Breast Augmentation/Breast Implant Risk

Every surgical procedure has potential complications, such as infection, bleeding and scarring. Additionally, there are some potential complications specific to breast implants. It is important for women considering breast implant surgery to understand these potential problems and put them into perspective before deciding if the benefits of implants will achieve her goals and that the risks and potential complications are acceptable.

Risks related to breast implants

Silicone bleed & Implant rupture
Some silicone gel may diffuse or ‘bleed' through the shell of an intact implant into the scar tissue or the capsule that surround the implant. Rupture of an implant may be related to force or trauma, such as a blow to the chest in a car accident or it may be related to the length of time an implant has been in the body. Both silicon bleed and implant rupture will require removal and replacement of the implant. 

Capsular contracture
Anytime something is implanted, whether it is a breast implant, knee joint or heart valve, the body reacts by forming a protective coating or lining of scar-like tissue around it. This is referred to as a ‘capsule'. This is a natural process and happens in everyone regardless of whether the implant is smooth or textured, silicon or saline.

Over time the capsule may tighten or contract excessively, much like squeezing a soft balloon, causing a change in breast firmness, shape and/or discomfort. This is referred to as capsular contracture. The appearance of the breast may appear artificially round and feel unnaturally firm to touch. There are 4 grades of capsular contracture: Baker Grades I-IV as follows:

• Grade I - the breast is normally soft and looks natural
• Grade II - the breast is a little firm but looks natural
• Grade III - the breast feels firmer than normal and looks somewhat abnormal (visible distortion)
• Grade IV - the breast is hard, may be painful and clearly looks abnormal (greater distortion)

The contracture may occur one side, both sides or not at all. The degree of contraction may also be different on one side compared to the other. Although both breasts never match exactly, if any of these deformities occur, differences in the two breasts may be more noticeable and may not be correctable.

Excessive firmness of the breasts can occur soon after the surgery or years later. The occurrence of troublesome capsular contracture is not predictable, however, the chance of it happening increases with time.

Treatment options
Treatment often begins with non-surgical methods such as prescribed antibiotics and Vitamin E, ultra sound or anti-inflammatory medication.

Severe cases of capsular contracture may require surgery to remove the scar tissue around the implant and or implant replacement.

• Open capsulotomy. The capsule is surgically cut open in order to release the pressure in the implant and so it will re-form slightly larger.
• Open capsulectomy. This is generally the most successful, as well as the most intensive form of treatment. The entire capsule is removed, allowing new tissue to re-develop around the implant. In some cases the surgeon will change implant placement: for example the implant may be placed underneath the muscle in the hopes of better results. Capsular contracture may recur after surgical procedures to correct this condition.

In some cases, the contracture may not be correctable and implant removal may be necessary.

Calcification
Calcium deposits can form in the scar tissue surrounding the implant and may cause pain and firmness. These deposits may interfere with mammograms as these deposits must be differentiated from calcium deposits which are signs of breast cancer.

Implant extrusion
If the skin or breast tissue covering the implant is very thin or if there is a problem with healing, the implant may protrude thought the skin. This will require removal of the implant.

Risks of larger implants
The placement of excessively-sized breast implants which exceeds the normal dimensions of the breast may produce irreversible tissue thinning and exposure of the implant requiring implant removal. The breast may droop excessively and may show visible rippling and the implant may be palpable.

Wound healing problems tissue necrosis
Some patients experience delayed healing or the incision site may not heal well. The incision may open from injury or infection.

Tissue breakdown, or necrosis, is the development of dead tissue around the implant. This will delay wound healing and may cause a wound infection and may require surgical correction or implant removal. Tissue breakdown has been reported following the use of steroid drugs, chemotherapy, radiation to chest area, smoking, and excessive heat or cold therapy. In some cases, it may occur without any known cause.

Visible rippling
Visible rippling can result when an implant pulls on the overlying tissues or when the natural folds in the implant are visible through the skin. This is more likely to occur with saline implants.

Change in nipple sensation
Change in nipple sensation is normal after surgery, however, most patients have normal nipple sensation after several months. Occasionally, partial or permanent loss of nipple and skin sensation or hypersensitivity may occur in one or both breasts. This may affect sexual response or the ability to breast feed.

Malposition
A breast implant may rotate or shift position after the initial placement. This may cause discomfort and distortion of breast shape. Excessive sagging of the lower breast tissue may result in an implant that appears too low or causes the nipple to point upwards. This is sometimes referred to as "bottoming out". The implants can also shift to the side, widening the gap between the breasts. Contracture or tightening of the lower implant pocket may cause the implant to move upwards.  Patients are advised to wear a compression garment after breast augmentation as some bra styles may contribute to the malposition of implants in the early postoperative period.

Asymmetry
Most women's breasts have at least some asymmetry. Breast implants can help improve size differences, but may make nipple position accentuated. There is no accurate way of measuring breast size so it is difficult to determine the difference in volume of an implant to correct size differences.

Surface contamination of implants

Breast tissue atrophy
Pressure from implants may cause the breast tissue to thin and shrink as a result the implant may become more visible or palpable. Thinning of breast tissue may also occur naturally with ageing.

Toxic shock syndrome
In extremely rare cases, life-threatening infections, such as toxic shock syndrome may occur after breast implant surgery.

Infection
An infection after breast augmentation is uncommon, in the range of 0-4% in cosmetic augmentation, and 2-25% in breast reconstruction with a breast implant. The infection may appear shortly after surgery or at anytime following the insertion of the implant. An infection around an implant may be difficult to diagnose and is more difficult to treat than in normal body tissue. If an infection occur antibiotics are normally given, however if the infection does not respond to treatment, the implant may have to be removed. After the infection is treated, a new breast implant can usually be inserted several months later.

Patient compliance
Follow all physician advice carefully; this is essential for the success of your outcome. It is important that the surgical incisions are not subjected to excessive force, swelling, abrasion, or motion during the time of healing. Protective dressings and drains should not be removed unless instructed by your plastic surgeon. Successful post-operative outcome depends both on surgery and subsequent care. Physical activity which increases your pulse rate may cause bruising, swelling, fluid accumulation around implants and the need for re-operation. It is advisable to refrain from intimate physical activities until given the ok from your surgeon. It is important that you participate in follow-up care, return for post-surgery consultations and promote your recovery after surgery.

Mental health disorders and elective surgery
It is important that all patients wanting elective surgery have realistic expectations that focus on improvement rather than perfection. Complications and less than satisfactory results are sometimes unavoidable, may require additional surgery and are often stressful. Please openly discuss with your surgeon, prior to surgery, any history of mental health disorders. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.

Long term results
Subsequent alterations in breast shape may occur as the result of ageing, weight loss, weight gain, pregnancy, menopause, or other circumstances not related to breast augmentation. Breast sagginess may naturally occur.

Unsatisfactory results
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 your results of surgery. asymmetry in implant placement, displacement, nipple location, unanticipated breast shape and size, loss of function, wound disruption, poor healing, and loss of sensation may occur after surgery. Breast size may be incorrect. Unsatisfactory surgical scar location may occur. In some situations it may not be possible to achieve optimal results from a single procedure. It may be necessary to perform additional surgery to improve the results, change implant size or remove and not replace implant.

Re-operation estimates
Devices placed within the body do not last forever, and breast implants, like any other implanted devices may need to be replaced after a period of years. Manufacture's statistics show a re-operation rate in five years of approximately 20-30% for breast augmentation and 30-40% for breast reconstruction with an implant. It appears that re-operation rate has improved with newer types of breast implants. Most common indications for re-operation include; major or minor complications, capsular contractures, and replace of ruptured or deflated implants.