Local complications may still occur following breast augmentation. Some of the most common long-term complications are implant rupture, deflation, and capsular contracture. Direct surgical complications include breast pain, altered sensation, impeded breast feeding function, visible wrinkling, asymmetry, thinning of breast tissue, and symmastia (the “fusing” of the breasts at the sternum). Because it is a surgical procedure, breast augmentation also carries risks common to any surgery, such as bleeding, infection, and scarring.
The risk of implant rupture, though small, increases with time, and is usually caused by blunt or penetrating trauma to the breast area, which can be compounded by the natural chemical degradation of the implant shell. Certain types of implants, such as saline implants, are more likely to rupture due to their thinner membranes. Saline implants are also more likely than silicone implants to deflate slowly over time. When a saline implant ruptures, it quickly deflates, spilling the harmless salt water solution into the woman’s body. It can then be readily surgically removed with minimal complication. Silicone implants usually do not immediately deflate upon rupture, making their rupture more difficult to detect. In fact, women with silicone implants are advised to monitor for “silent rupture.” Although the leaked silicone filler can migrate to other area’s of the woman’s body, it is usually limited to the breast cavity and armpit area, where it may manifest as granulomas (inflammatory nodules) or enlarged lymph glands in the armpit. In 1992, the FDA placed restrictions on the use of silicone implant devices, citing fears of silicone leakage into the body in cases of implant rupture, and declaring that their safety could not be proven. These restrictions have since been lifted; silicone implants are generally considered safe and are the preferred choice of many surgeons.
Capsular contracture is often cited as the biggest cause of implant removals
, with one study showing that contracture was the reason for 73% of implant removals. Because the body considers breast implants foreign objects, it forms a protective capsule of fibrous tissue around the implant that resembles scar tissue. Over time, this tissue can build up and harden, causing a painful tightening or squeezing of the breast implant and surrounding tissue. The severity of capsular contracture is categorized into four classes; surgical intervention is recommended for classes III and IV, or once breast distortion becomes visible. The incidence of capsular contracture is higher among women with silicone implants than among those with saline implants. Submuscular placement of implants also seems to lower the risk of contracture by about two thirds compared with subglandular placement. The cause of capsular contracture is presently unknown, but may be associated with bacterial contamination, implant rupture, filler leakage, and hematoma (bleeding outside the blood vessels e.g. bruising).
Some long-term complications can primarily affect the appearance of the breasts, such as implant displacement. Your implants may “bottom out,” which occurs when supporting tissue gives way to the implant, which can fall lower on the chest while the nipple remains high. This occurs more commonly with subglandular placement. If your breasts begin to sag naturally, you may experience a “double bubble” effect in which the sagging breast forms a second breast crease. Women whose breasts are beginning to sag naturally are typically advised to combine their breast augmentation with a breast lift. Breast rippling is another side-effect wherein the wrinkles of the breast implant can be seen through the skin. Rippling is more common with saline implants, especially among women with very little breast tissue. These women may be advised to choose silicone implants. While some of these conditions may require corrective surgery, your surgeon is highly trained to prevent them from occurring in the first place.
Infection, altered sensation, and interference with breast feeding are risks primarily associated with periareolar incisions, which are made at the border of the areola, in close proximity to the milk ducts and nerve endings of the nipples. Because of the risks involved, periareolar incisions are usually not preferred. Other surgical complications, such as asymmetry, symmastia, and thinning of breast tissue, are easily avoided in the hands of a skilled specialist surgeon, and these conditions are usually a mark of inferior work. Unfortunately, many of these issues require further surgery to correct, making it crucial to choose a highly skilled, expert surgeon the first time.