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Possible
Risks and Complications of Breast Surgery:
Anesthesia reaction
Asymmetry
Bleeding
Breast droop
Capsular Contracture (hardening of scar tissue
around implant)
Deflation (approximately 7%)
Displacement
Hematoma (pooling of clotted blood; risk is 3-4%)
Implant leak
Infection (risk is less than 1%; always involves
removal of implant)
Interference with mammography
Keloid (heavy scar)
Nerve Damage
Nipple numbness
Pain
Permanent numbness (risk is 15%)
Reactions to medications
Rippling
Rupture of the implant (often due to injury)
Seroma (pooling of watery blood)
Skin irregularities
Sloshing
Slow healing
Swelling
Symmastia (breasts merge into one mass)
Visible scar
Capsular Contracture
Capsular contracture is one of the most common
complications associated with breast augmentation.
It occurs when the scar tissue hardens around the
implant. It may be more common following infection,
hematoma, and seroma. Capsular Contracture is much
less common and less severe with saline implants
than with silicone breast implants.
There are four grades of capsular contracture -
Baker Grades I through IV.
The Baker grading is as follows:
Grade I - the breast is normally soft and looks
natural
Grade II - the breast is a little firm but looks
normal
Grade III - the breast is firm and looks abnormal
(visible distortion)
Grade IV - the breast is hard, painful, and looks
abnormal (greater distortion)
Grade I and Grade II require no treatment. Grade III
is treated by reopening the incision and releasing
the capsule. Grade IV requires repositioning the
implant and may require implant removal. Capsular
contracture may recur after additional surgery.
According to the FDA, in a clinical study of
saline-filled breast implants conducted by Mentor,
9% of 1264 women with implants experienced Grades
III and IV capsular contracture after 3 years of the
study. In a similar study by McGhan, the rate was
also 9% (of 901 patients). The rate of contracture
in reconstructive patients is higher.
Another FDA study indicated that 17.5 % of 749 women
had at least one surgical procedure over an average
of 7.8 years because of capsular contracture.(1)
This study included women who had implants for
cosmetic and reconstruction purposes, most of whom
had silicone gel-filled breast implants.
Dr. Jorges Planas, a plastic surgeon in Barcelona,
Spain, conducted two studies on women with capsular
contracture (a group of 52 women and a group of 24)
and found an 83.8% improvement at 1-year follow-up
following external ultrasonic treatment. On average,
positive, long term results were achieved in less
than 8 sessions. Ultrasound can also be used as a
preventative method. You may want to discuss this
treatment with your surgeon.
Source: Planas J, Cervelli V, Planas G. Five
years experience on ultrasonic treatment of breast
contractures. Aesth Plast Surg 2001;25:89-93.
Hematoma/Seroma
Hematoma is a collection of blood inside a body
cavity, and seroma is a collection of watery blood
around the implant or around the incision.
Postoperatively, they may contribute to infection
and/or capsular contracture. If a hematoma occurs,
it is usually soon after surgery; it can also occur
after an injury to the breast. While the body
absorbs small hematomas and seromas, large ones will
require the placement of surgical drains for proper
healing. A small scar can result from surgical
draining.
Implant displacement
Implants can move out of position at anytime after
surgery. If they move only a little, it may not be
noticeable. If they move a lot, you may need surgery
to put them into position. This is very uncommon
except in women who have very large implants. The
larger the implant, the greater the chance that it
will displace.
Infection
Infection is very uncommon. The risk is about 1% but
if it occurs the implants will have to be removed.
If infection does occur, it is usually within six
weeks of surgery.
Necrosis
Necrosis is the dead tissue around the implant. This
may prevent wound healing and require surgical
correction and/or implant removal. Permanent scar
and/or deformity may occur following necrosis.
Factors associated with increased necrosis include
infection, use of steroids in the surgical pocket,
smoking, chemotherapy/radiation, and excessive heat
or cold therapy.
Galactorrhea
Sometimes after breast implant surgery, you may
begin producing breast milk. This is more likely if
you have previously lactated. The milk production
often stops spontaneously or medication may be given
to suppress milk production. In other cases, removal
of the implant(s) may be needed.
Mammography
Saline and silicone implants affect a mammogram
reading. Implants placed below the muscle permit a
clearer reading. When implants are below the muscle,
90% of breast tissue is visible. When implants are
above the muscle, 75% of breast tissue is visible.
Regardless of where placed, implants do not
interfere with self-exams. They do not interfere
with MRI scans or ultrasounds, which are
alternatives to a mammogram. No studies have shown a
connection between implants and breast cancer (See
http://www.pla sticsurgery.org/mediactr/evidence.htm).
However, ineffective mammography could result in a
higher risk of undetected breast cancer from other
causes. If you have a history of breast cancer in
your family, breast augmentation may not be an
option.
Rippling
Rippling looks like indentations or waviness on the
surface of the breast. It is the saline moving
inside the implants. In most cases it occurs during
movement. According to a 1994 survey (commissioned
by implant manufacturers) 12% of women who were
dissatisfied with their implants were dissatisfied
because of rippling. Rippling is less likely to
occur with implants that have a smooth surface. It
is more common in implants that are placed above the
muscle, especially in women with little or no breast
tissue. Rippling can be a result of underfilling the
implant.
Sagging
Sagging is less likely in implants placed above the
muscle. Because the implant is likely to be higher
on the chest than the breast tissue, you may have
separate tissue hanging from the firmer implant.
Your surgeon may recommend a mastopexy (breast lift)
in addition to the augmentation.
Sensation Loss/Change
After surgery, you may have temporary or permanent
numbness. There is also possibility of diminished
sensation or increased sensitivity. The risk of
having permanently numb nipples is roughly 15%.
Implants placed above the muscle may have a greater
risk for this as the surgery may interfere with
breast tissue near the skin. You can also expect
sensation change if your incision is in the aerola.
If the surgeon injures the nerves which lead to the
nipple area it can lead to temporary or permanent
numbness. All incisions have a risk of diminished
sensation.
Rupture or Leak
Rupture of Saline Implants
If a saline implant breaks, it will deflate and the
salt water will be absorbed by the body. Alert your
physician right away as the implants will have to be
replaced. Some implants deflate or rupture in the
first few months after being implanted and some
deflate after several years. You should also be
aware that the breast implant may wear out over time
and deflate. Additional surgery is needed to remove
deflated implants.
In a study conducted by Mentor, 3% of 1264 patients
had deflation after 3 years. In a similar study by
McGhan, the deflation rate was 5%of 901 women after
3 years. Another study indicates that 10.1% of women
followed for an average of 6 years had at least one
implant deflated.(2)
Rupture of Silicone-Gel Implants
When silicone gel implants rupture, women may notice
decreased breast size, hard knots, uneven appearance
of the breasts, pain or tenderness, tingling,
swelling, numbness, burning, or changes in
sensation. According to the FDA, 69% of 344 women
had at least one ruptured breast implant. Factors
that were associated with rupture included
increasing age of the implant, the implant
manufacturer, and submuscular rather than
subglandular location of the implant. A summary of
the findings of this study is also available at the
FDA's website at
http://www.fda.gov/cdrh/breastimplants/studies/biinterview.pdf
For silicone gel and saline-filled implants, some
causes of rupture or deflation include:
- damage by surgical instruments during surgery
- underfilling of implant (saline only)
- capsular contracture
- trauma, injury, or intense physical
manipulation
- excessive compression during mammographic
imaging
- placement through the belly button
- normal aging of the implant
Deflation is less likely to occur if the implants
are over filled. If the implants are not over filled
they will fold when you move and may eventually
rupture and deflate.
The Department of Surgery at Fairfield Hospital in
Cleveland, OH, recorded the spontaneous deflation
rates in 305 saline solution-filled breast implants:
Deflation rates compared to fill
volumes
| Fill volume |
Number of implants |
Number of deflations |
Rate |
| Within recommended volume
amount |
305 |
22 |
7.21% |
| Filled to original implant
size |
84 |
10 |
11.9% |
| Greater
than recommended volume |
21 |
0 |
0.00% |
| Less than recommended volume |
19 |
3 |
15.80% |
| Totals |
345 |
25 |
- |
According to this data, overfilling greatly
reduces the risk of deflation.
Source: Raj J, Wojtanowski MH,
Spontaneous Deflation in Saline
Solution-filled Breast Implants. Aesth Surg
J. January/February 1999;19:24-26
Additional Surgeries
Additional surgery may be needed to replace
or remove the implants due to problems such
as deflation, capsular contracture,
infection, shifting, and calcium deposits.
Women who do not have their implants
replaced may have cosmetically undesirable
dimpling, puckering of the breast following
removal of the implant, or other
unsatisfactory cosmetic outcomes.
In a study of saline-filled breast implants
conducted by Mentor, 13% of 1264 patients
needed additional surgery after 3 years. In
a similar study by McGhan, 21% of 901
patients needed additional surgery after 3
years.(2)
A study by Gabriel et al. of both saline and
silicone-filled implants concluded that 24%
of women with breast implants experience
adverse events resulting in surgery during
the first 5 years after surgery.(1)
According to this study, about 1 in 3 women
getting breast implants for reconstruction
may need a second surgery within five years,
and about 1 in 8 women getting breast
implants for augmentation may need a second
surgery within five years. These additional
surgeries may result in the loss of breast
tissue.
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(1) Gabriel SE, Woods JE, O'Fallon
WM, Beard CM, Kurland LT, Melton LJ.
Complications leading to surgery after
breast implantation. New Engl J Med 1997;
336:679-682.
(2) Gutowski KA, Mesna GT, Cunningham BL.
Saline-filled Breast Implants: A Plastic
Surgery Educational Foundation Multicenter
Outcomes Study. Plastic Reconstructive
Surgery. 1997 (100): 1019-27.
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