Breast Augmentation Risks

Capsular Contraction: Capsular contraction is the most common side effect of breast implants. During surgery, a pocket is created for the implant that is somewhat larger than the implant. A fibrous membrane, called a capsule, then forms around the device. Under ideal circumstances, the pocket maintains its original dimensions and the implant “rests” inside, remaining soft and natural. For reasons that appear to relate to the individual characteristics of the patient, the scar capsule shrinks in some women and squeezes the implant, resulting in various degrees of firmness.

Capsular contraction is not a health risk, but it can detract from the quality of the result. Symptoms of capsular contracture range from mild firmness and mild discomfort to severe pain, distorted shape of the implant, and palpability (ability to feel the implant).

Four Levels of Capsular Contracture: Capsular contracture is graded into 4 levels depending on its severity. Levels 3 or 4 are considered severe and often additional surgery is needed to correct these grades:

  • Level 1: the breast is normally soft and looks natural
  • Level 2: the breast is a little firm but looks normal
  • Level 3: the breast is firm and looks abnormal
  • Level 4: the breast is hard, painful, and looks abnormal

This surgery ranges from removal of the implant capsule tissue, to removal and possible replacement of the implant itself. The surgery may result in loss of your breast tissue. Capsular contracture may happen again after these additional surgeries and may increase risk of rupture. Rarely, if the contraction persists and cannot be eliminated, the occasional patient may choose to have the implants permanently removed. Capsular contracture is a risk factor for implant rupture, and it is the most common reason for reoperation.

Capsular contracture may be more common following infection, hematoma, and seroma, and the chance of it happening may increase over time. This contraction can occur soon after surgery or many years later and can appear in one or both breasts. Current theories suggest that a low-grade infection may “trigger” some contraction.

Hematoma: Some postoperative bleeding into the pocket containing the breast implant occurs. If the bleeding is minimal, the body will absorb it with time. Marked swelling will probably require surgical removal of the blood.

Infection: Postoperative infection is uncommon, but possible. We reduce this to a minimum by giving intravenous antibiotics during surgery and oral antibiotics after surgery. Most infections are mild and resolve without incident. If a serious infection develops, the implant will probably need to be removed, and cannot be safely replaced for at least 2 months after healing.

Loss of sensation to skin or nipple(s): Nerves that supply skin or nipple sensation may be cut or damaged while the pocket or space for the implant is being created. Feeling in the nipple and breast can increase or decrease after implant surgery. The range of changes varies from intense sensitivity to 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.

Exposure or Extrusion of Implant: Thin skin, inadequate tissue coverage, capsule formation, infection or severe wrinkling may all contribute to the erosion of an implant through the skin or scar. Should this very rare complication occur, implant removal would probably by indicated (at least temporarily).

Skin Wrinkling and Rippling: Wrinkling that can be felt through the skin can occur with any implant. It seems to occur less often with smooth surfaced implants than with textured implants. Usually, the problem is mild and requires no treatment. Experience has shown that the wrinkles frequently improve or even disappear with time. If wrinkling is severe, secondary surgery may be indicated.

Asymmetry: if your breasts had slightly different shapes before surgery, they may remain slightly different after surgery. Rarely, in spite of careful attention to detail, the dissected pockets may end up slightly different in shape or height. If this is not noted while you are in surgery, but becomes a problem after healing, you may later need a small adjustment procedure.

Subpectoral Placement of the Implant (Under the Muscle): If you and Dr. Davidson have decided to place the implants under the pectoralis muscle, a unique set of risks apply. During contraction of the muscle, the implants will temporarily be flattened and/or pulled upward. Ocassionally, the implants may “ride” higher than their original position because of the muscular contraction. Implants were originally placed under the muscle to reduce the frequency of capsular contraction. The newer implants provoke capsular contraction at a much lower rate than older implants. Contraction appears to occur in less than 10% of breasts, whether the implants are placed below or above the muscle, though the rate of contraction may be slightly less if the subpectoral position is used. Implants are usually placed under the muscle in thin, small-breasted women to provide more “cover” over the implant. Placing the implant under the muscle may reduce visible wrinkling.

Deflation: The valve through which the implant is filled can fail and leak over time. The outer shell of the implant can develop a small tear or a pinhole defect and leak. While neither of these problems occur frequently, when they do, the saline (fluid) leaks out of the implant and is absorbed by the body. The breast size becomes smaller. Sometimes, only a portion of the fluid leaks out and the breast does not deflate all the way to pre-operative size. Leakage of saline is not dangerous, but the only solution is to replace the implant with a new one.

Loss of Skin, Breast Tissue, or Nipple: This is an extremely rare complication of breast enlargement. It usually develops from an infection that has gotten out of control and results in the death of the involved tissues. This very rare complication will usually involve only small areas that will eventually heal with good wound care. Secondary surgery is a remote possibility.

Interference with Breast Feeding: Many women with breast implants have nursed their babies successfully. Nevertheless, any breast surgery can theoretically interfere with your ability to breast feed.

Calcium Deposits in the Tissue Around the Implant: In some patients, a thin layer of calcium will develop within the scar capsule surrounding the implant. This usually occurs several years after the implant has been inserted. In these patients, the added density of the scar may reduce the detectability of lesions close to the scar on mammograms. Breast cancers may still be visible and detectable when specialized techniques are used.

Breast Cancer: There is no evidence linking implants and breast cancer. Reports in the medical literature indicate that patients with breast implants are not a greater risk than those without breast implants for developing cancer.

Interference with Mammography: You should alert the technician to the fact that you have implants. Special techniques will be used and extra views may be needed in order to see as much of the breast tissue as possible. Even under the most ideal circumstances, some breast tissue may remain unseen and a suspicious lesion missed. Because the breast is compressed during mammography, an implant may rupture during the procedure.

Symmastia (Loss of Cleavage): This is a very unusual problem that can develop after normal augmentation either above or below the muscle.  The skin over the lower sternum (breastbone) pulls away from the bone, and normal cleavage is reduced or eliminated. In its more serious form, the pockets on either side merge to form a single pocket. In the more minor form, the pockets remain separate, but the skin tents upward. Reduced fibrous or elastic “strength” in the subcutaneous tissues may be contributory but is difficult to predict. If the problem develops, correction will require secondary surgery.

Breast Tissue Atrophy/Chest Wall Deformity: The pressure of the breast implant may cause the breast tissue to thin and shrink.  This can occur while the 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.

Presence of Silicone Rubber: Saline filled implants are made of silicone rubber. Silicone rubber, more commonly referred to as silicone elastomer, is a synthetic product.

Connective Tissue Disorder: 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.