will be discussed with you at your 2-week post-operative appointment. Regular moisturizing and massage of your scars is important, and silicone gel can help ensure your scars settle down as quickly as possible.

Further Reading about Breast Surgery with Consultant Plastic Surgeon Anthony MacQuillan