What complications can occur?
Some patients will bleed into the space around the implant. This usually happens immediately after the operation, but occasionally occurs up to two weeks later. If it happens the breast becomes very swollen and tight. You need to go back to the operating room and have the blood removed and the bleeding stopped.
The implant can be retained. You are likely to spend an extra night in hospital and will be rather more bruised than expected, but things should settle down in time and it is unlikely to adversely affect your outcome from surgery. The risk of bleeding is less than 1%.
This is the most problematic complication of breast augmentation. Again it is rare, occurring in less than 1% of cases. It will usually become apparent over the first two or three weeks after the operation that things are not settling down as expected. The breast will be swollen and tender, it may look red, there may be wound discharge, and you may feel unwell with a raised temperature. If this occurs you need to contact your hospital or surgeon who should see you again.
Sometimes a mild infection will settle down with antibiotics, but usually this will not be enough. Most patients with an established infection around the implant will need to have the implant removed. A new implant cannot be inserted immediately. It is important to wait between three to six months for the effects of the infection to resolve before a new implant is inserted. The package price you pay for your breast augmentation should cover the cost of dealing with bleeding or infection.
Adverse capsular contracture
In every patient the body forms a scar or capsule around the implant that fixes it in place. In most people this is not obvious and the breast feels soft and looks natural. In a proportion of patients (for reasons that are not fully understood) this scar contracts around the implant and makes it feel firmer than a normal breast. In most patients they are not too troubled by this as the breast still looks satisfactory. However, in some patients the breast becomes unacceptably firm and may take on a spherical shape. It may also become tender. If this happens you should see your surgeon again to discuss the situation. Sometimes if the contracture is not too bad then you may decide to stay as you are. It is certainly safe to do this. Some patients will elect to have the implant removed and the capsule released/removed. This is called a capsulotomy or a capsulectomy. A new implant can then be inserted. Hopefully this will improve matters.
The risk of noticeable firmness is up to 10% of all breast augmentations, but most of these patients will not need revision surgery. The chance of having a re-operation for any reason is about 1% a year. So, after 10 years about 10% of women will have had a re-operation.
Adverse capsular contracture is the most common reason for re-operation. In addition, once capsular contracture has happened once it is more likely to happen after the revision operation.
Changes to the feeling of the breasts
Most patients will get some alteration in the sensation in their breasts after breast augmentation surgery, the most usual symptoms being some numbness near the scar, and oversensitivity of the nipples.
This oversensitivity gradually settles down, but usually takes several months to do so. A few patients will get numbness of the nipples. If numbness persists for more than six weeks after the surgery it is likely to be permanent.
Being able to feel or see the implants under the skin
In particularly slim patients it is to be expected that you will be able to feel the edges of the implants. This is an inevitable consequence of the operation and will not improve with time. It is much less likely in patients who start off with a reasonable amount of their own tissue covering the implant. As time goes by some people will be able to see or feel ripples or folds in their implants perhaps when leaning forwards.
For most patients it is best to simply accept that this has occurred and is a limitation of the surgery. It can be difficult to correct with another operation. In some patients the situation can be improved by injecting small amounts of your own fat under the skin. This is called lipomodelling or lipofilling.
Occasionally a more marked crease can be felt. This can be a sign of adverse capsular contracture.
Implants are made to be very tough, but the shell can eventually fail and a leak can occur. This is not usually a serious event, in many cases the leak is contained within the capsule and the patient does not notice problem. Patients may, therefore, have an implant that has failed and be unaware of it. This does not appear to be harmful. Some patients will notice a change in the size, shape or consistency of the implant. A lump might appear and the breast look swollen. If these things happen you should seek advice. A scan will usually be carried out and if this suggests the implant has ruptured, removal and exchange of the implant will be advised.
There is no universally agreed replacement schedule for breast implants, and it is unusual for there to be a need to exchange breast implants before ten years. If you have not noticed any change in relation to your implants then you do not need regular follow up or regular scans. However, you may develop one of the problems described above and may need or choose to have revision surgery at some time in the future. For this reason anyone having breast enlargement should be prepared both personally and financially to have surgery again at some time in the future.
Other reasons for reoperation
• Most patients are delighted with their breast augmentation, but a few decide as time goes by that they want to be bigger so will choose to have reaugmentation with larger implants.
• With time augmented breasts, just like natural breasts, will change shape. In the case of most women this will not trouble them, but sometimes the shape is not as good as it was and further surgery might be considered.
• Very occasionally teardrop-shaped implants can rotate behind the breast. The patient will notice a marked shape change, usually evident on waking in the morning. The implant will usually rotate back to its correct position by itself or can be gently pushed back in to position. This may happen only once, but if it becomes a repeated problem re-operation will be needed. Rotation is more likely in patients who have quite large implants inserted to correct markedly droopy breasts.
• Some patients get intermittent swelling around their breast implants. This can be associated with fluid around the implant. If it occurs scans will usually be recommended to ensure the implants are intact and to see if there is a fluid collection. Further tests or implant replacement may be recommended if the problem persists.
Introduction to breast augmentation