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Complications of Breast Implants

Wednesday, July 6, 2011

Although for many patients breast augmentation with implants can be a positive and even life changing experience, all surgery carries certain risks.   The results of breast augmentation using implants (silicone or saline) are not completely predictable and will be affected by the nature of your tissues and healing process.  Therefore, the aesthetic result cannot be guaranteed and it is possible for you to be dissatisfied with some aspect of the results of your operation.  A good relationship with an experienced surgeon is your best insurance for a happy outcome.

The following is a list of possible complications of which you should be aware and which may occur despite the surgeon’s best efforts.

Bleeding

Excessive bleeding will result in bruising and swelling.  A haematoma (blood clot inside the breast) may form and this may require evacuation in the operating theatre.  This usually occurs in the first 24 hours after surgery and the risk can be minimized by patients avoiding anti-inflammatory drugs (other than Panadol) for a month before surgery.

Infection

Infection is a rare but serious complication which may necessitate removal of the implants.  Prevention of infection is the reason that patients are given antibiotics during and after their surgery.

Scarring

Although the incision is usually only 3-4 cm in length, it is often red and thickened for several months before fading.  In some patients, the scar may thicken, widen or become pigmented.

Asymmetry

Slight asymmetry of the chest wall, nipple position and breast volume may not be obvious prior to surgery and only noticed after breast augmentation. Correction of unequal breast sizes with different size implants, while useful, may not be perfectly accurate in resolving asymmetries. If you have  significant breast asymmetry, then other procedures may be necessary for its correction.

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This woman has a breast volume of approximately 100 ml (an A cup).  Saline implants with a volume of 300 ml were inserted behind the pectoral muscles and the inframammary folds lowered slightly to prevent excessive fullness in the upper part of the breast.  Note that her right nipple is a little lower than her left nipple and this slight asymmetry is still visible following her procedure.  In other words breast augmentation surgery will enlarge and enhance the breasts but not change them in other ways.

Capsular contracture

The body always isolates the implants in a pocket of scar tissue.  This is normally thin and loose allowing the implant to move around freely.  Occasionally, however, the scar tissue that forms is thick and unyielding causing the breasts to feel hard.  Often, no intervention is required as the breasts soften with time as the scar tissue matures but in some cases the hardening can cause deformity and pain necessitating a surgical procedure to divide or remove the scar tissue and then replace the implants.   Interestingly, some studies put the incidence of capsular contracture as less than 5% when the implant is placed under the muscle and as high as 60% when the implant is placed in front of the muscle.

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This is a case of bilateral capsule contracture.  Note that the breasts are rounded and look unnatural.  They are also very firm and the nipple areola complex has stretched.  This woman found it painful to lie on her stomach and her breasts were tender and sore.

Her surgeon had inserted silicone implants in front of the pectoral muscles.

The corrective procedure performed was to remove the old silicone implants and place saline implants with a slightly smaller volume behind the pectoral muscles.  The nipple- areola complex was also reduced in size and some excess breast skin removed.  The inframammary folds have also been lowered.  The breasts are now soft and comfortable and obviously look a lot better.

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This is what “capsule contracture” looks like. The implants are textured silicone gel and it is interesting that the textured surface is marketed as preventing capsule contracture! On the right, the capsule around the implant has begun to form as a “biofilm”. On the left, the capsule is mature and is constricting and distorting the implant. The breast was hard and tender. The patient had the implants removed and replaced with smooth -walled saline implants inserted in a new pocket behind the muscle. The incidence of capsule contracture is 5% behind the muscle and up to 60% above the muscle.

Rapid descent

In some patients, the tissues are thin and are not strong enough  to hold the implants in their position. This results in the implants moving down slightly on the chest wall and make the breast look “bottom heavy”. This can happen regardless of wearing adequate support bras and may require a procedure known as a “capsulodesis” for correction.

Detectability

Especially in very thin patients, the edge of the implant may become palpable especially at the side of the chest where you can feel your ribs.  Occasionally, this may be felt as a kind of “rippling”.  Weight loss makes this situation worse.  If it is troublesome, rippling can be reduced by “over filling” the implant.

Nerve damage

Some localized numbness and abnormal sensations (such as heat) are common and usually resolve. Permanent nipple numbness can occur but is very rare.

Tightness and swelling

It is normal for the breasts to feel tight and swollen for the first few weeks after surgery. The swelling may be uneven and subside more quickly on one side.  The tightness and swelling ease as the tissues relax.

Double bubble

This occurs where a breast implant has been placed behind a breast with excessive sagging. Further surgery including a mastopexy (breast lift) may be required.

Active breast deformities

Placement of the implants under the pectoral muscle will cause the breast to be compressed with contraction of the muscle. Usually, this is not noticeable; however, on occasion, it can be very obvious – e.g in the gym with certain chest exercises.

Veins and tight bands

Occasionally the breast veins become more apparent after surgery but this usually settles.  In addition, some patients develop tight bands between the breasts and the chest wall.  These resolve spontaneously in a few months.

Implant rupture

It is to be expected that all implants will rupture with time. Rupture of a silicone implant is not usually detectable and silicone can migrate into the tissues. As the longevity of silicone implants is unknown, the FDA in the United Sates, as a condition of approval of silicone implants, recommends that all women with silicone breast implants have an MRI scan after 3 years and then every 2 years thereafter.

Rupture of smooth-walled saline implants is extremely rare with the current style of implant having been available for 20 years.  If the implant does rupture it will be immediately obvious as the breast will diminish in size.  The saline is, of course, harmless to the body as it is naturally absorbed. Therefore, routine radiological investigation is not required to detect implant rupture.

Should an implant rupture, then implant removal and replacement will be required.

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Unacceptable new body image

Rarely, some women find that their larger breasts are not to their liking and they request implant removal.

Comments from others

Although it is anticipated that most comments will be complimentary it is possible that unkind comments made by a third party can lead to anxiety and dissatisfaction.

Emotional effects

Patients’ ambitions for breast augmentation to achieve social and professional goals may not be achieved. Additionally, should complications occur, there may be significant adverse affects on a patient’s life including social, sexual, emotional, physical and financial.

Cleavage

Thin patients may be unable to achieve good cleavage with breast augmentation.

Pregnancy and breast feeding

Pregnancy may alter the shape and size of your breasts but will not have any effect on the implants. Breast feeding is not interfered with by the presence of breast implants.

Revision surgery

Should revision surgery be required this may be emotionally, socially and financially demanding. The surgery may be more difficult than the original operation and the outcome is not guaranteed.  At Avenue Plastic Surgery we seek to minimize the cost (and the financial stress) associated with secondary procedures.

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