Breast Augmentation Considerations

What Are Potential Breast Implant Complications?

Undergoing any surgical procedure may involve complications and side-effects related to: anesthesia, infection, swelling, redness, bleeding, and pain. In addition, there are potential complications specific to breast implants.

Infection can occur with any surgery. Most infections resulting from surgery appear within a few days to weeks after the operation. However, infection is possible at any time after surgery. Infections with an implant present are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the implant may have to be removed, and another implant may be placed after the infection is resolved.

In rare instances, toxic shock syndrome has been noted in women after breast implant surgery, and it is a life-threatening condition. Symptoms include sudden fever, vomiting, diarrhea, fainting, dizziness, and/or sunburn-like rash. A doctor should be seen immediately for diagnosis and treatment for this condition.

Breast implants deflate when the saline solution leaks either through an unsealed or damaged valve or through a break in the implant shell. Implant deflation can occur immediately or slowly over a period of days and is noticed by loss of size or shape of your breast. Some implants deflate (or rupture) in the first few months after being implanted and some deflate after several years. Causes of deflation include damage by surgical instruments during surgery, overfilling or under filling of the implant with saline solution, capsular contracture, stresses such as trauma or intense physical manipulation, excessive compression during mammography imaging, umbilical incision placement, and unknown/unexplained reasons. You should also be aware that the breast implant may wear out over time and deflate/rupture.

Deflated implants require additional surgery to remove and to possibly replace the implant.

The scar tissue or capsule that normally forms around the implant may tighten and squeeze the implant and is called capsular contracture. Capsular contracture is more common following infection, hematoma, and seroma. It is also more common with sub-glandular placement (behind the mammary gland and on top of the chest muscle). Symptoms range from firmness and discomfort to severe pain, distorted shape, palpability of the implant, and/or movement of the implant.

Additional surgery is needed in cases where pain and/or firmness are severe. This surgery ranges from removal of the implant capsule tissue to removal and possibly replacement of the implant itself. Capsular contracture may happen again after these additional surgeries.

Pain of varying intensity and duration may occur and persist following breast implant surgery. In addition, improper size, placement, surgical technique, or capsular contracture may result in pain associated with nerve entrapment or interference with muscle motion. You should tell your surgeon about severe pain.

Breast enhancement surgery will require future surgery at some point to replace the implants. They are not intended to last a lifetime. There is a high chance that you will need to have additional surgery at some point to replace or remove the implant. Also, problems such as deflation, capsular contracture, infection, shifting, and calcium deposits can require removal of the implants. Many women decide to have the implants replaced, but some women do not. If you choose not to, you may have cosmetically unacceptable dimpling and/or puckering of the breast following removal of the implant.

Dissatisfying results such as wrinkling, asymmetry, implant displacement (shifting), incorrect size, unanticipated shape, implant palpability, scar deformity, hypertrophic (irregular, raised scar) scarring may occur. Careful surgical planning and technique can minimize but not always prevent such results.

Hematoma is a collection of blood inside a body cavity. A seroma is a collection of the watery portion of the blood (in this case, around the implant or around the incision). Postoperative hematoma and seroma may contribute to infection and/or capsular contracture. Swelling, pain, and bruising may result. If a hematoma occurs, it will usually be soon after surgery. However, this can also occur at any time after 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 deflation/rupture can occur from surgical draining if damage to the implant occurs during the draining procedure.

Feeling in the nipple and breast can increase or decrease after implant surgery. The range of changes varies from intense sensitivity to minimal or no feeling in the nipple or breast following surgery. Changes in feeling can be temporary or permanent and may affect your sexual response or your ability to nurse a baby. (See the paragraph on breast feeding below.)

At this time it is not known if a small amount of silicone may diffuse (pass through) from the saline-filled breast implant silicone shell and may find its way into breast milk. If this occurs, it is not known what effect it may have on the nursing infant. Although there are no current methods for detecting silicone levels in breast milk, a study measuring silicon (one component in silicone) levels did not indicate higher levels in breast milk from women with silicone-filled gel implants when compared to women without implants.

With respect to the ability to successfully breast feed after breast implantation, one study reported up to 64% of women with implants who were unable to breast feed compared to 7% without implants. The periareolar incision site may significantly reduce the ability to successfully breast feed.

Deposits of calcium can be seen on mammograms and can be mistaken for possible cancer, resulting in additional surgery for biopsy and/or removal of the implant to distinguish calcium deposits from cancer.

In some instances, the incision site takes longer to heal than normally, which ranges from a week to 20 days.

The pressure of the breast implant may cause the breast tissue to thin and shrink. This can occur while implants are still in place or following implant removal without replacement. In addition to these common complications, there have been concerns with rarer diseases, of which you should be aware:

Concern over the association of breast implants to the development of autoimmune or connective tissue diseases, such as lupus, scleroderma, or rheumatoid arthritis, was raised because of cases reported in the literature of small numbers of women with implants. A review of several large epidemiological studies of women with and without implants indicates that these diseases are no more common in women with implants than those in women without implants. However, a lot of women with breast implants believe that their implants caused a connective tissue disease.

Published studies indicate that breast cancer is no more common in women with implants than those without implants.