Why discuss the risks of breast surgery?
It is our responsibility to inform you of the details of the procedure you are considering, the alternatives to the procedure and the risks associated with the procedure. With that accomplished you can then make an informed decision about having surgery and determine if the risks are acceptable to you and if the benefits of surgery outweigh the risks.
Will I benefit from understanding the risks of breast surgery?
Absolutely. Once you understand the risks and benefits of surgery you can then proceed with confidence. Well informed patients are the best patients and tend to have more peace of mind throughout their surgical experience. Informed patients are also better prepared to calmly deal with problems with their breasts after surgery, if they occur.
Why don't most websites talk about risk as much as this website?
In some cases, websites are designed to basically glamorize and sell surgical procedures. In that setting, risks are often downplayed or ignored completely. We greatly respect our patients' intelligence and take a straightforward, honest and candid approach in everything we do, including with the content of this website and the discussions of risks.
Is breast surgery risky?
Life is full of risks. Indeed, any activity we do has some risk associated with it. Driving around town, taking a long distance vacation by car, bicycle riding, snowboarding, fitness training, drinking alcohol, routine medical procedures, and pregnancy are just a few common activities that women undertake without much concern with the risks involved. But, these activities all have risks associated with them. All surgery, including breast surgery, has risks. It is our goal to minimize your risks as much as possible to make the decision to proceed with surgery a reasonable one and in balance with other medical and non-medical risks you may take on a during your life.
How are risks communicated to me?
We use a number of methods to educate you about your procedure and the associated risks. First, we provide you with this website as a resource which has a lot of direct content and links to many informative documents and websites. Two, we provide you with an on-line tutorial called Emmi. Emmi will review the procedure and risks using clear and simple language and illustrations. Three, we provide you with written literature on your procedure. Four, we provide highly detailed discussions about your procedure and risks during your consultation and pre-operative visits with Dr. Connall and our staff. Five, we provide detailed informed consent documents for you to review and consider before your pre-operative visit.
How are risks minimized?
We are vigilant in minimizing risks at every turn. Our practice and surgical culture are built around making your safety and risk management our number one priority.
Is this section a comprehensive review of all risks of surgery?
What is capsular contracture?
Capsular contracture is when the scar tissue or soft tissue "capsule" that normally forms around the implant tightens and squeezes the breast implant. Capsular contracture is more common following infection, hematoma (bleeding and blood clot formation around the implant), and seroma (fluid around the implant). Symptoms range from firmness and mild discomfort to pain, distortion of the breast, palpability of the implant, and/or displacement of the implant.
Breast implant capsular contracture
This is an example of capsular contracture. The breast on the right is smaller, tighter and porly shaped compared to the normal augmented breast on the left.
Does a capsular contracture require treatment?
Not necessarily. Some capsular contractures are mild and only cause slight firmness of the breast. In such cases, some women elect not to undergo additional surgery for treatment of the contracture. Additional surgery is needed in cases where firmness and/or pain are severe. Surgical treatment ranges from opening the space around the implant and making cuts in the scar capsule (capsulotomy) to removal of the scar capsule tissue (capsulectomy) and possibly replacement of the implant. Capsular contracture may happen again even after these corrective surgeries.
Can breast implants break?
Yes. Since the devices are not considered lifetime devices, you must assume your implant(s) will break at some point.
How long do breast implants last?
This is a difficult question to give a simple answer to and it is best to refer to the detailed information provided by each implant manufacturer, as the data varies depending on implant type and manufacturer. Generally, saline implants likely have about a 10% failure rate at 10 years, and a 1-2% per year failure rate thereafter. Silicone gel implants have about an 8% failure rate at 12 years.
What if a saline breast implant ruptures?
Occasionally, saline breast implants may break or leak. Rupture can occur as a result of the normal compression and movement of your breasts and implants, causing the shell to break. An implant certainly moves a lot during your lifetime, and any man-made device can fail if it is under prolonged stress and movement. Even while you are resting, your implants continue to move from your breathing and heart beating! As an example, consider the fate of a piece of metal if it is bent a lot, such as a paper clip that you bend many times-It will eventually break. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be absorbed by the body. The leaking salt water is not harmful.
What causes a breast implant to break?
Breast implants are man-made devices that are subject to a lot of movement and stress simply from the ordinary activities of a woman's life. Implant failure occurs from fatigue and eventual breakage of part of the implant shell. Locations of failure include: a leak at the fill valve (for saline implants), a hole at the patch on the back of an implant, or a tear or hole in the implant shell itself. Although your implants may last a long time, they are not lifetime devices, and it is best to plan that you will need an implant exchange at some point in your life.
Can a silicone gel breast implant leak?
Just like the shell of a saline implant, the shell of a silicone gel implant can also fail. The silicone in current silicone gel implants is very thick, similar to Jell-O. Therefore, when a silicone gel implant leaks, it will usually bulge at the location of the shell failure. If a large part of the shell has failed then a large part of the gel can extrude and the implant will lose its shape and a large part of the soft tissue capsule can become contaminated with silicone gel.
What is breast implant malposition?
This is when the breast implants do not settle into a good, aesthetic position. In some cases, implants are too high on the chest. In such cases, the upper breast fullness is excessive and the nipples sit too low on the implants. In some cases, implants are too low on the chest and the nipples are too high on the implants. Sometimes implant malposition is only on one side, leading to an imbalance in implant position and breast shape between the breasts.
Can poor breast implant position be corrected?
Yes, usually. To do so, additional surgery is needed to reposition the implant(s).
What is "bottoming out"?
Two situations are commonly referred to as bottoming out. In one case, the implant settles at the normal base of the breast, but the skin below the areola expands greatly. In this setting, the lower pole of the breast will be too full and the distance from the nipple to the base of the breast will be long and the nipples will appear too high on the implant. In the second case, the implants settle below the natural base of the breast (the inframammary fold) and, again, the lower pole of the breast will be excessive and the nipples will be high on the implant.
How can bottoming out be corrected?
This is a difficult problem to correct. In some cases surgery can be useful to elevate the inframammary fold with sutures. This approach can lead to a higher and more appropriate position of the implants.
What is breast implant visibility?
There are two basic types of implant visibility. One is when the ripples of the implants can be seen through the skin. Two, is when the edges of the implants can be seen or they dominate or define the shape of the breasts.
What is breast implant "rippling"?
Rippling is a term to describe visibility of the implant ripples. All breast implant shells have some ripples at the edges. In some cases (especially in patients with thin skin and soft tissues) the implant edges can be seen by deforming the skin in a rippling pattern. These look like wide wrinkles or waves in the skin. Rippling is most common at the outer part of the breasts, where the soft tissues are thinnest, but it can occur anywhere.
Breast Implant ripples at the side of the breast
This photo shows fine irregularities in the skin at the outside of the breast. These ripples, or waves, in the skin are from the deformation caused by the ripples in the breast implant shell. This patient is very thin and understood that such ripples would occur.
How is rippling avoided?
All breast implants can lead to rippling. However, in most cases the risk of rippling can be limited by proper planning. The key to avoiding rippling is to ensure that adequate soft tissue thickness exists to cover the implants. A great way to achieve greater coverage of the implants is to place the implants under the pectoralis major muscle. Another key is to select implants that are appropriately sized for the individual patient's size and soft tissue characteristics. Very large implants are more likely to ripple than small implants because they push and stretch the soft tissues.
How is breast implant edge visibility avoided?
The keys to having a natural appearing augmentation are: one, ensuring optimal soft tissue padding over the implants. Two, sizing the implants to fit the dimensions of the breasts. If these goals are achieved then implant edge visibility will be minimized, but not necessarily eliminated.
Do all patient wish to avoid breast implant edge visibility?
No. Some patients desire an "augmented" look where the round, bubble-like edges of the implants are seen and define the shape of the breasts.
What is breast implant palpability?
This is when the implants, especially the implant shells can be felt.
Is breast implant palpability common?
Yes. Most saline implant shells can be felt through the skin during self breast exams and in intimate encounters. Silicone gel implant shells are softer and often are not easily felt.
What is an implant infection?
Breast implants can become infected. This most often occurs in the first few weeks after surgery. This is an uncommon complication. Though rare, an implant can also become infected at anytime in a woman's life.
How is a breast implant infection treated?
Some infections may respond to antibiotics, but in most cases the implant must be removed. Once removed, about 3-6 months must pass before an implant can be replaced.
How is the risk of implant infection minimized?
As with all risks, we are vigilant to do everything we can to minimize infection after surgery. Pre-operative surgical scrub soap is prescribed for you to use at home the day before and the day of surgery, we use appropriate antibiotics, and we use meticulous sterile surgical technique.
What is the risk of poor scarring?
Plastic surgery leaves scars. It is our goal to minimize the visibility of those scars. All patients are at risk for having unfavorable scars. However, most augmentation patients have fine scars and they are generally not troubled by them. Mastopexy and breast reduction patients have more extensive scarring. Usually, the resulting scars are acceptable to patients. But, sometimes the scars do thicken and widen and they are bothersome to patients.
Can nipple sensation be lost with breast surgery?
Yes. But, overall the incidence of permanent loss of sensation is low.
What are axillary scar bands?
Axillary scar bands can occur after axillary breast augmentation. The connective tissue and the lymphatic vessels in the underarm and upper arm can get tethered in the early deep axillary scar tissue. If this occurs, the tethered tissue causes bands under the skin which tract down the arm. This can limit range of motion of the arm and cause pain. This is a relatively frequent problem, occurring in about 1 in 5 of axillary augmentation patients. However, this problem typically resolves spontaneously in the first 6-8 weeks after surgery. Since this problem resolves, we don't think this risk should be a significant deterrent to those considering axillary breast augmentation.
What is the risk of bleeding during and after breast surgery?
In surgery there will be some bleeding, but it is controlled and, therefore, a very minor risk. The greater risk of bleeding occurs after surgery. The operated tissues and blood vessels are very fragile for the first few weeks after surgery. If a blood clot is disturbed and breaks loose from a blood vessel, internal bleeding can occur. In this case, the breast will fill up with blood, causing a hematoma. The risk of such bleeding and major hematoma formation after breast augmentation is probably about 0.5-1.0%.
How is a major hematoma treated?
Surgery is required. The incision is re-opened, the implant is removed, the blood is evacuated, the tissues are irrigated and the implant is replaced.
What is a deep vein thrombosis?
A deep vein thrombosis, or DVT, is a blood clot typically in a leg or thigh vein.
What is the risk of DVT during breast surgery?
Exact numbers are not known, but the risks are relatively low compared to many other major surgical procedures.
Why is the risk of DVT important?
The greatest concern with DVT is the associated risk of an embolus from the blood clot occurring. A piece of the blood clot can break off and travel through the veins to the lungs. Such an event is called a pulmonary embolus. A pulmonary embolus can lead to severe acute lung and heart problems and can be fatal.
What is the risk of pulmonary embolus after breast augmentation surgery?
The exact numbers are not known. But, the risk is very low.
What is done to minimize my risk of DVT and pulmonary embolus?
We obtain a history from you to assess your overall risk. We also ask you to discontinue hormone therapy, such as birth control pills, at least two weeks before surgery. In surgery and in recovery, we place compressive stockings and pneumatic squeezing devices on your legs to maintain circulation. And, after surgery we ask you to stay mobile and walk for short intervals every two hours to maintain good circulation in your legs.
What is Symmastia?
Symmastia, is when the implants slide together to the center of the chest, giving the appearance of a bread loaf or one single breast. Treatment typically requires surgery to reposition the implants and create normal appearing cleavage. This is a rare complication in our practice.
What is a "double-bubble"?
A "double-bubble" is when the implant and breast tissue do not appear as one unit. That is, the bubble of the implant can be seen and the overlying breast tissue appears as a separate shape. The classic example of this is in women with droopy breasts. In such cases, the implant may be in good position or slightly "high" on the chest. But, the sagging breast tissue may drop off the bottom of the implant. This condition can also occur in women after they have had breast implants for a while if the breast tissue sags (such as after pregnancy) and the implant remains high on the chest.
In addition, a reverse example of such a "double-bubble" can also occur. This happens if the implant is placed too low on the chest (below the breast fold) and breast tissue and skin are tight and firm on the upper part of the implant. In these cases, the breast tissue has a shape above the lower breast fold and a separate "bubble" of the implant can be seen below the breast fold.
How is a "double-bubble" deformity avoided?
This can usually be avoided with proper recognition of patients that are at risk for a "double-bubble" based on their natural breast shape. This is discussed during your consultation and pre-op if you are at risk. Then, a special surgical plan will be devised to limit this risk.
What is a "snoopy" deformity?
This term relates to the nose on the peanuts cartoon character Snoopy. This is another term for the "double-bubble" deformity described above.
Are there any risks with very large implants?
When determining implant size, it's important that your body and its characteristics be taken into consideration. Women without sufficient existing tissue who opt for very large implants may end up with implants that are more easily seen and felt through the skin after surgery. In addition, irreversible tissue thinning and breast ptosis can be caused by excessively large implants.
What is Mondor's Disease?
Mondor's Disease occurs when veins below the breast become clotted and firm. This can be painful and a "cord" can be felt under the skin. These usually resolve in a few weeks.