How often do complications occur after breast augmentation? Introduction Each time you decide or need to go through an operation, you always wonder “what if something happens to me?” Going through a surgery, no matter how easy or difficult, is always a bit scary for everyone, starting from the anesthesia and its possible side effects to all sorts of improbable complications. When you decide to have an elective surgery, there is also the aesthetic aspect that adds to all your worries apart from your own health. After all, your appearance is the one that made you decide to take this step in the first place. Breasts are one of the most important symbols of femininity that society recognizes. Women all over the world are faced daily with round, perfect breasts on magazines and TV, so no wonder some feel totally insecure when it comes to their own boobs. Instead of feeling sorry for themselves or dwell in a state of insecurity and lack of confidence, many women choose breast implants to correct, enhance, boost the way their breasts look, and be able to be happy and good in their own skin. Between deciding to get a surgery and actually undergoing it there is some time in between when you’ll have doubts and worries. And probably the closer to your surgery date, the more scared you’ll feel thinking of possible complications. The truth is that breast augmentation is the most common plastic surgery, performed daily all over the world. You could say it is like the appendectomy of plastic surgery. Also, complications do not occur that often and they are almost always linked to your surgeon’s skill and to your previous health issues. But let’s see what the possible complications are, what can trigger them, and how often they really occur. Capsular contracture This is one of the most common complications that can occur after the surgery. It can be visible one month from the operation, but more often than ever, the first signs appear only after three months from the surgery. Capsular contracture is in fact an exaggerated response of the immune system to the presence of implants as foreign objects in the body. A capsule of scar tissue is formed around any kind of implant. The body detects a foreign object inside it, and it protects itself by generating this scar tissue. Usually, this is helpful to the healing process because it helps the implants to stay in place and not move around. Still, there are some people that will develop a very thick scar tissue, and that is what doctors call capsular contracture. This can be a painless and unproblematic thing, but it can also lead to very painful breasts and/or deformation of implants and therefore an unaesthetic look of the breasts. Statistics say that one in six people going through breast augmentation surgery will develop a type of capsular contracture. Depending on the degree of capsular contracture, the surgeon might recommend nothing at all, or he might advise you on having a new operation to remove the scar tissue and put new implants. There is Grade 1 of capsular contracture that does not interfere with the shape or size of the implant and produces no visible issues, but only at Grade 3 capsular contracture do the symptoms become evident. At Grade 4 the breasts are extremely hard to the touch and they have changed their shape, move forward or upward, and they become painful. Both Grades 3 and 4 will require intervention from your plastic surgeon. Until recently there has been only one way to treat this complication: revision surgery. The doctor will have to remove the implants, let the scars heal or administer antibiotics in case of an infection, and then after some months, he will be able to put the implants back in again. It is complicated and it is another surgery, so it can lead to the same complications or even worse than before. In recent years, a new treatment method has been developed for Grade 3 capsular contracture: Aspen therapy. This method of treatment uses a device called an Aspen harmonizer that delivers controlled sound waves to the breasts, thus creating more collagen and increasing the elasticity of the scar tissue. There is a big debate regarding what causes capsular contracture. Some doctors believe that it is just a hereditary factor involved, meaning that there are some people who tend to develop thick scar tissue after surgery while some don’t. Lately, research has linked the occurrence of this complication to the formation of a thin layer of bacteria called “biofilm” that forms around the implant. This is just a minor infection, so it will not be accompanied by a fever or any other symptoms of infection. Therefore, most doctors will prescribe antibiotics together with any other treatment of capsular contracture. There is no definite way to avoid capsular contracture, but there are some recommended measures to reduce the risk to a minimum: – Massaging the breasts after the surgery can improve the elasticity of the tissue; – Manipulating the implants to a minimum to prevent the risk of the biofilm forming; – Placing the implants under the muscle; – Choosing a good implant size suited to your body type and previous breasts dimensions; bigger implants for people who have naturally small breasts will result in the incapacity of the tissue to sustain the weight and will probably lead to capsular contracture, if not more complications. The good news is that even if capsular contracture is the most common complication of breast augmentation surgery, it only occurs with a frequency of 1.9% to 2.3%, so the chance of you getting it is very low. Implant rupture Implant rupture can occur at any time from the moment of the surgery. For some, it happens just a few weeks after the surgery, but for the most people, rupture occurs after year. Some say that the life of a silicone implant is usually 10 to 15 years, and after this time you can always experience a rupture. With saline implants, studies have shown that rupture can occur even earlier, mostly in the first 10 years after the implants are inserted. According to the Archives of Plastic Surgery published on the PMC website, 3% to 5% of ruptures of saline implants have occurred in the first 3 years from the surgery, and 7% to 10% have been reported happening in the course of 10 years after the operation. Saline implants are silicone shells filled with sterile saline water. Being just water, after all, the patient can immediately notice when an implant tears because the affected breast will be deflated and will have less volume. Therefore, it is very easy to notice such a change and go to the doctor. The doctor will probably change the shell and fill it up with saline water again. This is an important advantage of saline implants, but there is more than one. Water is not toxic in any way and is very fluid, so it will be absorbed by your body with no harm. A silicone implant rupture poses more problems. There are two kind of ruptures in this case: intracapsular and extracapsular. An intracapsular one poses no risks because it means that the implant shell is torn but the gel stays within the capsule formed around the implant, so it will not spread. An extracapsular one is tricky because the gel will leak from the shell into your body. The silicone gel can get to your lungs or lymph nodes in extreme situations. Also, even if years of study have shown that silicone implants are safe to use, silicone is still a chemical substance. The trouble with silicone implants is that silicone is such a cohesive substance that you or your doctor might not notice the leak. Some persons experience symptoms like lumps or soreness, while others do not experience any kind of symptom, called a “silent” rupture. Doctors recommend an MRI for patients with silicone implants once every two years to see if anything happens. Implant rippling Another possible complication is implant rippling. This is something that doesn’t happen often, and it means that the implants make a ripple, a wrinkle, or a fold under the tissue that is covering it. This is usually evident and does not look very good. There are several reasons why this rippling might appear, such as: – Saline implants. Rippling can occur with these implants because they are not pre-filled with water. They come as shells and are inserted as such into the breast pockets. Only then will the doctor fill them up with sterile solution. If they are underfilled or overfilled, chances are they will wrinkle or fold due to too much or too little tissue left to cover it. – Placement of the implant. Implants placed above the muscle have a higher chance of developing a visible wrinkle or fold. For those placed under the muscle, the rippling will not be visible even if it occurs. – Size of the implant. If the implant is too big for your body type, then your chances are higher to develop implant rippling. That is because there will not be enough tissue to hold and cover the implant. Conclusion Apart from all the above complications that are the most common but still occur in small percentages, there are of course other ones such as infection, symmastia (“uniboob”), auto-immune diseases, and even a rare type of cancer called Anaplastic Large Cell Lymphoma. The most important way to sure your surgery will be a success without any complication of any kind is to choose a good and experienced doctor. Read about some of the best, go and see several options, talk to them and ask all the questions, and only decide when you have that undeniable feeling that that one doctor is right for you. There is no one in the world that will be able to guarantee your operation will be 100% successful because that is just not possible, so run from any doctor that says this.