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Risks and Complications Breast Augmentation

There are risks to all cosmetic plastic surgery and breast augmentation is no exception. Just because you are going home the same day and may not be using general anesthesia does not mean that there are no risks. You must remember that this is surgery and that, even with the best surgeon and everything going well, you may still have a complication. Serious risks to breast augmentation are rare, but they do exist. Make sure you know about all the risks when you decide to have breast implants and breast augmentation. Some risks are to your health and some are risks to your appearance.

General Risks of Breast Augmentation Surgery

These are the risks that may occur with breast implant surgery. The first risk to consider is that you may have an allergic reaction or other complication due to anesthesia. General anesthesia is considered to be more risky, but you can have an adverse reaction to any kind of anesthesia.

Another risk is that you bleed excessively during or after your surgery. This may lead to the necessity of undergoing further surgery to control the bleeding and drain any collected blood. You may develop a hematoma (a pocket of clotted blood), a seroma (a pocket of blood serum or plasma, the watery portion of the blood), or a thrombosis (a large clot in a blood vessel). 

You may experience tissue death (necrosis) of the breast tissue, breast envelope, skin, and tissue along the incision. This is extremely rare, but the incidence of necrosis is increased if you smoke, have poor circulation, have bleeding disorders, or undergo radiation or chemotherapy treatment, or cryotherapy postoperatively.

Another rare complication is extrusion of the breast implant, where your body rejects the implant and pushes it out. The implant may become visible under the skin and must be removed before it breaks through the skin, which can result in an infection and scarring.

You may lose sensitivity in your nipples and skin over your breasts or by incisions. Loss of sensitivity is common, but it is usually temporary. Permanent sensation loss in the areola (nipple) area or breasts can happen.

You may develop calcifications in your breasts, which is more likely if you have a thick capsule around the implant. You may also develop galactorrhea, which is when you spontaneously start producing breast milk. This usually resolves on its own, but some cases may need medication or implant removal.

Atrophy of your natural breast tissue is a possibility. 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".

Infection

As with all types of surgery, you may develop an infection. If you develop a serious postoperative infection, you may need to have the implant removed, the infection dealt with, and then have to wait for several months before you can be reimplanted. Infections usually occur within the first 4 to 6 weeks after surgery. One common cause of postsurgical infections is Staphylococcus bacteria.

The general consensus is that infection occurs in less than 2% of breast augmentation patients. To help reduce the risk of infection, your surgeon may instruct you to wash the skin of your breasts the areas of incision thoroughly with an antibacterial soap such as Hibiclens or Antibacterial Dial before your surgery. Some surgeons ask their patients to do this for three days before their surgery and others say to do it just the night and morning before. This precaution will help eliminate staph bacteria, which occur naturally on the skin. Your surgeon will also scrub your skin with a disinfectant right before making the incisions.

Capsular Contracture

Capsular contracture is the formation of scar tissue around the implant that contracts and squeezes the implant. It is normal for tissue to form around a foreign body and the formation of scar tissue around a breast implant is not a problem in itself. The problem is when this tissue contacts and squeezes the implant. The breast can become hard and misshapen due to the contracture, and the implant may rupture.

Capsular contracture occurs in about 5% of patients. Your breasts may look like hard baseballs and it can be very painful. Capsular contracture rarely ever goes away on its own. It may develop after an infection or after an injury. It can even recur after the surgery to remove the scar tissue.

The degree of capsular contracture is graded on the Baker scale, 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)

Please see the Capsular Contracture Section  for more information.

Breastfeeding after Breast Implants Surgery

Many women ask if they can breastfeed after breast augmentation surgery. The answer is yes.  For the vast majority of women, breastfeeding is no more difficult with implants than without.  Some women who have breast fed with and without implants say that breastfeeding with implants is easier!

The only type of breast augmentation that might interfere with breastfeeding would be when the implants are inserted through a periareolar incision. This incision could potentially disrupt the milk ducts that bring milk to the nipple.

See the Breastfeeding With Breast Implants for more information.

Breast Implant Deflation

A breast implant can deflate or rupture due to an injury or from wear and tear. An underfilled implant can rupture or deflate because the motions of your breathing can cause small amounts of friction that it to weaken at creases. There are reports of implants rupturing or deflating due to a mammogram.

A saline implant can deflate within minutes or hours if it springs a leak. If a silicone gel-filled implant develops a leak or rupture, you may not know for months or years or may never know it, even with an MRI. A ruptured or leaky implant must be replaced. If a silicone implant ruptures, silicone may migrate out of the breast pocket, or may be contained within the pocket, which is called an  intracapsular rupture.

Breast implants do not last forever. Always keep it in the back of your mind that you will probably undergo at least one implant replacement surgery in the course of your life. 

Silicone Implants Issues

A silicone-filled implant can rupture and leak silicone gel. Usually this gel will stay in the pocket near the implant. It is possible for small amounts of silicone to migrate out of the breast pocket.

Silicone gel is a gooey substance and can vary in its cohesiveness. Earlier models of silicone-filled implants used thinner, more liquid gels that could bleed through the solid silicone shell. Still, the silicone breast implant can rupture and leak silicone. Bits of silicone gel can cause the body to react and form what is called a granuloma around the silicone. Many implants made today are made of firmer gels that are more likely to hold together in the event of a rupture. Implants with even more cohesive gels so called “gummy bear breast implants”  are under development.

For information regarding silicone-filled implants or silicone in general, please read Silicone and Your Body.

Breast Implant Appearance Problems

Rippling and Contour Irregularities
There is a chance of rippling, or visible indentations from the edges of the implant, especially if you have little or no breast tissue and chooses to go over the muscle. Even if you have significant breast tissue, it is possible that the implant can shift and make an indentation that shows and can be felt through the skin.

Many women choose a silicone-filled implant (even changing from saline to silicone-filled) to correct rippling problems. Some women choose to go completely under (full submuscular, under the serratus muscles and rectus abdominus fascia) to help cover the implants.

Symmastia or Uniboob
Yet another risk that you may incur is symmastia (synmastia is an alternate spelling and it is also called uniboob). Symmastia is when the two breast implants end up touching each other in the middle. You look like you have either a figure-eight shaped implant or like you have just one breast (“uniboob”). This can happen when the surgeon dissects tissues and muscles over your breastbone to bring the breasts closer together and create more cleavage. If your breast augmentation surgeon suggests that you need this, ask how many times he or she has used this particular technique and ask to see photos of patients and possibly speak with them as well.

Symmastia becomes apparent within a few days or weeks. Swelling and binding from bandages and bras can put pressure on the sides of your breast implants and move them to the center of your chest. Sleeping on your side can also cause one implant to move too far to the center. 

The only way to correct “uniboob” is with revision surgery. This means possible breast implant removal, correction, and replacement. The revision surgery entails sutures in the area over the breastbone. Your surgeon will most likely have to use permanent sutures and create an edge to the pockets to keep the implants in their proper place. The cleavage area will reattached to the breastbone so that once it heals there are no obvious lumps or filaments. Be advised this area may not look pretty right after the revision, but when it fully heals, it will be fine.

Bottoming Out
Bottoming out is when the implant has lost its tissue support and has slipped below the inframammary crease, either the natural one or one that has been surgically altered.

Correction for this problem also usually involves revision surgery, although it can be remedied with just sutures and a firm band supporting the breast for many weeks. See the page on Bottoming Out  for more information.

Double Bubble
A double bubble is a slang term for when an implant is placed under the muscle(s) of a patient with ptotic (sagging) breasts. Over placement is fine for slight ptosis and act some surgeons choose it when a patient doesn't want a lift and isn't too saggy. But if the patient is given unders and has substantial sag, her breast tissue may fall further. Her natural breasts are low and her implants have stayed up and she looks like she has two sets of breasts. The moral of the story is: if you need a  breast lift get one.

This problem can also happen after pregnant and breastfeeding. The tissue now sags with the excess weight and stretch of the full mammary, but the breast implant remains where it was originally placed.

Don’t confuse double bubble with breast implants that have not dropped yet. Your breast implants may stay high for several weeks after surgery and then drop into a more natural position.

Mondor's Cord
This is named for a French surgeon, Henri Mondor. It is a bulging vein under your breast lobe on your abdomen and breast and is caused by thrombophlebitis (inflammation) of a vein.

This condition appears rather spontaneously and is not serious. You can treat it by applying warm compresses. It will often disappear on its own, but if it doesn’t and you are worried, consult with your surgeon.

General Dissatisfaction with Breast Augmentation Surgery Results

With any type of cosmetic surgery, there is the risk that how you look will not live up to what you expected. You may wish you had gotten smaller implants or larger ones or feel that they just do not look right on you.

Before your breast augmentation surgery, when you trying on larger bras and filling them with implants or bags of rise, it will not look quite the same as having the implants in you. Take this into account. Talk to your doctor about what you want and how you really want to look after your surgery.

You may be disappointed that the implants are not lifting your breasts as you would like. Remember, this is not a breast lift; it is an augmentation. If it is breast lift you want as well as augmentation, get them both.

Also understand that after your augmentation, your breasts will be heavier than you were accustomed to. Get used to it and learn to enjoy your new breasts.