Every plastic surgeon has a few patients who will have complications requiring additional medical care and/or surgery. No surgeon can guarantee a perfect result, or promise zero complications. In breast augmentation there are certain problems that will happen statistically, no matter how good the care, or how careful the doctor and team. Additionally, patient compliance with post-operative care instructions and restrictions plays a large role in reducing complications after breast augmentation surgery, while non-compliance can jeopardize your result and drastically increase risk of complication or less than ideal result. We hope that no complication arises and no revisional surgery is necessary in your case. It is important for any patient undergoing a breast augmentation to understand the possible complications of the procedure. The listed breast augmentation complications below are the most common complications encountered after breast augmentation and, therefore, are assumed risks should you choose to proceed with augmentation. An exhaustive list will be reviewed at your pre-operative appointment.
The most frustrating part of Dr. Feldman's practice is when patients' fail to recognize the importance of following post-operative care instructions. Many of the complications encountered after breast augmentation are preventable, and directly attributable to not following activity restrictions, supportive bra use and/or massage after surgery. Compliance with our instructions, and restrictions, plays as large a role, or even larger, in your result as the surgery itself. We collectively call this "pride of ownership." Unfortuantely, actions have consequences, and many times overuse will lead to bleeding, bruising, hematoma, contracture, implant malposition or symmastia. Most of Dr. Feldman's patients over do it, most get away with it, but about 5% don't, meaning 5 out of every 100 surgeries require another operation in the first 6 months that could have been avoided by following instructions.
Hematoma(approximately 1% risk)
A hematoma is a collection of blood around the breast implant. This typically happens early in healing due to a cough, sneeze, dry heaving/vomiting, involuntary activity when sleeping or non-compliance with activity restrictions. It is not life threatening, and if treated expeditiously should mitigate impact on your result. In fact, the entire purpose of your first post-op appointment is to check for a hematoma. Should you have one, surgical exploration and washout, is both diagnostic, and therapeutic, and will be performed the same or next day.
Stretch Marks (Striae)
Similar to pregnancy and weight gain/loss, developing stretch marks after breast augmentation is unpredictable. Woman with very little to no breast tissue or lax skin, those who have stretch marks on other parts of their body, and large implant selection are all risk factors for stretch marks after augmentation. If you already have stretch marks on your breast, they can become red or purple for 3-6 months due to the increased blood flow needed to heal your augmentation, but will fade over time. Since there is no curative treatment, waiting for them to mature and fade, while simultaneously aggressively hydrating skin with moisturizer to mitigate development of new striae, is the best option.
Loss of Nipple Sensation (approximately 1% risk)
Although rare, permanent loss of sensation is possible after breast augmentation. It is, however, common to have temporary loss of sensation, or hyper sensation, for a few weeks to months after surgery. Nerves are the slowest healing tissue in the body and therefore, it can take up to 1-2 years to reach maximum return of sensation. Risk factors for permanent diminished/loss of sensation are large implant size/higher profile selection, and pre-op anatomy with absent lateral show/side boob.
Infection (less than 1% risk)
Although extremely rare in cosmetic augmentation, infection can become a breast threatening complication. 50% of woman who develop a breast pocket infection will ultimately need to have their implant removed for 3-6 months. Even if the infection is controlled, and implant salvaged, the risk of contracture greatly elevates. This is why prevention is essential. In addition to antibiotic pills, you will be given very strong antibiotics in your vein during surgery, the implant will be washed in antibiotics, a no touch technique with Keller funnel will be used, and you have the option of having your surgery in Feldman Plastic Surgery’s AAAASF accredited operating room where you can avoid being exposed to all of the drug resistant bacteria present in a hospital OR setting.
Capsular Contracture (approximately 4% risk)
The hallmark of contracture is one breast becoming firm and moving up towards your collarbone causing the nipple to rotate downward and can even be painful. Capsular Contracture is not well understood, and a single cause has not been identified. Leading theories include: subclinical venous bleed, low level bacterial contamination and/or biofilm, lint contamination from sterile drapes and genetic predisposition. Since the cause is unknown, treatment typically involves addressing all possible causes. There are four grades of contracture. Grade I is normal, looks good and feels soft and does not require treatment. Grade II feels firm but otherwise looks good. Grade III feels firm and looks distorted at rest. Grade IV feels firm, looks distorted at rest and is painful. Aggressive massage +/- Leukotriene Inhibitors can improve/soften Grade II contracture but in Dr. Feldman’s experience rarely improve the superior malposition present in Grade III and Grade IV contracture. These respond best to surgical revision/capsulectomy and implant exchange.
Implant Malposition (Bottoming out, symmastia, lateral displacement) approximately 2% risk
Nothing holds a breast implant in place except your breast tissue, muscle and skin. Unfortunately, not all patients’ tissue has the same strength and therefore, implants can move unexpectedly over time. Woman with more experience in life, or who have had life events like children or significant weight fluctuations, as well as genetic variations are likely to have weaker tissue than their less experienced, nulliparous (without children) counterparts. The larger, and heavier the implant, the more weight the tissue has to support and sometimes it’s just too much and may “bottom out.” Unfortunately there is no threshold size, as one woman’s tissue can support a very large implant and another woman may bottom out with a smaller implant due to the variables described above. Additionally, non-compliance with post-op activity restrictions, lack of supportive bras, stomach or side sleeping and overuse of pectoralis muscle can all move the implant into a less than ideal position. It usually takes surgery to “tighten the pocket” to correct implant malposition.
Implant Visibility (seeing implant) or palpability (feeling implant)
This is not a true complication, as anytime an implant is placed, seeing or feeling it is an expectation. Only two things control how much you will see or feel an implant. The type of implant you select, and the amount, and quality, of tissue hiding the implant. Neither of those are controlled by the surgeon. Dr. Feldman will guide your implant selection to minimize the likelihood of implant visibility or palpability.
Just about the only downside to putting implants under the muscle is what's called an animation deformity. An animation deformity is an expectation, not complication, with submuscular or dual plane implant placement as was discussed during your consult. Every woman, worldwide, with breast implants placed under the muscle, regardless of surgeon, has some widening and distortion of her cleavage when flexing/engaging her pectoralis muscle. This change in breast and cleavage appearance with muscle contraction is known as animation deformity. In fact, when a patient can't remember where her implants were placed, Dr. Feldman will have her flex her muscle and watch her cleavage as a diagnostic test! How noticable this change with flexion is, depends on how strong the pectorlis muscle is and where the bottom of the muscle was located relative to the natural breast crease. Ultimately, some distortion of cleavage, a few percent of the time when you're flexing your muscle, is far better than a permanent "bolted on" uber fake look, with visible 360 degrees rippling 100% of the time. Therefore, an animation deformity is a worthy tradeoff for all the benefits (less visibility of implant, lower rates of contracture and less interference with mammography) of submuscular implant placement.
Any mechanical device can fail. Failure could result from trauma, failure of valve (saline only) or progressive weakness of shell (think about repeatedly flexing a paperclip). Both saline and silicone have a lifetime manufacturer warranty against device failure, but the silicone implant includes a 10-year warranty to help pay some of the surgery fees (up to $3500) should the device fail. To put it simply, both have a lifetime “parts” warranty and silicone includes a 10 year “labor” warranty while that “labor” portion of the warranty is an additional $200 for saline, thereby negating most of the price savings of saline. If either device fails it will require surgery to remove and replace.
Anytime the skin is cut a scar results. Everyone heals differently despite the same meticulous tissue handling and closure techniques. 1/3 of patients heal with a barely perceptible scar, 1/3 have a fine line and 1/3 will have slightly wider scar. 1% may progress to hypertrophic or keloid scarring and need steroid creams, injections or scar revision. It’s impossible to predict which group you will fall into. I am amazed at the competition who promises scarless breast augmentation. It’s a flat out lie!
Anaplastic Large-Cell Lymphoma (ALCL)
An extremely rare occurrence - 359 cases out of over 20 million woman with implants worldwide or approximately 0.001795%.
- ALCL is not breast cancer.
- It’s extremely rare, with a total of 359 cases ever reported in the 55 year history of breast implants, versus 692 women diagnosed every single day in the US alone with breast cancer.
- ALCL seems to have a very strong link, if not exclusivity, to textured implant shells.
- 99.9% of the implants placed by Dr. Feldman have smooth shells.
- With proper diagnosis and timely treatment ALCL is a curable illness.
We hope that no complications arise and no revisional surgery is necessary in your case. However, no plastic surgeon can guarantee this to their patients. Please review our financial/revision policy and estimated fee schedule to understand your responsibility, should you develop a complication.