Breast Augmentation Complications And Risks

If you are considering a breast augmentation, it’s important to educate yourself on safety and risks associated with the procedure. Similarly, it’s critical to dispel some common myths associated with undergoing a breast augmentation, so you can cut through the noise and make the best decision possible. With this in mind, let’s run through some breast augmentation risks and complications below:

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What are some of breast augmentation risks & complications?

Asymmetry

Very few women have completely symmetrical breasts to begin with. Most women have slight differences in either size or shape. Therefore, if your breasts are asymmetric before a surgery, they may also be asymmetric afterward. While this isn’t a complication, a worsened asymmetry might be. The rate of asymmetry after breast augmentation is just 3.3%. 

Common reasons for an asymmetrical breast augmentation include:

• An implant pocket that is made asymmetrically between the two sides, preventing the implants from sitting in the optimal position. 
• Failure of one or both breast implants to settle into place properly during healing.

If the asymmetry is detracting from the final result, correction surgery may be necessary to achieve the correct appearance. 

Pain Post-Breast Augmentation 

According to Allergan, the risk of pain after a break augmentation is 11.5%, although this statistic is difficult to interpret accurately. The significance depends on the duration of pain post-surgery, because almost everyone experiences pain immediately after surgery, typically lasting a week or longer. The other factor that complicates this statistic is how much pain the patient is experiencing, as various degrees of pain are often subjective. For example, occasional nerve twinges are very common, and differ significantly from someone who is experiencing severe and ongoing pain in one or both breasts. 

At RSPS, we’ve found it extremely rare to have patients complain of significant breast pain after surgery. However, breast implant revision patients sometimes complain of pain, tenderness, or tightness, which can be the result of a capsule contracture or the position of the implant. Generally, replacing the breast implants can help, although pinpointing the source of pain can be difficult. 

Skin Sensation Change

Skin sensation change occurs when an area of the breast is numb or an increased or decreased sensation occurs. This may be as a result of cutting nerves or stretching nerves during the input of breast implants. The skin sensation change almost always disappears with time, and long-term noticeable skin sensation change is extremely rare. 

Hematoma/ Bleeding

Following a breast augmentation procedure, bleeding can come from the skin edges of the incisions, which is minor and stops on its own. Bleeding within the implant pocket can cause a blood collection called a hematoma. Most hematomas are small and go away on their own, but some may need to be removed by surgery.

Hematomas are typically easy to spot. The affected breast is usually bigger, more bruised and painful. Hematomas are treated in the operating room where we open the incisions, temporarily remove the implant, wash out the blood clot, and stop any ongoing bleeding. We then replace the implant and close the incision.

Scarring

Scarring is a normal part of breast augmentation surgery. However, scarring as a complication is known as hypertrophic scarring, a thick raised scar that's an abnormal response to wound healing. According to Allergan, the rate of  hypertrophic scarring for breast augmentation is 4.2%. However, at RSPS, our patient experience is significantly lower than this rate, with our clients rarely reporting hypertrophic scarring following a  breast augmentation.

Malposition

Malposition occurs when one or both implants end up in the incorrect position. Usually, malposition will also result in asymmetry. To fix malposition, a plastic surgeon surgically moves the implant into the correct position.

Infection 

Infection is an extremely rare breast augmentation risk, with rates being a fraction of a percentage. In the rare cases that infection occurs, it generally is a staph infection, the most common form of bacteria. In most cases, antibiotics can cure the infection, and in rare cases when the implant is infected, it may need to be temporarily removed.

Seroma

Seroma is a build up of clear yellow tissue fluid around the implant pocket. Seromas are rare following breast augmentation.

Most commonly, a seroma is caused by a pulling away of the implant from the scar capsule surrounding it, creating a double capsule. A double capsule refers to the two capsular layers, separated by an intracapsular space (ICS), around an implant. However, it’s important to note that double capsules occur with textured breast implants, and smooth breast implants are not associated with a double capsule.

Seromas can be drained via a needle under ultrasound guidance, or via a small drain. A very rare cause of late seromas is Anaplastic Large Cell Lymphoma (ALCL). Fluid drained from late seromas should always be tested for CD30, a marker found in ALCL.

Capsular Contracture

The formation of a scar capsule around breast implants is a normal part of the healing process. The body does this with any implanted device. In the case of capsular contracture, a build up and tightening of scar tissue takes place. This can deform the breast implant and move it out of its original position, resulting in an abnormally shaped or unusually hard breast. This type of scar capsule will need to be surgically removed. The involved breast implant is usually replaced at the same time. The national rate of capsular contracture after breast augmentation is 18.9%, however, this varies largely from surgeon to surgeon. Our capsular contracture rate at RSPS is approximately 0.25 percent.

Breastfeeding Difficulties

A breast augmentation can make it difficult to breastfeed later on, but this mainly depends on the surgeon's placement of the incision. If the incision is around the areola, your surgeon will have to cut down through the breast tissue to make the implant pocket and will interrupt some milk ducts. This can cause problems with breastfeeding later on. However, even with this incision, there should be many milk ducts left, and breastfeeding should proceed without difficulties.

If your surgeon uses the incision in the underarm or underneath the breast (the incision we usually recommend), they will barely come in contact with the breast tissue, and no milk ducts will be cut. With this incision, there should be no impact on your ability to breastfeed.

ALCL 

Anaplastic large cell lymphoma is a very rare immune system cancer that seems to occur more frequently in women who have breast implants. ALCL is only proven to occur in women with textured surface breast implants. It may possibly form in women who have smooth-shelled implants, though there isn't much evidence to support this.

ALCL might be caused by bacterial contamination of the breast implants, either at the time of placement or after. It usually occurs years after surgery and will present as a gradual swelling of the affected breast. If you have breast implants, and experience late swelling of one of your breasts, you should notify your surgeon. Although ALCL isn’t the likely cause, it's important to have the fluid removed and tested for a marker called CD30 that diagnoses ALCL.

Please remember that a LCL is extremely rare. There have been fewer than 1000 cases reported (as of September 2022) since the 1960s versus tens - and possibly hundreds - of millions of breast implants placed. It is treated by removing the breast implant and the surrounding scar capsule. This is almost always curative.

Connective Tissue Disease

In the late 1980s and early 1990s, there was a growing concern that silicone gel breast implants, particularly when ruptured, gave women autoimmune connective tissue diseases like Lupus and Scleroderma. In 1993, silicone implathe FDA removed silicone gel implants from the market for study. Huge epidemiologic studies were conducted between 1993 and 2006, when the FDA re-released silicone gel breast implants.

These studies measured rates of diseases in large groups of women with and without silicone gel breast implants. All the illnesses occurred with the same frequency whether the women had silicone gel implants or not. So the women who got connective tissue diseases were simply going to get them even if they didn’t have breast implants.. 

This data has held up since the re-release of silicone gel implants in 2006, and there remains to date no compelling evidence that breast implants cause connective tissue disease. 

Breast Implant Illness

There are several online communities of women who do not have a diagnosis of a connective tissue disease, but have symptoms associated with them. This can include muscle and joint pain, headaches, confusion, and chronic fatigue. A lot of these women don't have the necessary criteria to be diagnosed with a connective tissue disease, but they feel their symptoms are caused by their breast implants. At the moment, there is no scientific data to support this.

I have treated women with these symptoms by removing the implants at their request. And, in some cases the symptoms have resolved, or at least improved. This is just anecdotal information and not a scientific study, but it does occasionally happen.

Re-Operation

Although a re-operation isn't a complication in itself, it is often the response needed to treat complications.

According to Allergan, the re-operation rate is 36.1%. However, this data is difficult to interpret because it includes re-operation on implant ruptures, which isn’t a complication but a known predictable event in the lifecycle of a breast implant. Other re-operation reasons include hematoma, seroma, infection, capsular contracture, and malposition of implants. 

The rate also varies from clinic to clinic. At RSPS, our re-operation rate over 24 years and approximately 4,000 augmentations and/or breast implant revisions is less than 1%.

Serious Complications and Risks

The risks of any surgery include death, major allergic reaction, heart attack, or stroke. These occur extremely infrequently in cosmetic surgery. In the most recent study,  the mortality rate for outpatient cosmetic surgery is 0.25–0.50 per 100,000 procedures.

Conclusion

At RSPS, breast augmentation safety is our top priority for all clients undergoing the procedure. Although, like all other surgeries, complications from breast implant surgery do arise, it’s important to remember the infrequency of such risks, as well as educating yourself on some more common risks and complications. If you would like to learn more about breast augmentation safety at RSPS, please reach out to us. 

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Read our article about the top ten tips for breast augmentation recovery! Also don't forget to read how painful breast augmenation is.

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