What complications can occur?
All operations are associated with risks. Serious complications are uncommon with breast augmentation occurring in less than 1 in 100 operations. However, some of the following complications may 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.
The risk of bleeding is less than 1 in 100. If it happens the breast becomes very swollen and tight. You will need to go back to the operating room and have the blood (haematoma) 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. Haematoma can increase the risk of subsequent capsular contracture (see below).
This is an uncommon complication occurring in less than 1 in 1000 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.
Asymmetry / Difference in breasts
It is important to understand that it is normal to have some asymmetry or difference between your breasts. Perfect symmetry is not an achievable goal.
Asymmetry can be of breast or nipple, and asymmetry can be of size, shape and position. Asymmetry may appear more pronounced after surgery. In the case of size asymmetry, a larger implant in the smaller breast can be used, but this will only assist in improving the volume difference, not other asymmetries such as the position of the nipples.
Asymmetry can sometimes occur following surgery as the implants can settle differently in the pockets and this may not be possible to correct.
Some patients have a naturally wide cleavage. Implants are positioned centrally behind the nipples and implants will not improve a wide cleavage. With a sub muscular placement the cleavage can even appear wider. Your breasts and implants may fall to the sides when you lie down. This is normal.
Stretch marks and veins
Stretch marks may develop after surgery, especially with larger implant sizes. Veins may become more noticeable on the breast surface
Patients undergoing a breast enlargement must understand that the breasts will sag with time as they are larger and heavier (the larger the implant, the heavier the implant and the more the breast will droop). When breasts sag they may also “bottom out”, which means the implant sits more below the nipple than above.
Implants do not interfere with the ability to breast feed. There is some evidence suggesting the amount of milk produced by some women with implants is reduced. There is no evidence of an increase in illness in children of women with silicone gel breast implants. Pregnancy and breast feeding may adversely affect the shape of the breast.
In every patient, the body forms a scar, called a capsule around the implant. This 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 round 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 choose to have the capsule released (capsulotomy) or removed (capsulectomy) and a new implant inserted. Hopefully this will improve matters, but the scar tissue can return in at least half of the people who have secondary surgery.
The risk of noticeable firmness or capsular contracture is up to 1 in 10 of all breast augmentations, but most of these patients will not need revision surgery.
The chance of needing to have a re-operation for any reason is about 1% (1 in 100) a year. So, after 10 years about 10% (10 women out of every 100) will have had to have more surgery. Capsular contracture is the most common reason for re-operation. Once capsular contracture has happened, even if it is re-operated on again, it is likely to recur in 1 in 2 cases.
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 and oversensitivity of the nipples.
This oversensitivity gradually settles down, but usually takes several months to do so. Around 1 in 5 patients will have a reduction in sensation to their nipples. Recovery can take up to 12 months, but 1 in 10 patients will have some permanent numbness.
Being able to feel or see the implants under the skin (palpability and rippling)
It is common to be able to feel the implant, especially in patients who are slim or have little breast tissue. This is an inevitable consequence of the operation and will not improve with time. 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 capsular contracture.
Implants are made to be very tough, but the shell can eventually fail and a leak can occur (implant rupture). The American Core study (FDA Update on the Safety of Silicone Gel-Filled Breast Implants June 2011) suggested 1 in 10 implants had ruptured at 10 years. It’s estimated half of all breast implants may rupture by 15 years.
This is not usually a serious event, in many cases the leak is contained within the body’s own capsule. Patients may therefore have an implant that has failed and be unaware of it (silent rupture). 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 or 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 pleased with their breast augmentation, but a few decide as time goes by that they want to be bigger so will choose to have re-augmentation with larger implants.
- Just like natural breasts, augmented breasts will change shape with time. 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. Breasts will change with pregnancy and fluctuations in a person’s weight
- Occasionally teardrop-shaped implants can rotate behind the breast. The patient will notice a 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 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.
Many of these more long-term problems will not be covered by any package that you buy at the time of your breast augmentation. Neither should you expect the NHS to provide your future treatment. You must be prepared to pay for consultations, scans and further surgery if needed.
Breast Implant Associated Anaplastic Large Cell Lymphoma(BIA-ALCL)
Since 2016, a condition called Anaplastic Large Cell Lymphoma (ALCL) in association with breast implants has been recognised by WHO ( World Health Organisation).The risk of this is small. It is not a breast cancer but a type of cancer associated with the scar tissue or capsule laid down by the body around a breast implant.
Cases of Breast Implant Associated –ALCL(BIA-ALCL) have occurred between 2 and 28 years after breast implant insertion with the average time being 8 years. It is most likely to show up as a swelling around the implant causing an increase in size of the breast (a seroma). It can usually be successfully treated by an operation to remove the implant and the capsule of tissue surrounding it.
Because it is so uncommon, international organisations are sharing data and information about this condition. Most of the cases worldwide have occurred in women with textured breast implants with higher numbers of BIA-ALCL seen in women with implants that have a coarser texture than those with a finer texture. It is important to ask your surgeon what the most up-to-date recommendations are.
However, breast implants continue to have safety approval from Government organisations such as the UK MHRA and USA FDA. They continue to be used in breast reconstruction patients following treatment of cancer worldwide. For more information, please see the links at the end of this booklet.
Breast Implant Illness
Breast Implant Illness (BII) is a term used by some patients who have breast implants and experience a variety of symptoms that they feel are directly connected to their silicone breast implants.
Breast Implant Illness is not a medical diagnosis and there is no proven association with breast implants. The symptoms include tiredness, “brain fog”, joint aches, immune-related symptoms, sleep disturbance, depression, hormonal issues, headaches, hair loss, chills, rash, hormonal issues and neurological issues. There is currently no scientific evidence to confirm this proposed link or any diagnostic test to show that a patient suffers from such a condition. Research continues in this area to establish if all of the symptoms that patients describe can be brought together into a single diagnosis.
Some patients do report that their symptoms improve if their implants are removed but this is not true for all. More guidance on BII can be found at these websites.
Introduction to breast augmentation