Okemos Michigan Plastic Surgeons Cosmetic Surgery Procedures

Breast Augmentation

Risks and Possible Complications of Breast Augmentation

What Are the Risks & Complications?

These complications are aggregate (across the United States), and are for all surgeons, all implant types, all incisions, all placement positions, and all other variables. The incidence of some complications may be decreased by various factors, which will be discussed as you read on. At Trillium, we believe that many of these numbers can be significantly reduced by experience, implant choice, implant placement, and incision type. This remains to be seen. Some of the complications require another surgery (sometimes within days, some after months or years).

Remember this: Although some complications clearly must be corrected by further surgery, many complications will improve with time. Many are acceptable to the patients (and do not require further intervention), but some patients will not accept even the slightest abnormality.

If you refuse to accept small, often temporary complications, do not have breast implant surgery. If you have perfect breasts, you shouldn't be considering implant surgery. If you have imperfect breasts (almost all women) and you wish to improve their volume (and possibly equalize their size), do not expect implant surgery to correct nipple size, asymmetry, breast drooping, or any other "pre-existing" breast abnormality.

In other words, your breasts will look very much like they did before the surgery, only larger and wider, probably with mild enlargement of the areola.

Most Common Complications/Complaints with Saline Breat Implants

Excessive Rippling: 10-60%
Palpability & Immobility: 20%
Noticeable Scars : 10%
Problems with shape, position, double fold, synmastia: 10%
Asymmetry : 10%
Numbness of breast or nipple : 10%
Hematoma : 4%
Implant rupture : 2%
Pneumothorax : 2%
Seroma : 2%
Blue window, extrusion : 1%
Infection : 1%
Capsular contracture requiring re-operation: 1-3%

10-60% Excessive Rippling

Rippling is caused by partial folds or ridges in the implant, usually at the side of the breast under the armpit, which can be felt and/or seen. Proper surgical technique, adequate implant filling, and proper choice of implant size minimize this. Many surgeons believe that almost all implant patients will have some amount of rippling at some time. This is usually worst at 3 months after surgery, and is more frequent and pronounced in smokers, those with thin skin, and those who have lost a large amount of weight, or who are below ideal body weight.

10-50% Excessive Firmness

Capsule formation and contracture cause excessive firmness. A capsule created by the body around any foreign object surrounds any breast implant. A capsule that continues to harden and contract over time causes excessive firmness (capsular contracture) and may require re-operation. Some of these capsules do not appear for over two years after surgery. Re-operation, if needed, is usually done at least 6 months after the abnormal capsule is detected. Capsular contracture may require multiple, repeat surgeries.

5-50% Deflation

Deflation of the implant (loss of the salt water inside) can happen anytime after the implant is placed, from almost immediately after the surgery to many years later. All saline implants have a solid, but permeable, silicone shell. Tiny amounts of fluid move across the shell barrier during the entire life of the implant. In most cases, as the tiny amounts of salt water leave the shell, they are replaced by tiny amounts of body fluid (mostly salt water) to maintain the original volume of the implant. In other patients, this outward movement of saline will cause a decrease in the volume of the implant over years. The tiny amounts of salt-water leakage (if they happen) are harmless, but deflation can, over the course of many years, lead to replacement of the original implant.

20% Palpability and Immobility

You should realize (before you ever have surgery) that breast implants (regardless of the circumstances, surgeon, or implant type) never feel or look completely natural. Your implants will never feel or look exactly like the normal human breast. Please realize that breast implants are somewhat firmer (or much firmer) and do not move as much as natural human breasts. This is often a very individual judgement. For some women, this may not necessarily be an unwanted result. Our usual goal (at least in the Midwest) is to mimic the natural form as much as possible. In California and Texas, many women actually request an "artificial, augmented look," while in Europe, smaller implants are preferred, for a more natural look.

10% Noticeable Scars

This is often dependent upon the opinion of the patient. One woman may readily accept a scar that another woman would find unacceptable. Incisions around the nipple/areola complex and under the breast are most likely to be noticed. The TUBA and underarm incisions are usually almost invisible, except under unusual circumstances. At Trillium, we prefer to avoid breast scars of any kind whenever possible.

10% Problems with Shape, Position, Double Fold, Synmastia

Shape and position abnormalities can be pre-existing, or a result of the surgery. Every attempt is made to achieve a natural shape and position. Double folds and synmastia, an extra crease at the bottom of the breast, will usually dramatically improve with time, over months.

10% Asymmetry

Many (if not most) women have one breast that is at least slightly larger than the other. The goal at surgery is to make the two volumes as close to visually identical as possible. A complication occurs if there is a noticeable difference in the size. Many asymmetries cannot be corrected with implants.

10% Numbness of the Breast or Nipple

Almost all numbness that may occur will be temporary, and will improve after weeks or months. Permanent numbness of either area is very rare.

4% Hematoma (blood around the implant)

This requires re-operation within a relatively short time period (days), usually with replacement of the same implant during the hematoma surgery. These are more common in patients who have not stopped taking their herbal supplements, ibuprofen, aspirin, Vitamin E, estrogens or other medicines which inhibit blood clotting. They are more common for patients with elevated blood pressure, blood-clotting problems, and those exposed to excessive heat or over-exertion after surgery.

2% Implant Rupture

Implant rupture (complete deflation) is almost always caused by trauma to the breasts and implants. This can be during an auto accident, falling while skiing, biking, or running, or any very exuberant physical activity or event that involves contact to the breasts (including sex).

2% Pneumothorax

This is a surgical complication, when the very thin muscle between the ribs is crossed with a surgical instrument, and the tissues around the lungs are entered. Usually, a small tube is placed between the ribs for several days. In some cases this requires hospitalization.

2% Seroma

This is a collection of fluid within the cavity where the implant has been placed. This will sometimes require further surgery, but can often be treated over time without re-operation.

1% Blue Window, Extrusion

The implant thins the breast skin to the point that the implant can be seen beneath the skin as a bluish area, or the skin becomes so thin that the implant actually creates a hole in the skin. This is somewhat more common with very large implants, with sub mammary placement, and with sub mammary and areola incisions.

1% Infection

This will almost always require re-operation, with removal of the infected implant. The implant cannot be replaced for at least 6 months. This is more common after breast-feeding and any other mouth to nipple contact, particularly within the first three months after surgery. Your surgeon should forbid mouth to nipple contact for at least 3 months following surgery. We require that all body piercings be removed for at leat one week before and 3 months after augmentation surgery. Nipple piercings should be removed forever. All dental surgery should be done before the implant surgery. After the implants are in place, prophylactic antibiotics should be taken before subsequent surgery.

1-3% Capsular Contracture Requiring Re-Operation

All breast implants cause capsule formation. Sometimes, the capsule will contract, or shrink, deforming the implant to such a degree that another surgery is needed.

There are other, more unusual complications which can occur with breast augmentation. If you someday decide to proceed with surgery, these will be explained to you in detail.

Contraindications to Breast Implant Surgery

Poor Health

Bleeding tendencies, hypertension (high blood pressure), heart disease, chronic pulmonary (lung), renal (kidney), or hepatic (liver) disease are all contraindications. We will not perform surgery for patients with acute or chronic skin, ear, or periodontal infections. Keloid, excessive scar formers, and those with dermatographia will not be treated with implants. See also the general contraindication sheet for cosmetic surgery.

Chest Wall Deformities

Patients with chest wall deformities (such as Poland's syndrome, pectus excavatum, and markedly hypoplastic breasts) are advised against breast implant surgery

Pendulous Breasts

Drooping or sagging breast (particularly larger breasts) are not always an "absolute" contraindication, but an adequate final result is very difficult to achieve with breasts that droop significantly. This will be determined in consultation.

You may also estimate the degree of drooping yourself. If a string is placed under the breast, and placed as high in the groove or fold as it will go (stretched horizontally), a ruler is then placed next to the nipple, and the vertical distance from the central nipple to the string in measured. If the nipple is one inch or less below the string in the infra-mammary crease, then the drooping can be considered to be mild to moderate. If the nipple is greater than 1.5-2 inches below the string, you may want to consider some type of breast lift, unless you do not mind very significant drooping of the breast after implant surgery. Despite the drooping, some patients will be very happy with their results.

Gross Asymmetries

Pre-existing problems such as different size areola, nipples pointing in different directions, unequal infra-mammary folds, nipple inversion, or very unequal breasts will not be adequately corrected by implant surgery alone. The patient must be willing to accept that these problems will be present after implantation surgery. Other corrective surgeries can sometimes help these problems.

Lactating Breasts

Implants should not be placed until at least six months after breast-feeding and lactation have completely stopped. If even a few drops of milk can be expressed with mild pressure on the breast, lactation has not stopped. If implants are placed earlier, severe capsular contracture usually results.

Strong Family History of Breast Cancer

If a single close family member has had breast cancer, the increased risk is probably minimal. If your mother, sisters, and grandmother have/had breast cancer, don?t even consider it. The risk is not worth it. Genetic testing for the inherited type of breast cancer is now available (regionally) at the University of Michigan. Although implants can interfere with mammograms to some degree (and 5-15% of breast cancers are not detected by mammograms) the incidence of breast cancer in women with implants is actually slightly less than it is in women without implants. (No one can explain this, but it is good news)

Personal History of Autoimmune Disease; such as Scleroderma, Rheumatoid Arthritis, Lupus, or Fibromyalgia

It has been shown that implants do not cause these diseases. What if just having any elective operation of any kind could make these diseases worse?

HIV or Hepatitis

These can stress the immune system, and any additional, elective event that stresses the immune system is probably not a good idea, particularly when a foreign object is placed in the body.

Pregnancy

Obviously, implantation will not be done if you are pregnant.

If any of these apply to you, breast augmentation may be unwise. Check carefully with your surgeon. (Possible Contraindications)

Cannot or will not miss 5-10 work days
Very low pain threshold
Very prolonged healing time
Current psychiatric treatment
Realistically expect to gain or lose 30 pounds or more within 6 months of treatment
Pregnancy
Chemotherapy or radiation therapy within one year of surgery
Anorexia, other eating disorders, or deviation from "normal" weight for body type
Vitamin deficiency
Active local or systemic malignancies
Possible, or known, exposure to HIV virus, hepatitis, or any other blood infection
Active infections of any kind, skin, venereal, or otherwise
Herpes simplex patients
Collagen-vascular disease
Significant relationship, marital, job, psychological, or sexual problems
Difficulty with gender identity
Patients who expect a completely painless experience with permanent results; total (100%) improvement of area treated; guarantees and/or promises; the surgeon to decide "what she/he needs" to make her/him more attractive
Patients who cannot or will not understand and accept alternatives, potential risks and possible complications
Patients who have suffered traumatic life events within 6-12 months of procedure
Divorce
Death of a spouse or close family member
Change or loss of job
Move to a new city
Ending of long-term relationship
Traumatic and/or disfiguring surgery or injury