How many risks are there with breast augmentation?

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 personal re-operation rate is less than 5% for all non-size-related 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. National CC rates average around 10%.
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 rare! Numbness (some degree) is common, but usually not bothersome (see #4 below).
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. Skin numbness id different from nipple numbness; most skin 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. National saline deflation rates are around 4-9%. (One of the reasons I'm not a fan of saline implants--and we used thousands between 1991 and 2006, courtesy of the FDA restrictions. Rippling--despite proper overfill--is another concern.).
6) The present generation of silicone gel implants (by both manufacturers) are cohesive and cannot deflate or leak, and take an extraordinary force (or manufacturer defect--very rare--or surgeon damage) to cause rupture. MRI is incorrect 21% of the time (FDA data), and with these newest implants is unnecessary, IMHO.
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 27-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! Best wishes! Dr. Tholen

Hi there and thank you for the question
The complications are certainly in the realm of a top 10 list of the most frequent implant based issues post operatively. Now these certainly dont occur often but they are definitely worth mentioning and involved in something called “informed consent”. 
Now there are other complications that can occur but these are even more infrequent and if you are looking for a most extensive exhaustive list then perhaps a repeat consultation or assessment with your surgeon is necessary. 
Best
Waqqas Jalil
MD FRCSC

Thank you for your question.  For the most part, breast augmentation surgery is very safe.  In fact, it is one of the safest surgeries we perform.  However, there are indeed potential complications ranging from infection, to undesired cosmetic outcome, implant rupture, capsular contracture, bottoming out, implant malposition, etc.  Many of these can be found at the link attached or covered in the video attached.

Great questions. Before you think of undergoing any cosmetic surgery, make sure your doctor is a board certified plastic surgeon with experience. It is possible for some complications to arise when undergoing a breast augmentation. Some complications may include infection (which can be treated with an antibiotic), chronic breast pain, or nipple numbness, calcium buildup in breast tissue, capsular contracture, which is hardening of the breast area around the implant. Hope this helped, best of luck.  Dhaval M. Patel Double board certified Plastic surgeonHoffman EstatesBarringtonOakbrookChicago

Although breast augmentation is generally considered a safe
procedure, complications can occasionally occur. The vast majority of complications are
related to breast aesthetics. Frequent
issues include size, shape, contour and symmetry of the breasts.Additional
areas of concern including bleeding, infection, pain, anesthesia problems,
seroma, scarring, fat necrosis, decreased sensation, wound separation, capsular
contracture and implant leakage.Complications
can be minimized by consulting a board certified plastic surgeon with
experience performing this procedure.This procedure is associated with high satisfaction rates and improved
quality of life.

There are other risks.  A comprehensive consultation with a board certified plastic surgeon in your area should cover all of these.

Best,

The newer silicone implants are from a more cohesive gel and are safe for insertion. However, with any device there are risks and side effects.  The risks include changes in sensation of breasts or nipple/areola complexes, infection, asymmetry, and poor scars.

Hello. You pose a great question. Your list is comprehensive. Although some complications, occur more frequently than others, when breast augmentation is performed in a fully accredited surgery center with board certified anesthesiologists by a competent board certified plastic surgeon who specializes in breast augmenation theses risks are extremely low.

The risks of breast augmentation and other cosmetic procedures are real and need to be fully understood. But at the same time, they are relatively rare and should not prevent you from having the surgery if you really want to do so and are a good candidate. Each of the listed issues (reoperations, capsular contracture, sensation changes, rupture, etc) are neither one in a million nor one in 10, but somewhere in between for each of the complications. The complication rate does vary with surgeon technique and experience, so finding a board certified plastic surgeon is extremely important. 

its ok to worry.  and its ok to do your homework!  the list of risks you mentioned are relatively comprehensive.  that being said, most of these risks are quite low.  there are some things that will definitely happen, given enough time, such as need for replacement of implants.  other things, like breast pain and change in nipple sensation are actually quite low.  silicone implants have been proven to be quite safe and i believe the risk of capsular contracture is lower with the new silicone implants than with the old ones.

Satisfaction rates among breast augmentation patients are among the highest of all plastic surgery procedures performed in the United States.  Over 90% of patients report satisfaction with their breast augmentation and 95% feel that their appearance has been significantly improved.  Despite this high satisfaction rate, there are risks associated with breast augmentation that must be considered before undergoing surgery.  

Risks of Breast Augmentation Include:

Postoperative Blood Collection (Hematoma, Requiring Removal):  1-3%

Infection of the Breast Implant (Requiring Removal):  < 1%

Permanent Increase, Decrease, or Change in Nipple Sensation:  ~15%

10-Year Re-Operation Rate (for Implant-Related Causes):  25-40%

Saline Implant Rupture:  5-10% Chance over 10 years (or ~ 1% per year)

Silicone Implant Rupture:  1-6% Chance over 6 years (depending on type)

Capsular Contracture (Requiring Surgical Correction):  ~10% Chance over 10 years

Silicone Gel Migration:  Unlikely with today's silicone implants

Breast Pain:  5-17% at 5 years

In summary, most patients are extremely happy with their breast augmentation results, but there are real risks associated with the surgery.  In addition to educating yourself on the potential risks and benefits of breast augmentation, I also recommend that you choose a plastic surgeon certified by the American Board of Plastic Surgery with experience in breast augmentation.  I hope this information is useful, and congratulations on being proactive and seeking as much information as possible prior to surgery.

Jaime Perez, M.D.

Breast Augmentation Specialist

Plastic Surgery Center of Tampa, Florida