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Possible Complications of Breast Augmentation Surgery

What are the potential risks of the surgery?

The overall risk of complications for saline breast implant surgery is 27.6%, with 25.8% of patients requiring re-operation for deflation of capsular contracture. (Note that the chart below depicts average rates of complication.)

Early

  1. Hypertrophic Scarring - This is a very thick, raised, red scar that develops after surgery. Hypertrophic scarring occurs in 2%-5% of patients and may require treatment with additional operations or steroid injections into the scar.
  2. Hematoma - A hematoma is a pocket of blood inside the wound. It occurs in 1%-6% of patients and is usually occurs within 2-3 days after surgery. Hematoma symptoms are swelling of the breast and severe pain that does not respond to pain pills. Treatment includes putting a tube in the breast to drain the blood. This procedure often requires a trip back to the operating room. Sometimes, if the collection of blood is small, no treatment is required and the body is able to clear the hematoma on its own.
  3. Seroma - In the days or weeks following the surgery, fluid can collect around the implant, causing pain or swelling. This can be thought of as "blister fluid." Just like a hematoma, it can leak from vessels damaged during the surgery and form a collection. Removal of larger seromas is recommended since they can become infected. Usually, the fluid can be removed carefully by a needle and does not require additional surgery. However, this technique of draining the seroma with a needle also may create a hole in the implant leading to implant deflation.
  4. Wound Separation (Dehiscence) - A relatively rare complication within the first 2 weeks where the edges of the wound separate resulting in an open wound or possibly exposure of the implant. This can be solved by using Steristrips to close the incision, or may require additional surgery.
  5. Infection (Cellulitis) - This complication occurs in 2%-4% of patients, and is usually from bacteria that normally live on the skin. Most surgeons will give a single dose of antibiotics before the surgery, and use an antibiotic solution in the wound before implant placement to help reduce the chance of infection. Symptoms of infection include pain, redness, swelling, and fever. Doctors may treat this complication with antibiotic pills, or if the infection is severe, by having the patient go to the hospital for intravenous antibiotics until the swelling and redness go away. After leaving the hospital, antibiotics pills are taken for 1-2 weeks. For infections of the implant itself, surgery to remove the implant is often the only option. Though some surgeons will attempt to save the implant from being removed by reopening the pocket and washing out the wound, this may not be effective. Infected implants put the patient at additional risks including: scar contracture, wound separation, and (in very rare cases) a severe illness called Toxic Shock Syndrome. After removal, healing and softening of the breast need to take place before the implant can be replaced, which often takes several months.
  6. Mondor's Disease - This is an inflammation of the blood vessels that run under the surface of the breast and it occurs in about 1% of patients. Fortunately, this condition requires no additional treatment and will go away on its own.

Late

  1. Asymmetry (difference in size or shape between breasts) - Most breast are asymmetric before breast augmentation, and all breasts remain (at least to some degree) asymmetric after the operation. Usually, the differences between the breasts can be improved during surgery, but occasionally the breast can become even more asymmetric after the operation and additional surgery may be required to improve this problem. For problems with sinking implants or implants placed off center, the wound is opened and the implant is moved. Sometimes if the first procedure is done in a subglandular approach, fixing the asymmetry can be done with submuscular implant placement.
  2. Contour problems - These may be seen before or after breast augmentation. Although implants usually improve breast shape, contour irregularities may persist or worsen after the operation requiring additional surgery to correct them.
  3. Capsular Contracture -
    • Definition - Once an implant has been placed, cells called fibroblasts make scar tissue to surround the surface of the implant. This occurs around every implant in the body, including artificial joints, pacemakers, or shunts. The scar tissue that forms around the implant is called "connective tissue" or the "fibrous capsule" and is responsible for keeping the implant in place. This capsule, for reasons which are poorly understood, can sometimes thicken and contract. This squeezing of the implant can cause shape changes, hardening, or pain.
    • Preventing Contracture - A number of factors may reduce the occurrence of capsular contracture. These include submuscular implant location, use of textured implants, and prevention of post-operative infection or bleeding. Sometimes doctors will also ask patients to start massaging the breast 5 days after surgery to reduce hardening of the capsule surrounding the implant. It should be noted, however, that massaging with textured implants is discouraged.
    • Treatment For Capsulars Contracture - For severe capsular contractures, the treatment of choice is re-operation. During this procedure, scar tissue lining the implant pocket is removed. Subglandular implants may be moved to a submuscular position.
  4. Altered Sensation or Feeling - Most women have some decrease of breast/nipple feeling or sensation following surgery. For women with these changes, feeling often returns after 6-12 months. Unfortunately, 15% of patients have permanent loss of nipple sensation in at least one of their breasts. Loss of feeling to areas besides the nipple is common as well, though within a year most patients return to normal. Rarely, symptoms such as itching and tingling occur, but like the others, these normally end in 6 months.
  5. Deflation or Rupture - The rate of deflation was published in one large, well-controlled study at 8.3%, though in the past this has often been a largely debated number. Implants that are placed in the subglandular position and implants larger than 450cc are at greatest risk for deflation. If this complication occurs, additional surgery is required to replace the implant. The cost of replacement usually is the responsibility of the patient.

Cunnigham BL. Lokeh A. Gutowski KA. Saline-filed breast implant safety and efficacy: a muliticenter retrospective review. Plastic & Reconstructive Surgery 105(6):2143-9 2000 May

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