Breast augmentation
Complications
Although breast augmentation is a reliable procedure a small minority of patients do experience complications.
The operation is performed under general anaesthesia and you must consider the risks of a general anaesthetic.
General operative risks
As an operative procedure there is a risk of excessive bleeding and infection. If an excessive amount of blood accumulates in the cavity surrounding the implant we will advise a return to the operating theatre to remove the blood clot and prevent its re-accumulation.
Infection is fortunately a very rare complication following breast augmentation. If infection does occur and it is not possible to control it with antibiotics it may be necessary to remove the implant.
Sensory changes in the nipple
In approximately 5% of patients there will be altered sensation in the nipple. The nipple may be more sensitive, similar to the heightened sensation in pregnancy or feeling may be reduced. Changes in sensation are usually temporary recovering over a few days or weeks but loss of feeling may be total and permanent.
Capsular contracture or hardening
When an implant is placed inside the body the body will lay down a layer of scar tissue around it. This scar tissue has the ability to contract and this capsular contracture can cause undue hardening of the breast. As the scar tissue contracts the implant is squeezed. The implant is effectively fluid filled and cannot shrink so that as more pressure occurs the implant adopts a spherical shape and becomes firmer.
Capsular contracture is usually not of significance if it just leaves the breast firmer than ideal. If capsular contracture is more severe it can cause pain and distortion of the breast. If this occurs patients usually elect to undergo revisional surgery which involves removal of the implant, release or excision of the capsule, and re-implantation.
Wrinkling of the implant shell can also occur. This is a folding of the silicone shell which can be felt as a "lump" in the breast. A "lump" due to wrinkling rapidly disappears with light pressure only to appear elsewhere in the breast. This movement may be accompanied by a popping sensation.
Reducing the risk of capsular contracture
There is increasing evidence that scar tissue production around an implant is increased in the presence of mild infection and tissue damage. To minimise the risk of capsular contracture I think it is important to adhere to any very strict regime of meticulous asepsis and delicate surgical techniques.
Strict aseptic conditions must be followed including the use of lamina flow air enclosures in the operating theatre. The nipple of each breast is isolated from the operative field with a waterproof film. Prophylactic antibiotics are given during surgery.
The tissue should be dissected carefully and not torn when creating the space for the implant. Meticulous attention to stop bleeding should also be undertaken to reduce the accumulation of fluid around the implant and drains are left in the wound to remove any remaining fluid.
Textured implants are used and have been shown to significantly reduce the incidence of capsular contracture.
Breast cancer
There is no detrimental change in the incidence of breast cancer in those patients who have breast implants. Some studies actually show that the incidence of breast cancer is lower in patients who have been augmented which is probably an effect of selection rather then a protective effect of the implant.
Mammograms
An implant throws a shadow on the breast when a mammogram is taken. At the age of 50 you will be contacted and entered into the National Breast Cancer Screening Programme with regular mammograms. Providing you tell the radiographer that you have implants further views can be taken to maximise the volume of breast tissue imaged. Unfortunately because of the technique of mammography not all the breast will be imaged when the implant is in place but this does not appear to have a clinical significance in the outcome of breast cancer.
The presence of an implant does not impair palpation of the breast tissue, ultrasound scans, or MRI scans.
Rotation of the implant
Rotation of a shaped implant can occur causing abnormal distortion of the breast. It is probably due to the implant being placed in too large a cavity and not being stabilised adequately in the immediate post-operative phase.
Safety of silicone
As you may be aware there have been major concerns about the safety of silicone. Silicone rubber and silicone gel are derived from the mineral silica which is the commonest element on our planet. Concerns about the safety of silicone led to the withdrawal of silicone filled implants from the market in the United States in the early 1990s. Following extensive research no causal link has been found between silicone and a variety of diseases that were claimed to be caused by the leakage of silicone. The regulatory authorities in the United States are now allowing the use of silicone filled implants under carefully controlled conditions. The regulatory authorities in the United Kingdom did not feel that it was necessary to withdraw the implants and this decision has been justified in the light of today's knowledge. Withdrawing the implants would have denied many women the benefits of silicone implants, particularly when they are used from breast reconstruction. Silicone can now be considered to be entirely safe as a material.
This does not mean that silicone implants are entirely safe but the risks are related to the operation and the presence of a non-biological device rather than due to any “toxicity” of silicone.
Implant rupture
Silicone is a very durable material and does not degenerate significantly over the time of a human lifespan. Implants are, however, manmade devices and there is a rupture rate. The risk of a rupture is very small (around 1 - 2%).
If rupture does occur you will notice a change in shape of your breast. You will no doubt want the implant replaced but this is not a surgical emergency as you will not come to any harm if the implant is left ruptured for even a few months.
As we move about the silicone is continually undergoing a modest degree of flexion and movement. This process may eventually cause rupture but laboratory testing of the implants with simulated wear patterns has suggested that the average implant will outlive its recipient. However as manmade devices there is a failure rate which is the cause of implant rupture.
If an implant does rupture there may be some migration of silicone. This can cause a local inflammatory reaction, which can be uncomfortable but is not dangerous. If you are particularly concerned about the implications of the leakage of silicone a cohesive gel implant may be the better option for you, as in the unlikely event that this implant ruptures the solid silicone does not leak.
Breast massage
This used to be advised for patients following breast augmentation surgery but we would now advise against this to allow a good bond to develop between the implant and your body. To help the prevention of capsular contracture the use of a textured surfaced implant reduces the incidence of capsular contracture by influencing the structure of the scar tissue capsule that the body will form around the implant. The exact mechanism of this is not well understood at the moment.
Lifespan of an implant
Implants are durable and long lasting. If an implant is performing well and maintaining good shape there is no justifiable reason for changing it. The risk of surgery to change the implant after some years is greater than leaving the implant in place until or if a problem occurs.
Institutions that recommend change after 10 or 15 years are gaining significant financial benefit from doing a procedure that is not required and has significant risk.
