Breast Augmentation Risks

hi. i am an admited worry wort. i want to get breast implants, its just that i worry about the risks. i have researched lots of questions here on this site and also went to the fda web site for understanding risks. the list on the fda site:

* reoperations (additional surgeries), with or without removal of the device
* capsular contracture (hardening of the area around the implant)
* breast pain
* changes in nipple and breast sensation
* rupture with deflation for saline-filled implants
* rupture with or without symptoms for silicone gel-filled implants
* migration of silicone gel for silicone gel-filled breast implants.

Do doctors think this is comprehenisve list? are these one in a million type of problems or one in ten?  in other words, what are actual risk of bad complications from BA?

Doctor Answers (40)

Breast implants are safe. . .but, EVERYTHING in life (including surgery) has some risk.

+5

Worry wart or not, these and many others are wise questions to have answered by an experienced, board-certified (American Board of Plastic Surgery) plastic surgeon who does more than a few breast enlargements per year. I have been in practice for over 20 years, do hundreds of breast surgeries per year, and I still have some patients who request or require re-operation. Fortunately, very few, but my perfection badge has not yet arrived in the mail! To answer your posted questions briefly:

1) The main reason for re-operation is size change, so choosing properly is important. There are lots of ways for doing this--use as many as possible, but also listen to your plastic surgeon. See my article "What is the Right Breast Implant Size for You?" for more detailed information. Other reasons for re-operation are bleeding, infection (requires removal of implants in most cases), malposition, and capsular contracture. My re-operation rate is less than 5% for all reasons.

2) Capsular contracture is caused mainly by bleeding, or bacteria, so surgical technique is critical. Good surgeons have capsular contracture rates less than 5%.Surgeons whose patients have significant post-operative bruising, swelling, and pain, or who routinely use a drain for breast augmentation cases, tend to have much higher capsular contracture rates.

3) Breast pain is mild after surgery and virtually always goes away completely with time. Contracture can cause pain in addition to firmness--that's why it is best to avoid this in the first place. See #2 above. Chronic breast pain (from any cause) is exceedingly rare!

4) The implant has to be in a space within your body, so some sensory nerves are unavoidably cut, regardless of surgeon, incision placement, or care during surgery. Most sensation recovers over time, but 5-10% of women may have permanent loss of nipple sensation; if a breast lift is also performed, the rate of nipple sensation loss is around 15%. When numbness occurs, this does not affect the ability to breast feed.

5) Saline implants can eventually leak and deflate, more common with textured implants, and more common in implants that are under-filled. The fluid is IV saline so this is not a problem, but the deflated implant must be replaced via surgery. Free implant, sometimes free surgery, but re-operation required.

6) The present generation of silicone gel implants (by both manufacturers) are cohesive and cannot deflate, leak, or rupture. MRI is incorrect 21% of the time (FDA data), and with these newest implants is unnecessary.

7) See #6 above. Older silicone implants had a more sticky silicone gel filling (less crosslinking and therefore not cohesive), and could rupture and cause inflammation or capsular contracture requiring surgery to remove the capsule and replace the implant(s). Use only the newest generation of silicone gel implants. See #6 above! BTW, you already have microscopic molecules of silicone in your body from needle lubricant on any shot you have received (like tetanus booster, immunizations, etc.), or intravenous lines. Less silicone will come off your breast implants than you already have in your system. For more information about this, read my article "Are Silicone Breast Implants Safe?"

I have written an 23-page informational article that I give to my breast implant patients. Many more questions are answered; but nothing beats asking a qualified, experienced plastic surgeon!


Minneapolis Plastic Surgeon
5.0 out of 5 stars 123 reviews

Breast Augmentation Risks over a 7 year period

+3

Here are some numbers of a study supplied by one of the breast implant manufacturers.

Some of these risks appear to be quite elevated, but keep in mind that this study is over a 7 year period.

Inclusions to the list of Postoperative Complications may or may not be directly related to the reason for which the surgery was performed or to the surgery itself.

For example reoperation may be related to wanting a change in size  -bigger or smaller - due to:

pregnancies, wieght gain / loss 7 years down the line after breast augmentation.

 

COMPLICATION RATES IN 455  PATIENTS OVER A SEVEN YEAR PERIOD AFTER UNDERGOING BREAST AUGMENTATION WITH SILICONE COHESIVE GEL IMPLANTS.

  1. Reoperation 30.1%
  2. Capsular Contracture 15.5%
  3. Breast Pain 11.4%
  4. Implant Removal with Replacement 11.0%
  5. Swelling 9.2%
  6. Implant Rupture (MRI cohort) 8.6%
  7. Nipple Complications 6.7%
  8. Implant Malposition 5.2%
  9. Hypertrophic/Other Abnormal Scarring 3.7%
  10. Asymmetry 3.3%
  11. Implant Removal without Replacement 3.1%
  12. Ptosis 2.2%
  13. Breast/Skin Sensation Changes 1.6%
  14. Hematoma 1.6%
  15. Implant Palpability/Visibility 1.6%
  16. Seroma/Fluid Accumulation 1.6%
  17. Wrinkling/Rippling 1.2%
  18. Delayed Wound Healing 1.1%
  19. Bruising <1%
  20. Infection <1%

Don't forget death is also a risk - WITH ANY SURGERY OR MEDICAL PROCEDURE , again very, very, small but nonetheless a possibility.

THE BOTTOM LINE IS THAT IF YOU ARE NOT WILLING TO ACCEPT A WELL CALCULATED RISK, THEN IT IS QUITE SIMPLE, NO SURGERY.

 

If you are a good candidate with reasonable expectations and otherwise healthy, i would highly recommend this procedure despite the list that I have placed above.  You must be aware of the above though.

I hope that you understand the potential risks better.

Dr. Carlos Cordoba
MDCM, CSPQ, FRCS, FACS
Plastic & Esthetic Surgeon
4055 Ste-Catherine O. Suite 100
Montreal, QC. Canada H3Z 3J8
514-932-7667

Carlos Cordoba, MD
Montreal Plastic Surgeon
5.0 out of 5 stars 7 reviews

Breast Augmentation Risks

+3

These are some of the main points in regards to Breast Augmentation Risks:

  • The risks associated with breast Augmentation procedure exists but are limited  if your surgeon is methodical, patient and critically evaluates his result to improve his outcome.
  •  
  • The most important and frequent complication is capsular contracture. Because of a variety of techniques and methodologies we employ in our practice the risk of this complication is very limited.
  •  
  • I always review all the risks with patients and give them and extensive booklet that is published by the implant company that reviews all risks extensively.
  •  
  • It is important to remember this is a very common procedure and patients are usually very satisfied with their choice of having this procedure done.

Hope this was helpful.

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 117 reviews

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Real risks, real benefits

+2

Hi! Good for you for doing some research! I always encourage patients to consider the risks of a procedure before going through with it. While most cosmetic procedures are safe, they are still real surgeries, and it is important that patients understand the potential risks. Most patients are extremely satisfied with breast augmentation. That said, the risks you have listed are real. I always tell my patients that breast implants are a bit like buying a car in the sense that both are man-made and will eventually require some form of maintenance. But, if you want the car and understand what you are getting into, you will likely be very happy with your decision.  

B. Aviva Preminger, MD
New York Plastic Surgeon

Risks of Breast Augmentation Surgery

+2
There are potential risks to breast augmentation surgery or any surgery. The best way to protect yourself from a complication is to select the appropriate plastic surgeon for you. This means finding a plastic surgeon certified by the American Board of Plastic surgery with appropriate training credentials and experience. Search realself for how to choose a surgeon for more information on how to select a surgeon.
The following is a list of some things to discuss with your plastic surgeon prior to surgery.  It is also critical that as a patient to share your entire health history with your plastic surgery c=and carefully follow all pre-operative and post-operative instructions. 
Cohesive silicone gel vs. saline breast implants
How many cc's? - deciding on implant volume
Incision locations
Subpectoral vs prepectoral implant position
Attention to detail in breast augmentation
Breast augmentation after pregnancy
Special considerations: asymmetry, tuberous/constricted breasts, etc
Recovery and downtime
Avoiding capsular contracture
Revisional breast augmentation surgery

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 40 reviews

Breast Augmentation is Unfortunately Not Without Potential Complications

+2

While many women are satisfied following cosmetic breast augmentation, many others are have significant complications that not infrequently lead to the need for additional surgery. In fact, according to the FDA, “It is likely that you will need to have one or more reoperations over the course of your life because of local complications from breast implants.”

According to data submitted to the FDA by the manufacturers of approved breast implants:

  • Women who undergo cosmetic breast augmentation have about a 25% chance, and women who undergo implant reconstruction have about a 40% chance of needing additional surgery within 4 years; with additional time, the chances of needing additional surgery increase.
  • More than one-third of the women who require surgery to address an implant related complication will require further additional surgery within just four years to address implant related problems.

The FDA has several excellent publications on their website highlighting the more common problems that occur in the breast or chest area following implant placement as well as photographs of implant complications. Searching the Internet for "FDA and Breast Implant Consumer Information" will help you find this information. Also, be sure to ask to read through the "labeling for Approved Breast Implants" booklet that comes with every breast implant; your surgeon should be able to provide you with this information at the time of your consultation or it can be obtained on the FDA's website. Finally, know that the FDA currently recommends that women who have silicone-filled implants undergo regular MRI exams to evaluate for "silent" implant ruptures; the cost of these MRIs are generally not covered by health insurance plans.

In the end, breast augmentation is right for some women and not others. Knowing the facts about the risks and benefits will help each woman to decide on what is best for her.

David Greenspun, MD, MSc
New York Plastic Surgeon

Breast augmentation risks

+2

Like most cosmetic plastic surgery procedures, breast augmentation tends be safe when performed by an experienced board certified plastic surgeon.  However, it must be stressed that there are substantial risks associated with this operation, and although they are rare, they can be costly to correct, and emotionally troubling to put it mildly. 

The most common complications experienced include the following:  nausea and vomiting, infection, hematoma (bleeding), abnormal scarring, loss of nipple sensation, asymmetry, implant malposition, dissatisfaction with size, rippling/wrinkling, implant deflation or rupture, capsular contracture (abnormal internal scarring), and implant exposure.

It is entirely normal for patients to have anxiety about complications before surgery.  This usually is a sign that they are taking the risks seriously.  The best way to deal with anxiety is to get accurate information about the risks from a board certified plastic surgeon in your area. 

Kelly Gallego, MD, FACS
Yuba City Plastic Surgeon
5.0 out of 5 stars 33 reviews

Risk with breast augmentation

+2

As with any other surgery, breast augmentation also come with its risks. You have done pretty good research and those are the main risks associated with breast augmentation. To help answer your question, the risks associated with breast augmentation are pretty low and the success rate is pretty high. Most patients are extremely happy with their results and would do it all over again in a heart beat.

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 78 reviews

Breast implants are safe.

+2

Hi.

All I can tell you is that if my daughter were flat chested and wanted breast implants, I would tell her to do it. Most patients are very happy, and the occasional problems are local to the breast and do not affect your health.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Risks of breast augmentation

+2

It's great that you are doing your research about breast augmentation and considering the risks and benefits. The risk of device rupture is usually <2% over the course of 7 years. Most women will require a reoperation at some point, as implants are not lifelong devices and do wear out usually within 10 years.

Capsular contracture has been reported to be as high as 15%, although the newer generation of implants seems to have a lower risk, closer to 5% (but no hard data on this yet). Breast pain and change in sensation are probably around 2-4%. Silicone migration is low, I suspect less than 1%, but again I don't have real data on this for you.

Make sure you see a board-certified plastic surgeon, and ask about these concerns. The American Society of Plastic Surgeons has a very good information form about these risks which many of us can also provide to you during a visit. Best wishes.

Nina S. Naidu, MD, FACS
New York Plastic Surgeon
4.0 out of 5 stars 5 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.