While breast augmentation is typically a predictable procedure, all surgery carries some level of risk. Complications arising from breast augmentation can include the following.
CAPSULAR CONTRACTURE
Capsular contracture, or hardening of the breast, is thought to be the most common complication of breast implant surgery. It can occur at any time but more commonly in the months immediately after surgery.
During surgery, a pocket is made for the implant in the breast tissue. After the implant has been inserted, the body naturally forms a capsule of brous tissue around the implant. This lining, or capsule, is formed by the body’s living tissue, and is the body’s natural response. The capsule allows the implant to look and feel quite natural. In some cases, however, the capsule begins to tighten, causing a shrink-wrap effect and squeezing the implant that it surrounds. Depending on the severity, the breast can feel rm or hard, become distorted and cause pain.
It is not actually the implant that has hardened – the shrinking of the capsule compresses the implant and causes it to feel hard, but if the implant is removed it is still in its original soft state.
Though the exact causes of capsular contracture are unknown, there are factors that may lead to this complication, including seroma (the development of extra uid around the implant), haematoma, infection and smoking. Another contributing factor is the placement of the implant above the chest muscle. When the implant is placed below the muscle, capsular contracture is said to be typically less likely to occur.
To treat capsular contracture, there are both surgical and non-surgical options, although generally most cases of capsular contracture will require secondary surgery to remove the implant. If the implants are replaced, to prevent reoccurrence a new pocket should be made as fresh tissue needs to be in contact with the implant.
FURTHER SURGERY
It’s important to understand that breast implants have a limited life span and, before going ahead with breast augmentation, patients must accept that more surgery may be required initially or in the future to address complications, remove or replace the implants.
Additionally, the size of the original implants may become less suited to a woman’s body over time, due to hormones, pregnancies, weight gain and menopause.
INFECTION
Infection is a serious risk of any surgery and occurs when wounds become contaminated with microorganisms, such as bacteria or fungi. When infection occurs, it generally appears within six weeks of the procedure. Most infections can be treated with antibiotics, but in the worst cases the implant may need to be removed and the infection eliminated before the implant is replaced.
It’s important to keep an eye out for signs of infection, which may include redness at the site, fatigue and fever. Increased pain and swelling are also typical signs of infection but, because these symptoms are typical of all breast surgeries, they can be difficult to detect.
RIPPLING
Rippling occurs when the lling inside the breast implant moves, creating a winkle or fold on the outer shell of the implant which then
can be felt by the patient, or which becomes outwardly visible. Rippling can also occur when adhesion to the envelope restricts its movement.
Various factors govern the likelihood of rippling, including the implant type, texture and position. It occurs less with silicone gel-filled implants, smooth-surfaced implants and those that are positioned under the chest muscle.
If it occurs, the appearance of rippling is dependent on the patient – their physique and the thickness and quality of their skin. If there is little muscle or fatty tissue to cover the implant, any rippling that results will be more noticeable. Rippling generally appears on the outer and bottom sides of the breast and in the cleavage.
IMPLANT DISPLACEMENT
Displacement refers to the implants moving out of their desired position, and is more prone in women who have teardrop-shaped or very high-pro le implants. Displacement may occur due to the implant being misplaced in the tissue pocket, or from excessively stretched tissue, or trauma. Displacement can occur at any time after the procedure, and will generally need to be surgically corrected.
INTERFERENCE WITH MAMMOGRAPHY
Depending on where the implant is placed, breast augmentation may interfere with the ability of an x-ray to ‘see’ all the breast tissue, and therefore can hinder the success of a mammogram. Women with breast implants should therefore choose a facility that has technicians experienced in obtaining reliable mammograms from those who have had breast augmentation.
Repeated studies have shown there is no delay in the diagnosis of breast cancer in women with breast implants compared to women without implants.
Women should inform technicians of the age of their implants before mammography, as the age of the implant increases the risk of rupture during mammography.
Recently, there have been media reports about a rare type of cancer linked to breast implants: anaplastic large cell carcinoma (ALCL).
Breast-implant associated ALCL is not the same as breast cancer; it is a rare type of lymphoma that develops in the uid surrounding breast implants, not in the breast tissue itself.
Current expert opinion is that the risk of contracting breast-implant associated ALCL is about one in 5,000 women with implants. By comparison, the risk of breast cancer is one in eight.
The majority of cases are cured with the removal of implants and the brous capsule around them from both breasts.
If there are changes in your breasts associated with breast implants, and especially if there is general swelling or a lump, contact your specialist for further investigation.
