Posted on Jun 22, 2024 in Breast augmentation, Complications
Not surprisingly, breast augmentation surgery has been among the top plastic surgery procedures sought after by women for decades and for quite obvious reasons. It also has among the highest satisfaction rates of all cosmetic procedures as expressed by those who have undergone the procedure.
The results are often outstanding and with immediate physical and psychological benefits.
You can look far more attractive, alluring, shapely and balanced. Even the mundane issues of finding clothes that fit and that are complimentary to your appearance are positively affected by this procedure.
As regards the psychological impact of a breast enlargement on a woman’s emotional and mental well-being, this absolutely should not be underestimated. The results of the procedure can be greater self-confidence and assuredness, improved sense of femininity and attractiveness, wider social interactions and more confidence in sexual related issues.
However, like virtually everything in life, there are also risks and downside issues that can be associated with a breast enlargement.
It is not all the Garden of Eden minus the apple. Or snake.
But close!
Is a Breast Enlargement a Safe Procedure?
A breast augmentation is unequivocally a “safe” procedure for most women seeking to have it done. Of course, safe is a relative term as there are always risks associated with most things in life.
When performed in an appropriate setting by a competent surgeon and anesthesiologist (or anesthetist), life threatening issues are close to a zero risk.
Are There Risks Associated with a Breast Augmentation?
Any surgical procedure, major or minor, has associated risks though these may largely be inconsequential or temporary versus life threatening. There are patient associated factors such as health, nutrition, genetics, compliance, smoking, age, etc. and there are physician related issues. Outside random factors can also be impactful.
Of course, risks are an intrinsic part of our everyday life in many of the things we do or are exposed to. Like:
Driving or being a passenger in a car.
Getting injured playing sports or engaging in physical activities including exercising.
Eating or tasting a very hot chili pepper or buying one of those hot dogs at a gas station because you just have to have one.
Crossing a street.
Going to a bar.
Marriage.
And so forth.
There are always attendant risks and issues and they have to be put into proper perspective otherwise we could not function in our lives.
A breast augmentation is no exception.
Specific Risks and Issues for a Breast Augmentation
The following encompass the vast majority of untoward issues, some extremely rare, that have been associated with a breast enlargement.
Size Issues – Too Large or Too Small
A not very rare issue with breast augmentation is ending up with a size that is bigger or smaller than you had wanted or thought that you had wanted. There are several reasons for this including:
- You may have desired a particular size but were not completely satisfied when you got what you asked for.
- You may not have expressed exactly what you wanted to your plastic surgeon who delivered what you had asked for.
- Over time, you tastes have changed or you have gained/lost weight so your breast size is either too big or not big enough now.
- Your surgeon did not give you the general size that you had wanted.
Addressing the issue of size can be accomplished with either an implant exchange or an explantation.
Capsular Contracture
This is the development of scar tissue around the implants which thickens, tightens and squeezes them which can result in a visual deformity and hardness. There is a spectrum of severity – from very mild (slightly less than naturally soft) to severe (very hard, deforming and painful).
Various options and treatments are available depending upon the degree of capsular contracture, symptoms and patient preferences.
Asymmetries
A woman’s breasts are rarely symmetrical. It is commonly stated that they are sisters, not identical twins. Therefore, they should not be expected to be identical appearing following breast augmentation surgery. In many situations, a significant asymmetry can be addressed by the procedure to reduce the difference.
On the other hand, if the difference is substantially greater after surgery, that is not a desired outcome.
Implant malposition
This is where one or both implants are not placed in the exact desired location as relates to the breast and the chest wall or to each other. The implant can be placed too high, too low, too close to the midline, too far out to the side or asymmetrically.
Implant displacement
This is where the implant, whether early in the postoperative period or at any time later on, “migrates” from its initial location to a less desirable one – often lower down on the chest wall or out to the side. There are several reasons that this can occur. Fortunately, this is a correctable problem.
Poor Surgical Technique and/or Decision Making or Random
There can be poor or even just less desirable outcomes from breast augmentation surgery that are directly related to the surgeon. This can pertain to surgical technique, skill level, errors in judgement, non-ideal decision making or other random causes.
Sometimes things happen for whatever reason.
To minimize the likelihood that this can be a significant factor, you should always seek a reputable plastic surgeon who is board certified by the American Board of Plastic Surgery.
And one more thing – don’t go south of the border or to some other country because the prices seem to be cheaper. The ultimate costs, on many levels, may be far greater than you had ever anticipated – including your life.
Anesthetic issues
Major anesthetic issues are extremely rare in breast augmentation surgery especially when done on a relatively healthy individual by a competent anesthesiologist or anesthetist and in a specially certified facility.
Implant rupture
Breast implants, whether silicone or saline, are not permanent devices that will last forever, relatively speaking. Given enough time, they ultimately will need to be replaced or removed. Though some may only last for 10 years or less, there are others that will last up to 30 – 40 years.
Bleeding/hematoma
Bleeding, resulting in a hematoma (accumulation of blood outside of the blood vessels), most commonly occur immediately following surgery and in the first few postoperative days. It can occur anytime thereafter, for a variety of reasons including in engaging in inappropriate activities, but most commonly up to 6 – 8 weeks following surgery.
The risk of this occurring is very low – around 1% to 2%.
Seroma
This is where fluid accumulates around the breast implants following surgery. Though quite rare, this needs to be addressed and the underlying cause determined.
Infection
When performed appropriately and with proper sterile technique, the occurrence of infection in a breast augmentation is extremely rare.
Loss of nipple-areola complex sensation
When done with proper technique, it is very rare to lose total sensation of the nipple-areola complexes. There can be some loss of sensation that can be permanent.
This occurs more commonly when the implants are placed in a submammary pocket (above the muscle) and when the infra-areola incision is used for implant insertion.
Impact on the ability to breast feed
Theoretically, breast augmentation surgery can impact on the ability to breast feed. However, when the inframammary and transaxillary implant insertion approaches are employed, this is effectively zero. The infra-areolar technique is more likely to impact this.
Rippling of skin
Rippling of the skin is most likely to be seen in individuals with extremely thin skin, especially when the implants are placed above the muscle and more so, when saline implants are used.
Palpability of the implants
Breast implants are more likely to be felt in individuals with thin skin and when they are placed above the chest wall muscle. Because saline breast implants do not simulate the feel of breast tissue very well and are much less natural feeling than silicone ones, they are far more likely to be felt as compared to silicone ones.
Implant exposure/implant extrusion
Skin breakdown in the breast can result in exposure or extrusion of breast implants. If this does occur, the implants will need to be removed and rarely can be salvaged. More commonly occurring in the early postoperative period, the underlying causes can include infection, smoking, vaping, application of heat or cold to the skin, trauma, wound healing issues, diabetes, compromised would closure, patient non-compliance, extremely large hematoma and massive, inappropriately sized implants for the anatomy.
Wound separation
Many of the same issues that can cause implant exposure/implant extrusion can result in wound separation. Poor nutrition, especially a diet deficient in protein, and engaging in inadvisable physical activities early on, are additional causes.
Vegans or vegetarians are at a much higher risk of experiencing this problem
Animation deformity
Animation deformity is when there is deformation of the implants when the pectoralis major muscle (chest wall muscle) contracts on the underlying breast implants during activities. The effect is manifest by the abnormal movements and distortions of the breasts.
This issue does not occur when breast implants are placed above the muscle.
Wide scars
The vast majority of scars resulting from breast augmentation surgery are narrow and largely inconspicuous. However, there is a risk that wide scars can develop.
In such situations, a scar revision can be considered to try to correct the situation.
Thick scars
The development of thick scars following a breast augmentation is fairly uncommon. However, certain individuals have a higher risk for this to occur. As above, if this occurs, a scar revision can be considered.
Pain
Aside from breast pain that can develop as the result of capsular contracture, the presence of chronic pain in one’s breasts is rare. Treatment may be an explantation.
Need for additional procedures
Rarely is a breast enlargement a one and done procedure – for many reasons as stated above. For example, given enough time and the fact that breast implants do not last “forever”, breast revision surgery may be required either for an implant exchange or explantation.
Contour irregularities
Irregularities of breast contour can be present immediately after surgery for several reasons. They can also develop over time.
Thinning of the skin
Though often avoidable, thinning of the skin can be the consequence of having disproportionately large breast implants placed above the muscle – especially in individuals with poor skin quality or who already having thin skin.
Skin stretching
The same causes of thinning of the breast skin can also lead to skin stretching and, ultimately, to breast drooping (ptosis).
Breast drooping
There are many causes of breast drooping including substantial weight fluctuations, gravity, health, pregnancy, not wearing a bra and, as state above, the placement of extremely large implants in a submammary pocket.
Breast implant illness (BII)
This is a constellation of various symptoms experienced by some women who have had a breast augmentation. They attribute their symptoms to their breast implants. Over 100 symptoms have been claimed including fatigue, brain fog, impairment of memory and irritability.
BIA-ALCL
This is an extremely rare type of lymphoma that has been largely associated with a certain type of textured surfaced breast implants. It has also occurred in individuals with dental or orthopedic implants.
Well, there you have it. A thorough list of issues to consider when you are contemplating breast augmentation surgery.
Your Consultation
If you would like more information on a breast augmentation, a mastopexy augmentation or any other cosmetic procedure or to schedule a consultation with me, Dr. Steven Turkeltaub, please feel free to either call the Arizona Center for Aesthetic Plastic Surgery at (480) 451-3000 or to contact us by email.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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