A Discussion Of Breast Implant Complications
Breast Implant Complications
It's time to talk about a subject that most surgeons would rather not have to deal with. That's the subject of complications from surgery. Today I'm writing specifically about breast implant complications. Surgeons do all they can to avoid complications. They never want to look a patient in the eye and say something went wrong, but complications are a fact of life. To brush them under the rug is disingenuous. For the surgeon to believe they never have complications is narcissistic. To avoid mentioning for fear of scaring a patient away is deceitful. So lets exam complications and see ways to mitigate the risk.
Complications Common to All Surgeries
These complications include simple wound infections, allergies to medications, blood clots in legs, and injuries to surrounding structures.this is the typical complications that you would see when signing a consent for surgery. They're also the complications that most people have heard of.
To begin with, there is the complication of a wound infection. This happens in about 1% of all surgeries although the risk varies by site. To limit the chances of infection, most surgeon give a dose of an appropriate antibiotic immediately before the incision is made. Many surgeons may also give a dose or two after surgery, but longer periods of antibiotics actually increase your risk of infection.
Next is the risk of having an allergic reaction to one of your surgical medications. This risk can be decreased by taking a careful history of any previous reaction you have had to medications or latex. Then the allergies are reviewed with everyone in the operating room during a 'time-out' just before the surgery. Of course this does not prevent against a brand new reaction and therefore anesthesia has several medicines right in their cart to treat a sudden allergic reaction.
A potentially fatal complication and fortunately a rare one is blood clots in the legs that move to the lungs - a pulmonary embolus. The prevention of these starts again with a careful history, including a family history, of any bleeding or clotting problems. If your surgery will last over an hour you will be supplied with a compression device for your legs to stop the blood from pooling and keep it moving so you don't make any clots. Depending on the type of surgery and the length, you may also be treated with blood thinners.
Complications Specific to Breast Implants
There are complications that are specific to breast implants. Let's look at these in some detail. The most common complication is capsular contracture. When a breast implant is placed inside of you, your body naturally creates a capsule or lining around the implant. This capsule is mostly composed of a tough material called collagen which is a major component of scar tissue. In half of the women with breast implants this scarred capsule remains soft and supple and cannot be felt even after many years. In the other half though, there is a capsule that is thick enough to feel. Most of the time it can just be felt and does not cause any significant firmness in the breast or change in shape. However, about 10% to 25 % of the time it is objectionable and in some women the capsule can cause a great deal of firmness, leading to an obvious deformity of the breast and / or pain. This capsule is often the most common reason for a repeat operation on the breast. In some series the rate is as high as 25% in the first year.
Although I have not had this problem personally, I think it's well worth keeping in mind when considering breast augmentation surgery. It is also worth remembering this when you read stories about bad plastic surgery or bad results from breast implants. They bad results are almost always caused by the formation of capsules.
Surgeons have tried a number of strategies over the years to prevent capsular contractures. Textured implants have been tried with limited success. Exercises have been used, also with limited success. There is some evidence that placing the implant under the muscle will lessen the rate of capsular contracture. This is not a hard and fast rule and some excellent surgeons I know do not follow this advice and have very good results.
Another complication that can occur is malposition of the implants. this can lead to obvious deformity with the implants either riding too high or moving out to the sides. The nipple and areola complex can point in different directions. This type of deformity requires additional surgery. This frequency of this complication can be limited by carefully marking the patient before surgery while in the standing position and then doing a careful dissection of the pocket for the implant. A well designed pocket will do much to ensure that the post op position is cosmetically appealing.
Another troubling issue is asymmetry. It is very important to realize that no person is symmetrical between both sides. When you visit us for you first consultation I will take measurements and will point out the differences to you. If some allowance is not made for asymmetry, then the difference you didn't notice before surgery will be quite glaring after surgery. To paraphrase a great surgeon - if you discuss outcomes and expectations before surgery then you have an explanation. If you discuss it after surgery, you just have an excuse.
The complication that concerns me most even though it is far less common than the others is infection at the breast implant. This can often lead to redness, swelling, and drainage. The only treatment that is successful is to remove the infected breast implant. Then a course of antibiotics will be necessary. The implant cannot be replaced for six months. This means that you will have one implant in and one breast without an implant for half a year. After six months a new implant can be placed. The most concerning thing about this is the excess cost. Although the supplemental insurance plan will cover removal of the infected implant it does not cover replacement of the implant six months later. Although so far I have not had any breast implant infections I would not charge a surgeons fee for replacement. There still would be a charge for the operating room and for anesthesia in addition to the charge for the new breast implant.
This list is not a complete list - just something to get you thinking about things to discuss with your surgeon. You might want to look at my breast implant page as well as my previous blog post on breast implantation.
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