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.
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.
Adverse capsular contracture
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.
Introduction to breast augmentation