Risks and Complications of Breast Augmentation

The breast augmentation procedure is an outpatient surgery that does not usually require general anesthesia or hospitalization, but it does not mean the surgery is without risks and complications. No matter how well-prepared you are or how experienced your surgeon is, the unexpected can happen – and it's best to be prepared for that possibility. It best or review breast implants before and after photos to understand the potential results of surgery. However, keep in mind that these pictures reflect successful surgery. Surgeons do not typically provide previous patient photos with complications, but they should fully describe the various risks. Risks associated with breast augmentation include:

Implant rupture can occur as the result of wear and tear, an injury or mammogram, or, in the case of saline, if it has been underfilled (the act of breathing causes enough friction over the course of years to weaken the implant at the creases). A saline implant rupture is obvious, and both you and your surgeon will know it has happened. The affected breast will become deflated, its size and shape changing as the saline solution leaks outside the implant shell. The disadvantage is that when a saline implant deflates, it can deflate completely and the breasts are asymmetrical until the implant is replaced. Although not a pretty sight, there are no medical complications involved because the saline is safely and easily absorbed by the body. A ruptured saline implant must be surgically removed as soon as possible. This is usually done through the same incisions that were during the original surgery, and a new implant can be inserted.

Silicone gel breast implants can rupture without you or your surgeon knowing it. This is known as a silent rupture, and you may not be aware of it for months or even years. If a silicone implant ruptures, silicone may remain in the breast pocket (known as an intracapsular rupture), or it may migrate out to other parts of the body. For this reason, the FDA and implant manufacturers recommend that patients have magnetic resonance imaging (MRI) about 3 years after implantation and then every 2 years thereafter to detect any leakage of the silicone gel. The cost of these MRIs may not be covered by your health insurance, so you may end up paying for them out of pocket. Some physical symptoms of a silicone implant rupture are hard knots or lumps surrounding the implant or in the armpit, a change in or loss of size or shape of the breast or implant, pain, tingling, swelling, numbness, burning, or hardening of the breast. A silicone implant must be removed if it ruptures.

Capsular contracture is the formation of scar tissue around the implant. The scar tissue contracts and squeezes the implant, causing the breast to harden and become misshapen and possibly rupturing the implant. A capsule almost always forms around a breast implant; it is the contracture of the capsule that is the problem. Capsular contracture occurs in about 5% of all patients. It is a very painful condition that does not go away without treatment. Women who smoke or have had multiple breast surgeries are at higher risk for capsule formation.

Adverse reaction to anesthesia during or after surgery.

Excessive bleeding during or after surgery, which may include developing a hematoma (pocket of clotted blood), a seroma (pocket of blood serum or plasma), or a thrombosis (large clot in a blood vessel).

Tissue death (necrosis) of breast tissue, the breast envelope, skin, or tissue along the incision. The risk of necrosis increases if the patient smokes, has poor circulation, bleeding disorders, or has undergone radiation, chemotherapy, or cryotherapy treatment postoperatively.

Extrusion of the breast implant, which occurs when the body rejects the implant and pushes it out. Extrusion can cause infection and scarring, and the implant must be removed before it breaks through the skin.

Loss of sensitivity in the nipples and skin over the breasts, or around incisions. This can be temporary or permanent.

Development of calcifications in the breasts or galactorrhea (spontaneous production of breast milk).

Atrophy of breast tissue.

Infection, which usually occurs within the first 4 to 6 weeks after surgery. This is why surgeons usually instruct their patients to wash their breasts thoroughly with antibacterial soap in the days leading up to their surgery. This precaution helps eliminate staph bacteria, which occur naturally on the skin. The surgeon will also scrub the area with disinfectant just before making the incisions.

Rippling or contour irregularities, including visible indentations from the edges of the implant. The implant may shift and be felt and seen through the skin. Inserting the implant under the muscle helps prevent this problem.

Symmastia, or uniboob, happens when the two breast implants touch in the middle of the chest. This occurs when the surgeon dissects tissues and muscles over the breastbone to bring the breasts closer together to create more cleavage, from swelling and pressure from bandages and bras, or from sleeping on your side. The condition becomes apparent within a few weeks, and the only way to correct it is with revision surgery, which could entail implant removal, correction, and replacement.

Bottoming out is when the implant loses its tissue support and slips below the inframammary crease. Revision surgery is usually required to correct bottoming out, although sutures and pressure bands are sometimes used successfully.

Double bubble, slang for when an implant is placed under the muscle of a patient with ptotic (sagging) breasts. The breasts hang low, the implants stay up high, and the patient looks like she has two sets of breasts. This can be avoided by having a breast lift along with the breast augmentation. Don't confuse this with breast implants that have not yet dropped, which usually happens within several weeks after surgery.

Mondor's cord, named for the French surgeon who identified the problem. This bulging vein under the breast lobe is caused by thrombophlebitis, or inflammation, of the vein. It disappears spontaneously and is not serious.

General dissatisfaction with the surgical results sometimes happens. There's always a risk that cosmetic surgery will not live up to your expectations. Maybe your breasts look smaller or larger than you thought they would, or just not "right". Talk to your surgeon before surgery to make sure you understand what improvements can realistically be expected. Let him or her know how you want to look after surgery, then listen to their feedback. If the recommendation is for breast augmentation and breast lift for optimal results, take it seriously.

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