The risks of any surgery include, but are not limited to: infection, bleeding, scarring, the wound edges opening up, recurrence of the deformity, nerve damage and anaesthesia risks. These risks are small, but they are not zero.
There are other risks associated with Breast Augmentation surgery and some of them are listed below.
Rippling may be defined as the appearance of little undulations or waves on the surface of an implant which resembles disturbed water. This rippling is apparent on the skin’s surface and is most often noticeable at the edges of the implants. Rippling is more commonly seen in subglandular implant placement because of traction between the implant, implant capsule and the skin. It is also seen with saline implants that are under filled and the folds of the implant become visible.
There is no inherent risk of rippling, it is mainly a cosmetic problem. There may be a theoretical increased rate of implant rupture because of the folds in the implant shell, but this rate is extremely small and not considered a significant risk for breast augmentation.
Capsular contracture is defined as the “encapsulation of a breast implant by a fibrotic, contractile scar”.
All breast implants are encased by a breast capsule or scar. This is the body’s normal response to a foreign material within it. In the vast majority of cases, the capsule is quiet and does nothing to the implant. In cases of capsular contracture, the capsule contracts or shrinks, squeezing the breast implant. This can cause pain, disfigurement of the implant and quite possibly, rupture the implant.
Capsular contracture is a definite risk of breast augmentation surgery. The true rate of capsular contracture is unknown, but most Plastic Surgeons would quote a rate of around 5% or so. The exact cause of capsular contracture is not known, but some factors include bacterial contamination, silicone breast implant rupture or leakage, and hematoma or bleeding after surgery. Capsular contracture may happen again after additional surgery.
Methods which have reduced capsular contracture include submuscular implant placement, using textured implants, using saline implants, limiting handling of the implants and skin contact prior to insertion, prophylactic antibiotics, careful control of bleeding, and irrigation with antibiotic solutions.
If left in place long enough, virtually all implants will eventually break. Think of implants as similar to parts on a car – they are subject to wear and tear and eventually will wear out. Implants will eventually need to be replaced.
The real question is how long do implants last. Studies indicate that the rate of failure of saline implants is about 1% per year. So if a saline implant has been in place for 7 years, the chance of it rupturing that year is about 7%.
The rupture rates of the newer cohesive gel silicone implants is not well known simply because they are newer. One recent study indicated that the rupture rate of implants was about 1% at 6 years after implantation, which, happily, is very low. Most Plastic Surgeons would say that a silicone implant should last about 10 – 20 years in most patients under most circumstances.
Should a saline implant break, it will be immediately noticeable as the size of the breast will rapidly decrease over a few hours. A silicone implant rupture, especially a cohesive gel one, is much more difficult to diagnose and often goes unnoticed for many years. This is because the volume remains constant and the gel stays within the implant shell, even if it is broken.
Other Causes of Disfigured Breast Implants
Capsular contracture is the most common complication that can cause physical disfigurement of the breast implants. Other complications that could potentially cause the implants to look unattractive include: hematoma (bleeding around the implant), seroma (non bloody fluid surrounding the implant), infection, rippling, implant rupture, and inadequate release or dissection of the breast implant pocket.
While most of the complications listed above are rare, they can happen. They all can happen even if the Plastic Surgeon did everything properly. In fact, experienced, meticulous Plastic Surgeons may have had patients with all of the above complications. This is just the nature of surgery. Of course, Plastic Surgeons who are not as meticulous as others may tend to have higher rates of complications than more conscientious Plastic Surgeons.