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Risks of Breast Augmentation

Oct 9, 2007
Although all routine cosmetic surgical procedures have very low complication rates, it is always important that you understand the standard potential risks and complications of any procedure. I joke with my patients and tell them that I have to scare them before I operate on them. The reality is, however, that even if the risk is one in a 100,000, if it happens to you it is 100 percent for you.

BLEEDING: Bleeding is a potential risk of any operation. The chance of needing a blood transfusion from breast augmentation is exceptionally small. If a collection of blood occurs around the implant, it is called a hematoma. If you get a significant hematoma, you need to go back to the Operating Room to have it removed. You cannot heal properly if a hematoma is in place. At the time of this writing, our practice has had only four hematomas over a period of over six years and approximately 400 cases.

INFECTION: Infection is a potential complication of any operation but can be especially serious in breast augmentation. Although every effort is made to prevent any infectious complications including use of intravenous antibiotics, placing the implant in antibiotics, placing antibiotics inside the pocket and giving postoperative antibiotics by mouth, infections can still occur. If the implant gets infected, the implant must be removed and must stay out of the body for at least 3 to 6 months. This is a potentially disastrous complication. Since our practice began, we have had one major infection that required implant removal.

DEFLATION: Breast implants are products and it is unlikely that they will last more than 10 to 20 years. Although there are some patients who have had saline implants for 20 to 30 years and have done just fine, it is doubtful that any surgical implant will last forever. If a saline implant ruptures, it contains saline which is easily absorbed by the body. Most patients describe not feeling anything, but rather waking up in the morning with a "flat tire."

The warranties regarding these implants have changed, but at the time of this writing, the implant company (Mentor) is willing to give you a new implant and pay $1200 toward replacement of the implant for the first five years. If you elect for the extended warranty, the warranty will be extended to 10 years and increased to $2200 to help you replace the implant. After 10 years, there is a life-time warranty on the implant, but any recurrent surgical fees would be your responsibility.

SENSORY CHANGES: It is inevitable with any operative site that sensation in that area will change. Whether the surgery is an appendectomy, hernia or a breast augmentation, the area of surgery will change in the way it feels. Any patient may experience numbness, tingling, burning sensation, twingy or shooting pains. Most of these sensation changes will be short-lived and resolve on their own, but they can be permanent. Thankfully, these sensations are rarely permanent.

SCARRING: Although every effort will be made to make the incisions and resulting scars as minimal as possible, visible scars are possible with any operation. Occasionally implants do not settle in the pocket properly and there can be some asymmetry in their Position. Occasionally reoperation is required to place an implant in a more natural Position. It has been more than five years since I have had to redo that for one of my own patients.

Despite using saline implants underneath the muscle, you can still have capsular contracture and hardness of the implant, but this is reported to be less than 5%. In seven years I have had one patient require repeat surgery for this problem.

BREAST ASYMMETRY: It is common for women to have one breast that is larger or in a different position from side to side. This is actually the norm and not the exception. Every effort will be made to minimize this asymmetry, but there will probably be asymmetries left after the surgery.

BREAST INDENTATION AND DEFORMITY WITH ANIMATION: Because the breast implant is located underneath the pectoralis major muscle, when that muscle is flexed with upper body workouts or exercises, the implant will be flattened and move laterally. This is inevitable because of the location of the implant.

BREAST CANCER: In our country the instance of breast cancer is one in eight women during their life-time. This is an unfortunate fact. The problem with breast implants is that x-rays do not go through them and therefore mammograms are not as good as without breast implants. If a patient has a mammogram without a breast implant in place, only 90% of the breast tissue is seen.

In women who have had breast implantation approximately 40% to 50% of the breast tissue is seen; however, what is interesting is that women who have breast implants if they do get breast cancer have a slightly higher cure rate than the general population.

Why is this? In general because women with breast implants tend to check their breasts and pick things up earlier. The earlier the cancer is detected the more likely it is curable. Also when a patient has a breast implant on their chest wall and the breast tissue is draped over the front of it, it is physically easier to do a physical exam and detect a smaller lesion.

PALPABILITY OR VISIBILITY OF THE IMPLANT: All of the implants wrinkle within the body, although in most cases these wrinkles are not visible through the skin. However, occasionally these wrinkles are visible and many times can be felt through the skin. This is one of the limitations of saline breast augmentation and is actually one indication for converting to Silicone gel. At the time of this writing, there are certain studies in which Silicone gel can be utilized and this would be one indication that would indicate that.

RARE COMPLICATIONS: Rarely there can be complications such as collapsed lungs and blood clots with pulmonary embolism, but these are exceptionally rare.

STANDARD ANESTHETIC RISKS: The administration of any medication has some amount of risk. Although every effort is made to minimize these risks, adverse reactions and side effects can not always be prevented. Complications of anesthesia can be as mild as slight dizziness or nausea to more profound abnormalities. Although rare, hospitalization may be necessary to control and/or treat any potential complication.

Any patient undergoing general anesthetic has a 1 in 200,000 chance of catastrophe and death. However this risk is small enough to say that it is safer to have general anesthetic than get into an automobile. It is not risk free, but severe complications are rare.

CALCIUM DEPOSITS: The longer implants are in the body, the more likely it is to have calcium deposits in the scar tissue surrounding the implant. It is possible these calcium deposits can make the breast firm, but they can also further impair mammograms. This does not occur in all patients.
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