Complications breast augmentation
Info on complications
As with all types of surgery, there is always some risk that complications arise as a consequence for a breast augmentation.
Some problems are related to the operation, such as bleeding, pain, allergy to anesthetic/anesthesia mm. These apply in a wider sense to all forms of surgery.
Here we list the most common long-term complications associated with breast augmentation surgery, and the fact that a breast augmentation introduces a foreign material in the body – the implant.
Before-/after images re-operation, complications
(Breast Implant Associated Anaplastic Large Cell Lymphoma)
BIA-ALCL is a relatively new and very unusual medical condition, but one that is important for all patients with breast implants to know about. It is believed to be caused by the texturing on breast implants in some cases creates a chronic inflammatory process inside the chest cavity. This can in turn lead to a gene mutation in the area with possible cancer as a result. The cancer cells are located in the capsule around the implant and are not aggressive. In other words, it rarely spreads to other parts of the body, as long as the capsule is removed. The main symptom is that your breast suddenly swells up, long after the surgery. If this happens, consult your plastic surgeon. The swelling is caused by fluid accumulation in the breast, a so-called seroma. This occurs on average 9-10 years after surgery, in these cases.
It is important to understand that this is not a case of breast cancer, but a cancer of the immune system.
What does it mean if I have BIA-ALCL?
Should you be diagnosed with BIA-ALCL, you most likely need to undergo a surgery to remove the capsule around the implant, which will also remove the cancer.
How common is BIA-ALCL?
The disease is as mentioned very rare, and exist today in 1 of 2 000 to 1 of 86 000 patients with textured implants, according to available data (1:2 000 – 1:86 000).
“Bottoming-out” usually happens with very thin patients with very little breast tissue and skin coverage, in combination with large implants. It occurs more often if the implant is placed above the muscle, and is less common with implants placed under the muscle completely. It doesn’t matter what type of implants have been used in this context, bottoming-out can happen with smooth, textured, saline, or silicone-based implants. However, there is an increased risk with smooth implants.
Bottoming-out means that the breast implant has dropped down too far on the chest, which causes the nipple to end up too high up on the breast. If bottoming-out occurs shortly after surgery, it is likely due to the “Pocket” is too large for the implant. If it occurs later, it is usually due to the weight of the implant.
Bottoming-out is corrected surgically with a tightening of the breast pocket, sometimes in combination with an implant replacement.
Around all foreign materials that are surgically inserted into the body, such as breast implants, a natural scar tissue is formed, called a connective tissue capsule. In some patients this connective tissue capsule becomes thick, firm and is åilled together. This is called a capsular contracture and can make the breast feel hard and also create a more unnatural appearance.
The problem with capsular contractures around breast implants have always existed and there has yet to be established any clear cause. In the 70 ‘s the risk was reduced by placing the smooth implants then used, deeper, under the large breast muscle. Later, in the 1980s, implants were developed with a rough, textured surface which reduced the risk even further, and implants could once again be placed both in front as behind the chest muscle with a relatively small risk for capsular contracture.
The following is believed to increase the risk of developing capsular contracture:
- Transmitted bacterial infection. Bacterial contamination and/or persistent bacterial contamination of the implant shell may cause an inflammatory reaction, leading to shrinkage of the capsule.
- Subglandular placement. Breast implants placed above the muscle tends to have a higher rate of capsular contracture, compared to placing them under the muscle.
- Infection. Capsular contracture seems to occur more often in connection with infections.
- Seroma (fluid build-up). If you have had a seroma, it can cause increased risk of capsular contracture.
- Hematoma (bleeding). A hematoma can cause an inflammatory reaction, which can lead to capsular contracture.
At present capsular contracture occurs in appx 10% of all breast enlargement operations. This figure, however, is an average and varies depending on the prosthesis used, and on the clinic and surgeon. Studies have shown that the implant type that we use at Victoriakliniken leads to a capsular contracture frequency of about 5% and our own results point to an even lower rate.
Capsular contracture can be fixed surgically through a so-called capsulectomy which usually is performed no earlier than six months after the initial surgery. However, it is important to fix a capsular contracture as soon as possible, because the tissue around the implant would otherwise gradually become thinne. There is a risk of about 50% to get a new capsular contracture despite doing a capsulectomy.
Loss of sensation/numbness
All breast surgeries can result in your breast and/or nipple either to become too sensitive or not sensitive enough. This change can vary in degree and can be temporary or permanent. This can affect the feeling at breastfeeding and sexual response.
During the healing process, you may feel numbness or hypersensitivity, or both. These usually disappear with time. It is important to remember that it can take up to a year, sometimes two, for full sensation to return after a breast augmentation.
The majority of women seem to get the feeling back in much less time than that. Sense of touch after surgery can be the same as it was before, or you can be more sensitive or less sensitive. It is impossible to predict how your body will react after surgery.
There are many factors that can affect the risk of “rippling”. The most important is the quality and thickness of the patient’s skin and tissue, the choice of implant type and size and the technology used by the surgeon. The skin type is, of course, not soemthing that can be changed, but the risk of rippling can be minimized by choosing “denser” silicone-implants (more stable) which are not wider than the patient’s natural breasts, and through placing the implant under the muscle.
The implants least likely to create rippling is the form-stable or drop-shaped implants (Ex: Natrelle Style 410) that has the densest silicone type, and Natrelle Inspira, round implants, which are slightly less dense. Although no implant is “rippling-safe”, the latter implants are a great choice, especially for slimmer patients.
All implants can rotate. However, it is more visible with anatomic (drop-shaped) implants, since they are asymmetric. If round implants rotate it doesn’t affect the sahpe of the. When an anatomic implant rotates, the breast shape is distorted. If it is a simple rotation it is possible to reposition the implant at a re-operation (and, if necessary, change the pocket that the implant rests in) or you can switch to round implants.
Stretchmarks can occur when the dermis-layer of the skin, which is located under the epidermis (outermost skin layer) is stretched and torn, something that usually happens during rapid growth or rapid weight change.
Given that a breast augmentation in one sense means a rapid growth of the chest area, it is not surprising that implants can cause stretch marks.
Fortunately, the skin on the breast is generally quite elastic and resistant, which means that it is very unusual for stretchmarks to develop as a result of a breast augmentation.
Stretchmarks can be formed when the tissue can’t expand fast enough or enough to accommodate for the growth that is taking place, and this is almost never the case with women’s breasts.
However, the stretchmarks sometimes occur as a complication of a breast augmentation, and there are some factors that can increase the risk. One of these factors – implants size – is quite controllable. The other – genetic conditions – is not.
At the most basic level, you could say that the larger the implant, the greater the risk of stretchmarks. If your skin is very durable and elastic, you might be able to increase your bust size considerably with little risk of stretchmarks. But if you have the predisposition for stretch marks (if you have thin skin with little elasticity), you may choose a more moderate enlargement of the breasts. If you don’t know whether or not you could easily get stretch marks, don’t be afraid to ask your plastic surgeon, who can help you work out how things relate.
Can breast implants cause stretch marks? Yes, but only very rarely. With the right plastic surgeon, to help you determine what works with your body, you are likely not at risk of getting them at all.
What is a scar?
After a surgical incision the body creates collagen to repair “damage”. Collagen is just like cement which fills the space between two bricks. Too much collagen is produced, and therefore we also produce an enzyme called collagenase, which “melts” away the excessive collagen. This casting process lasts for months. Collagen is produced and the excess is removed to restore the skin’s original form. If there is still a surplus of collagen, this will create a more visisble scar.
A perfect balance between collagen and collagenase leaves the smallest noticeable scars. Often, however, we heal too well! After the skin has-reconstituted, we continue to heal, and the scar can become larger than necessary. If we had been able to force the extra collagenase in our cells, we could digest this extra scar tissue.
Plastic surgeons and dermatologists have known for decades that there are ways to reduce the size of the scar. So far, however, it has not been particularly comforatable for the patient. For example, it was found that a pressure bandage contributed to increasing the production of collagenase and this has been used for burn victims in over a century. Cortisone creams not only soothes irritated skin, but also stimulates the natural production of collagenase. In extreme cases, doctors use cortisone injections.
For decades, doctors have prescribed silicone plates. Silikonfolie taped over a scar will reduce it. This was discovered in the early 1980s, when a doctor tried to put even more pressure on the scar using a silicone plate. The scars treated with silicone seemed to be reduced much quicker.
Vitamin E helps by working on the collagen fibers and make scars softer and more pliable.
To close the skin after a breast augmentation
The first step to getting as nice a scar as possible, is to close the skin without putting a lot of strain on the edges of the wound. The skin may look wrinkled at the beginning, but it evens out over time.
After the skin is properly closed, what more can you do to minimize scarring?
What we do at Victoriakliniken is to tape the breasts with silicone tape for 6 months after surgery. If you would then like to continue to treat the scar yourself, vitamin E or oil rich in vitamin E oil which is massaged into the skin might help. Do the massage with oil, by folding “macaronis” or “cheezedoodles” up and down along the scar, which makes it more flexible and softer (this also works well for other scars, such as after a caesarean section).