Breast Augmentation and Implant Education
Possible risks and complications to consider about breast implants.
At Skinsational Liposculpture, we will do everything possible to completely and truthfully inform our breast augmentation patients of the risks and possible complications of breast implants and their use. You, the patient, should avoid unrealistic expectations concerning the results that implants and cosmetic surgery can provide. Be advised that breast implants should not be considered “lifetime” implants, and the removal of an implant may be indicated at any time.
We make no claims or representations concerning the lifetime, duration, or term of implantation of breast implants. You, the patient, should also be informed that after your breast implant surgery, there is almost always a difference in the way your breasts (with implants in place) feel. Almost always, breast with implants can be distinguished from normal breast tissue by feel, many times by sight. In other words, the breast implant will simulate or be similar to breast tissue, but can usually be differentiated from a normal breast by almost anyone, even those who are untrained medical professionals
You must understand that this is a completely elective operation, that you have specifically requested that Dr. Sztulman perform it, and that it is done totally for cosmetic reasons. You should also understand that there are certain conditions which may occur or develop which may result in the need to remove the breast implants on a permanent basis, for the rest of your life. It is the opinion of many implant surgeons that a small percentage of women are unable to tolerate implants of any kind.
We will make every attempt to discuss all possible complications and risks that are associated or might arise from breast augmentation surgery. Please understand that it may be impossible to list every complication or problem that has ever occurred with breast implants.
The following is a list of the most common complications and risks that have, can, or could occur following your breast implant surgery:
Buckling, rippling, or wrinkling of the skin or the implant:
Many surgeons believe that almost all implant patients will have some amount of rippling at some time. This could be attributed to an unanticipated post-surgical tissue implant reaction. It is impossible to predict which patients will have wrinkling or rippling of the skin and/or the implant, although this is much more common in women with thin skin, women who smoke, thin women, and women who have lost large amounts of weight. It is probable that all saline implants ripple, although we may not see or feel the rippling. This may be permanent and there may be no satisfactory treatment for this condition, if it does occur. Smoking causes loss of skin elasticity. If you smoked, or continue to smoke, the chances of rippling are much greater. Rippling is much less with silicone implants.
Symmetry and Asymmetry: It is understood that the two sides of our bodies are different and asymmetrical and this includes the chest, breast, nipples and all other parts of our faces and bodies. While we usually want to make our two sides more alike, it is understood that it is not possible to make them look alike. The two sides of our bodies and of every part of our breasts will always be different, unequal and asymmetrical in every way to some degree. Rarely does a woman have breasts that are entirely symmetrical and equal, therefore, your chances of being entirely symmetrical are remote, although every attempt will be made to provide the desired symmetry.
Sagging of the breast after implants (breast ptosis): While women with breast implants may sag no more than those of the same size breast without,the implants do have some weight and can cause some additional sagging of the breasts as can pregnancy, weight gain and aging. Certainly, implants do not prevent sagging and certainly, the larger the implant, the more sagging that can be expected since any large breasted women, whether or not she has implants will have a tendency for more sagging.
Reaction to Medications: Unfavorable reaction to prescribed medications or to anesthetic drugs can occur. This may include, but is not limited to, vomiting, allergic reactions with skin rash and itching to more severe reactions, including convulsions, coma, or death.
Edema (Swelling): This occurs to some degree after every surgery. It may last days or weeks. You will be given special instructions or treatment if appropriate.
Bleeding: This is controlled at the time of surgery by sutures, cautery, or pressure. A hematoma (blood clot) may require removal. Some bloody drainage on the dressing is normal. If bleeding occurs, phone our office. If we (or he) cannot be reached promptly, and there are problems that concern you, go to the nearest hospital emergency room. In very rare cases, there may be extensive bleeding or other complications which could require hospitalization and blood transfusion. With most surgery, there is bleeding under the skin that leaves a bluish discoloration (bruising) for two or more weeks. Excessive bleeding occurs in about 1% of patients during their implant surgery. If excessive bleeding occurs, the incision must be opened and blood or blood clots evacuated, the bleeding controlled, and the wound re-sutured.. This may happen immediately after surgery or may occur after trauma, or may occur for unknown reasons days, weeks, or months after surgery. Rarely, the implant may need to be removed.
Anesthesia: Intravenous sedation anesthesia is routinely and safely performed in offices across North America. The most common example of this is oral surgery, where IV sedation is almost uniformly used for the removal of wisdom teeth. Even so, there are minro to fatal risks with IV sedation.
Infection: This can be expected to occur in approximately 0.5% of all patients undergoing breast augmentation. This infection may be immediate or may be delayed for several weeks, months or years. This may require implant removal and replacement with a new implant at a later time. Infection may occur with any break in the skin or with any operation, or following pregnancy. When infection occurs around a breast implant, the implant will almost always have to be removed. It may occur on only one side. When the implant is removed, it is necessary to leave it out for a period of months to be sure that the tissues are completely free of infection before the implant is replaced. It is sometimes necessary to wait six months or more before replacing the implant. Mouth to nipple contact is forbidden for three (3) months after implant placement. You must remove nipple rings at least one (1) month before surgery. Nipple rings must never be used after breast augmentation due to the risk of infection.
Scarring: A scar results whenever and wherever there is a surgical cut. We make every effort to place scars in areas where they will be minimal or invisible. Healing capabilities and the tendency to scar are very variable in different people and different areas of the body in the same person. How well a person will heal cannot be exactly predicted or controlled. If you are prone to them, excessive wide or thickened scars (hypertrophic or keloid) may occur.
Numbness: In cutting the skin, small nerve endings are also cut that can result in numbness around or adjacent to the surgical area. Sensation usually returns a matter of months or years as the small nerve endings re-grow. Rarely is an area permanently numb. Most numbness goes away with time.
Implant Rupture: Although an implant with a strong outer covering is used, abnormal stress or trauma applied to the breast may result in its rupture. This has also happened without a history of trauma to the chest or breast. Also, the gel interior of the silicone gel implant has been reported to migrate to certain areas of the body, including the lymph nodes in the armpit, chest, liver or other unspecified organs. This may be due to a very slow leaking or “bleed” of the silicone from the silicone gel implant. Implants may rupture at any time following surgery even without apparent cause. The most common cause of rupture is injury. A ruptured gel implant may result in gel migration, inflammation and formation of silicone granulomas. Additional surgery may be required to remove the implant and the gel. The long-term effect of silicone gel on the body with a ruptured implant is unknown. Be aware that the shell of the saline implant is solid silicone. When a saline implant ruptures, it must be replaced, even though the saline is absorbed by the body, and is non-toxic. However, with saline implants it is not unusual to have a few reactive or enlarged lymph nodes in the armpit, which are totally benign.
Foreign Body Reaction: An implant is recognized by the body as foreign object; your body treats it as such, and may reject it. The capsule contracture problem, of becoming too hard may be part of the rejection phenomenon. The body forms scar tissue capsule around every implant, in an attempt to isolate it from the body. This might occur to such an extent that a person cannot tolerate breast implants of any kind due to pain, and must live without breast implants. When the body‟s foreign body reaction is excessive, “capsular contracture” occurs, and the breast can become either distorted, very hard, or both. If this happens, and is unacceptable to you, a second operation will be required to reshape or loosen the capsule. This is usually done at least six months after the development of the capsular contracture. Capsular contracture can happen at any time after implant placement, anywhere from several months to many years after surgery.
Gel Bleed: All implants filled with silicone gel may leak or bleed through the shell even when the implant is not ruptured. The long-term effects of gel bleed are unknown. Over many years gel bleed could be harmful. This doesn't occur with saline implants.
Capsular Contracture: This is one of the most common problems with any type of breast implant. At times, this requires further surgery. Hardness and deformity in appearance often follow pregnancy. Contracture is also more common with silicone gel than saline implants. Some women will form capsular contracture with any and all implants, and will not be able to tolerate implants, requiring permanent removal.
Interference with Mammography: Breast implants may sometimes interfere with post-operative mammography. This is the reason that we insist on a pre-operative mammogram for all implant patients over 39 years of age. If a malignancy develops, a delay in detection could occur. This has not been the “North American” experience, but it could happen. (In fact, statistically, patients with implants, have no greater incidence of the occurrence or severity of breast cancer than all other women.) As we emphasize, about 1 in 8 or 9 women in North America will have breast cancer at sometime during their lives, with or without implants. That means that at least 1 in 9 of the women who now have implants will have breast cancer at some time in their lives. The pressure of mammography may rupture an implant or cause saline implant deflation. The standard recommendations of the American Cancer Society should be followed. They recommend that all women have a baseline mammography at age 40. Between 40 and 50, mammograms should be done every one to two years. Women over the age of 50 should have yearly mammograms. If there is a family history of breast cancer, mammograms should be begun earlier, and done more frequently.
Displacement and Distortion: A breast implant may become displaced following trauma, or for no explainable or logical reason. This usually happens with capsular contracture. The implants may seem too high or too low, too far to the side, or in any other conceivable abnormal position. It may even cross the midline, causing a “uni-breast,” with the skin over the breastbone lifting forward, causing an apparent communication from one side to the other. There may be no cause for this, or this may be due to enlargement of the pocket too far toward the middle at the time of surgery. This may require further surgery. Not all problems can be corrected. Many problems in appearance cannot be corrected or improved.
Skin Necrosis or Death or Breakdown: This may result from too much tension over the overlying skin of the implant or trauma to this area of skin during or after the surgical procedure. Skin over a portion of the implant may become very thin and break. The implants may become exposed and require removal. It is then often best to wait 6 months before replacing the implant.
Seroma: Serum is the fluid component of blood, with red blood cells, and this may accumulate around the implant immediately after surgery, or weeks, months, or years after the surgery. This is usually associated with swelling, pain, and sometimes fever. The fluid may be secondary to trauma, sub clinical infection, overt infection, or no reason at all, within days, months, or years after the surgery. A seroma may require removal of the fluid, removal of the implant, or both. If the implant requires removal, it will not be replaced for at least 3 months.
Firm or Hard Breasts: At least 5-20% of women will experience firmness or hardness greater than the normal breast. This can vary from only slight firmness to a breast that is extremely hard. The cause of this remains unknown, and different patients respond in different ways. If this happen, a second surgery may be needed, or the implants may need to be removed on a permanent basis. Fibrous contracture or hard breast is also more common in women who smoke. Also this condition is more common in women with silicone implants.
Calcification: Calcium deposits have been reported and occur occasionally around breast implants and surrounding tissues. The causes of this are unknown.
Nipple Sensation: Some temporary breast numbness is expected after every breast augmentation. The numbness is most often in the lower portion of the skin below the nipple. Occasionally, there is numbness of the nipples after breast surgery. You may also experience more sensitive nipples (hypersensitivity). Most of the numbness goes away in a period of months or years. Some numbness may be permanent and unequal.
Wound Healing Interruption: Due to infection, poor vascularity, tight closure, or cortisone therapy. The wound may be disrupted and require a second surgical procedure. Infection and abscess formation are also possible, and may result in mandatory removal of the implants.
Microwave Diathermy: This is used in the offices of chiropractors and physical therapists. It has been reported in the literature that this can cause skin erosion and skin death, with subsequent exposure of the implant in some patients.
Pregnancy: There is no way to determine the effects that pregnancy (with or without implants) will have upon breasts. If you should become pregnant after implant placement, the risks of certain complications increase, including capsular contracture, hard breast, mastitis, infection of the breast tissue, or infection around or in the implant itself. Also, rippling is much more common after pregnancy
Sensitization & Immune Response System Problems or Changes: Some doctors feel that an increased immune response occurs to breast implants, which would include or could include swelling in the joints, generalized swelling, acute or chronic rash, enlargement of the lymph nodes, or a general tired feeling. Some reports in the medical literature claim that this may be due to the silicone implant or silicone induced disease. Diseases of this nature which have been recorded include connective tissue diseases such as: rheumatoid arthritis, systemic lupus erythematosis, polyarteritis, scleroderma, and chronic fatigue syndrome. Statistically, according to most literature (but not all literature) there is no correlation between these diseases and breast implants. You must realize that a hyper-immune disease reaction, however rare, may require that your implants be removed at a later date. You should realize that if such a disease is contracted or begins while your implants are in place, removal of the implants may or may not correct the disease process. The above class of diseases can be fatal. According to the FDA, “There is no conclusive evidence at present that women with breast implants have an increased risk of developing arthritis like diseases, or other autoimmune diseases. Women with breast implants who have developed such diseases may have done so regardless of their implants.”
Pneumothorax: A life threatening lung collapse due to air in the chest and tissues around, but outside, the lungs. This is a surgical complication, when the very thin muscle between the ribs is crossed with a surgical instrument, and the tissues of the lung are entered. This may require treatment, medicines, and drainage, and could require additional incisions and treatment. Usually, a small tube is placed between the ribs for several days. In some cases, this requires hospitalization.
Wrinkling & Rippling: Implants with thicker shells, implants with lower profiles and implants that are textured cause more wrinkling and rippling. Therefore, it is our usual practice to use an implant which is “high profile” and non-textured, to keep rippling to a minimum. If the skin and breast tissue is very thin, rippling can and often occurs. This rippling can occur with any implant. Any degree of rippling CANNOT be predicted and correction may be impossible. Silicone implants ripple less than saline implants.
Revisions: When we have cosmetic surgery, we want an improvement in appearance, and want to look as good as possible. Even after the surgery is done, most of us still want to look better. This may even be true when the surgery is very successful. Sometimes, because the appearance is improved with so little discomfort, the patient wants more. Many patients want to look better than is realistically possible, which is the definition of „unrealistic expectations.” These expectations may be greater than Dr. Sztulman, or any surgeon, can achieve. Results of surgery are never perfect. The results can never match a preconceived drawing, picture, image, or goal. If further surgery is desired to look better, even in the previously operated area, there will be additional charges. Though the patient may want improvement, the surgeon may believe that the risks outweigh the rewards to the patient. When this is true, Dr. Sztulman will refuse to perform further surgery. It is understood that additional fees will be charged for revision surgery or repair work done.
Incison site, location, shape, implant size, position and type: Though these factors may be discussed and the patient‟s wishes may be followed as much as is prudent and reasonable, the patient must agree to whatever can be done for the patient with respect to all of these factors. The patient must also agree to whatever treatment or surgery is necessary, advisable or available at the time of, and during, the surgery. Permission is granted for other incisions, implants, or treatments as may be needed. No certain preconceived appearance or result can be obtained. Other incision sites may be needed later, if there are complications.
Leaking Implants & Deflation: Saline filled implants are expected to leak and eventually collapse, in every patient. The saline is not harmful to the body. If the leakage and deflation rate are on only one side, this may cause a distorted appearance. It is estimated that noticable loss of saline will occur in as many as 50% of women who have saline implants for seven (7) years or more. Further surgery is required to replace implants, at additional cost, if the warranty has expired.
Rejection or Extrusion: The body may recognize the implant as a foreign object and try to reject it. The capsular contracture problem of becoming too hard may be part of the rejection phenomenon.
Breastfeeding: Many patients have become pregnant and have breast fed infants after breast implant surgery. Breast implants may interfere with breastfeeding in many different ways. There may be numbness or hypersensitivity of the nipples. There may be tenderness or inadequate milk production. Pregnancy after breast implant surgery may cause stretching of the skin and deformity of the shape of the breast or stretch marks of the skin. There is an increase in capsular contracture following pregnancy and breast feeding.
Axillary Incision: There may be numbness or pain of the arms around the incision or of the upper part of the arms, forearms, or hands. These problems are uncommon, but could occur even when the surgery is perfectly performed. Another incision site may be necessary if there are problems with this surgery or surgery performed at a later date.
Breast Cancer & Implants: Breast implants may interfere with early detection of breast cancer. This could mean that women with breast implants have a reduced cure rate with breast cancer. Approximately three (3) million American women have breast implants.
Women with breast implants have not been shown to have an increased risk of breast cancer, and, according to the FDA, “There is no evidence at present that women with breast implants are at increased risk of breast cancer.” The results of studies in progress will not be known for many years to come.
Risks to Unborn Babies: Possibilities of risk to unborn babies cannot be ruled out. According to the FDA, “there is no evidence at present that women with breast implants or their unborn babies are at increased risk.”
Deformities of Appearance: Many deformities and disfigurements of appearance can occur after breast implant surgery. Among these are a “stuck on” appearance, nipples pointing down, the “ball in the sock” appearance, the “double bubble” deformity, the “unibreast,” unequal size, shape, and direction of pointing nipples, sagging, and too much or too little cleavage. Many other deformities are possible.
Stretch Marks or Striae: Stretch marks, such as of the skin of the abdomen following pregnancy, may also occur in breasts. They may not occur until after pregnancy, or many months or years later. Birth control pills seem to cause them in some patients. They may occur in women after implantation for no known reason. The veins in the skin of your breasts are almost always much more prominent for 4-6 months after surgery, and are usually blue in color.
Muscle Movement: Implants that are placed below the pectoral muscles may move whenever the muscles are contracted in normal arm movements. This may also cause visible distortion of the appearance of the breasts with movement of the arms. Occasionally, the movement is so annoying that women have further surgery, to put the implants above the muscle, because of this problem.
Muscle Weakness: Whenever the implants are placed below the muscle, there is some weakness of the muscle, because of the injury to the muscle itself, or to the nerve and blood supply to the muscle. The muscle is partially detached from the ribs, and is otherwise injured by the surgery. It is the policy of this office to place the implants in a subfascial plane, in an attempt to eliminate implant movement and muscle weakness.
Double Fold or Bubble: A fold in addition to the new inframammary fold may occur in the lower part of the breast. This is due to a persistence of the normal inframammary fold or crease. This can cause a double bubble appearance, which may or may not improve with time.
Implant Duration: Implants last many years in some women, and must be replaced frequently in others. The person choosing breast implants should expect to require further surgery to repair the implants at some time in the future, especially if they are filled with saline. About 50% of all women with breast implants will require further surgery within ten (10) years from the time of initial implantation, considering all implants, all surgeons, and all surgical techniques. Hopefully (and we do not know if this is true) this statistic will improve with better techniques and better implants.
Respiratory and Heart Failure: These are unusual complications of anesthesia. They are, however, known risks. Heart attacks, strokes or death may occur during any anesthesia.