After Breast Augmentation Complications

Complications can occur after any surgery. Breast augmentation is no exception. Knowing what to expect before you undergo any surgical procedure can help relieve some stress and nervousness. It also helps prevent the shock and disappointment that may occur if post-surgical complications do arise.

Some complications that commonly arise immediately after breast implant surgery include post-operative bleeding (hematoma), fluid collection (seroma), and infection at the site of the surgical incision. Later complications may include chronic breast pain, alterations in breast and nipple sensitivity, and interference with breast feeding,

Feelings in the breast and nipple can change after the implant surgery has been completed. These changes may include increased sensitivity, chronic pain and lack of feeling in the breast or nipple for several months or even years following the implant surgery. Within the first few years, 2-8% of breast augmentation patients report experiencing chronic breast pain.

Another 1-2% report breast sensitivity changes, and 3-10% experience nipple complications like losing sensations within that area. These reports are generally the same for both silicone gel and saline implants.

But long term data does indicate that 17% of women experience after-surgery breast pain within five years of saline implants. This change in sensitivity is usually either temporary or permanent. It may also have an affect on sexual response and the ability to breast feed a baby.

Being aware of these and other possible complications will help you make an informed decision and may aid in long term satisfaction with your breast augmentation.

Breast Augmentation - Not A New Idea

Breast augmentation isn t new. It s not even a twentieth century idea. Women have been trying to improve on nature for centuries. It was only a matter of time before women turned to science and medicine for aid.

In 1889, paraffin injections were tried. The results of this were disastrous. 1895 is the earliest known use of implants. The first one was done by the German surgeon, Vincenz Czerny. He used the adipose tissue (the fatty tissue) from the woman s back. This benign growth or a lipoma, seemed appropriate because they re comprised of fatty tissues, soft to the touch and moveable.

Between 1895 and the early to mid-1900 s many other substances were tried. Glass balls, ox cartilage, ivory, Terylene wood, polyethylene chips, ground rubber, polyester, Silastic rubber and Teflon-silicone prostheses were some of the choices.

In 1945 and 1950 attempts were made to rotate the woman s chest wall tissue into the breast to add volume. Different synthetics were used during the 1950s and 1960s. An estimated 50,000 women received injections of silicone. In some of these women, hardening of the breasts and development of silicone granulomas (small nodules) were so severe, mastectomies were needed for treatment. 30 years after these treatments, women are still seeking medical services from complications resulting from these injections.

Today s implants are much safer and the instances of complications have been greatly reduced. Hopefully, medical science will be able to keep up with women s attempts to improve on their natural gifts.

Breast Implant Ruptures

A saline implant rupture results in quick deflation and is easily removed. Recent FDA approved studies show rupture/deflation rates of 3-5% at 3 years and 7-10% at 5 years. Older studies depended on clinical exams to determine rupture rates.

Recent reports have determined these exams aren t adequate to evaluate rupture rates. One study reported ruptures in asymptomatic patients are correctly detected by experienced plastic surgeons 30% of the time. This is compared to a detection rate of 86% by MRIs.

The FDA currently recommends MRIs be used to screen for ruptures beginning three years after implantation and continuing every two years thereafter.

Other countries consider MRIs useful only in cases of suspected ruptures and to confirm ultrasound or mammographic studies suggesting a rupture.

Silicone implant ruptures rarely result in deflation. The silicone leaks into the space around the implant. This indicates the need for removal of the implant. The risk and treatment of extracapsular leakage is controversial. It s agreed the gel is difficult to remove, but there s disagreement about the health effects.

The majority of MRI data for silicone gel implants indicates after 11 years, most women had at least one ruptured implant with silicone leakage outside the capsule of 21% of the women. The available long term data deals with 3rd and 4th generation implants and shows a 15-30% risk of silent rupture. MRI evaluation of the 5th generation implants implies improved durability. A rupture rate of 1% or less at an average age of six years is reported.

Capsular Contracture

When a foreign object inters our body, our immune system tries to either destroy it or contain it. Some immune systems interpret a breast implant as a foreign object. Since the immune system can t destroy an implant, it tries to contain it. It attempts to build a wall around the intruder to keep it from spreading to the rest of the body. The wall around the implant is called a capsule.

When the capsule tightens around the implant it s called capsular contracture. The squeezing can be painful and can change the shape of the breast. The changed shape can affect the appearance of the breast as well.

The severity of the capsular contracture varies between cases. With the mildest case, the breast looks normal and still feels soft. This is classified as grade 1. Grade 2 still looks normal, but the breast is a little firm. At grade 3, the breast is firm and the appearance is considered abnormal. Grade 4 is the most severe and the most painful. The breast looks abnormal and is hard.

You may have to have another operation to fix capsular contracture. The capsule has to be removed, and sometimes the implant has to be replaced. But there are cases where successful treatments have been achieved without any additional surgery.

It s not known exactly what causes the body s immune system to behave abnormally towards an implant, but capsular contracture can happen after any implant or implant repair surgery. Not just breast implants.

Implant Placement

Complications commonly arise from any surgical procedure. The possibility and severity of these complications vary depending on all the circumstances of each individual surgery. The same is true for breast augmentation. One factor in determining any potential complications you may encounter is how and where the breast implants are placed. The placement can also affect the final appearance..

There are four commonly used methods of placing breast implants. The placements vary from being underneath, below or against the pectoralis muscle. These methods achieve different results as well as encountering different complications.

The subpectoral technique is the most common method used in North America. It has the lowest rate of capsular contracture. The subglandular method has a higher capsular contracture rate, but is thought to produce results that are more natural in appearance. This method also might show ripples or wrinkles in the implant in women with thin tissue in the placement area.

The benefits of a third method, subfascial, are still being debated. Supporters claim the method helps in sustaining the implant position. The fourth technique is called the submuscular implant. This method is commonly chosen when doing full breast reconstruction.

Your surgeon may have a preferred method, or choose it based on each individual case. He should discuss the method choices available to you before surgery is scheduled. No particular method rules out the chance of complications just as no method assures them either. And the appearance achieved by one technique may differ from person to person.

Incisions and Scaring

Surgery leaves scars. While most breast augmentation incisions do heal well, a rate of 6-7% of unfavorable scaring has been reported for primary augmentation patients in FDA clinical trials.

The extent of the scaring can be determined by many factors. These include the patient s ethnicity, smoking, tissue quality, suture material, wound tension, tissue trauma from surgery and the individual s tendency toward favorable wound healing.

The type of incision also affects the amount and visibility of scaring. The type of planned incision should be discussed with your surgeon prior to the procedure.

The most common incision for silicone gel implants is the inframammary incision. This affords maximum access for precise dissection and placement of an implant. The incision is placed below the breast in the infra-mammary fold. This incision can leave slightly more visible scars in smaller breasts which don t drape over the IMF.

Transaxillary incisions are placed in the armpit. This allows the implants to be placed without visible scars on the breasts. It s also more likely to consistently achieve symmetry of the inferior implant position.

Periareolar incisions are placed along the areolar border. The incision is usually placed around the inferior half of the areola s circumference. Because of the incision length required, silicone gel implants can be hard to place using this method. These scars are often less visible in women with lighter areolar pigment since they occur on the edge of the areola. There is a higher chance of capsular contracture with this incision.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

Repair or Revision Surgery

Breast implants don t last forever. Implant manufacturers are required to tell women that the implants they supply aren t permanent. The most common implant repair or replacement surgeries are due to the implant itself either rupturing or deflating.

Whatever type of breast implant you choose, the chances are good you ll need corrective surgery in your lifetime. The most common reason for additional surgery is complications. These could be miner or major complications which can occur after any surgery. Other things which require additional surgery include capsular constracture treatment and to repair any ripples or wrinkles in the implant that might show.

Breast reconstruction has a higher frequency of additional surgeries. Mastectcomy results in such drastic changes in the soft tissue and anatomical borders, multiple surgeries are often the only choice. It s also common for breast cancer patients to undergo several surgeries. Procedures to reconstruct the nipple-areola complex and to achieve symmetry with the remaining breast are done in planned stages

In cosmetic implants, additional surgeries can be drastically reduced by making the correct choices before surgery. Matching the size and type of implant with the patient s soft-tissue characteristics provides more successful results. These results provide the most aesthetically pleasing appearance and reduces the chances of ripples and wrinkles in the implant showing.

Choosing the breast implant that s best suited to your physical needs as well as choosing the best surgical procedure will reduce the occurrences of additional surgeries and result in the maximum satisfaction with your implants.