Failure rates for breast implant surgeries
Certainly, the failure rate for irradiated breast reconstructions with implants is exceedingly high. High enough that when I was performing all the breast reconstructions at the University of Washington, I wouldn't even try to do one after radiation without transferring the patient's own tissue to make the breast.
With breast augmentation, if you have had many failed surgeries, extrusions, infections etc. and are left with thin, scarred tissues, you need to realize that you will unfortunately never have a great breast augmentation. It is unfortunately the case that there are rare cases where implants and the patient just don't mix and they need to give up on the process rather than continuing to push forward into ever worsening results.
Breast Enhancement Surgery
The complication risk is higher for breast prosthesis in breast reconstruction compared to aesthetic breast surgery for a number of reasons
Breast augment and reconstruction complication rates
There is a major difference between augmentation in the "virgin" breast and reconstruction after mastectomy, particularly involving radiotherapy. The risk of extrusion and other complications increase exponentially because of the thinness and friability of the irradiated skin. In reconstruction, you take whatever remains of the skin (or not) as you find it. If you have undergone a failed breast augmentation, the key consideration is why: infection, too large an implant for the pocket created during surgery, bleeding. Only when the cause is evaluated can an intelligent decision be made on whether additional surgery could or should be pursued and under what circumstances.
Breast reconstruction after radiation and redo breast augmentation are both challenging
Breast reconstruction after radiation is difficult and is usually best treated with use of the patient's own tissues, such as from the abdomen or the back. While, in the past, reconstruction with tissue expanders for patients who had received radiation was virtually impossible, satisfactory results can now sometimes be achieved with use of some of the newer products to help cover the expanders such as FlexHD, Veritas, etc. These products might be useful in your case.
For you, redo augmentation will be challenging, since you have thinned tissues and scar tissue present. Your surgeon will want to place the implants underneath the muscle as much as possible, and I have had success in providing better coverage with the products noted above. Your risk of infection or implant exposure with need for explantation is obviously higher than for a first time augmentation, but there is a reasonable chance for success. Seek out a plastic surgeon experienced in breast surgery.
Options and Complications in Re-Do Breast Augmentation
If I understand your question correctly, you are drawing a comparison between the complications seen in a RADIATED breast and a SERIALLY IMPLANTED/FAILED breast - BOTH about to be implanted and want to know how PREDICTABLE such complications will be.
While BOTH cases present serious challenges to good results with breast implants, they have in common only the fact that they are difficult and have a high rate of complications.
Radiation destroys the blood supply in the skin AND makes the skin hard to stretch. As a result, incisions in radiated skin have a hard time healing, implants look unnatural and compressed and often extrude (come through the skin). Many Plastic surgeons prefer using your own tummy, buttock and back tissues to reconstruct a radiated breast than to attempt or re-use breast implants.
In cases of "multiple failed surgeries" "with tissue paper thin skin on one side" , your skin may also have a compromised blood supply, but the similarities end there. What CAN BE DONE with your breasts would depend on what exactly WAS done, on your exact physical examination and most importantly on what you want (IE your expectations). In fact, your options are limited and you will best be served by collecting all this information and seeing a Plastic surgeon who does a lot of reconstructive breast surgery who can offer you all possible options.
Dr. P. Aldea
Complications of Breast Augmentation
You ask several very interesting questions.
People with radiation to the breast have high complication rates with implant reconstruction due to the effects of radiation (decreased blood supply, poor tissue characteristics, and paucity of tissue). Complications also include very high rate of contracture.
Higher complication rates also have been reported with re-operation in non-cancer patients. I am not familiar with the exact numbers, but the rate of complications is much less that in cancer reconstruction.
That being said, if you like implants, and you are otherwise healthy, it is usually worth the risks. My big concern is the condition of the side with paper thin skin.
I advise you have an exam and serious discussion with an experienced plastic surgeon to see what YOUR risks are.
Breast reconstruction versus breast implants
Certainly breas reconstruction patients that have had radiation have a higher incidence of complications. This is secondary to the radiation. This rate is much higher than patient who have just had breasat augmentation. But, yes, if your tissues are paper thin you certainly will have more problems than someone with thicker tissues.
Complications after multiple breast implant operations
What you have read is true. With reconstruction after radiation treament, the tissue is changed in a way that makes it less supple, so it won't allow for expansion and a soft natural feeling envelope around a breast implant. For that reason, implant reconstruction is not the number one option after radiation.
With augmentation, statistics show that previous revision surgery is the best predictor of needing further revisions. Some patients get on a cycle of multiple surgeries where the result is thinning of the tissues. Fortunately there is a good option for cases like that. What is needed is something to replace the missing tissue and give better support to the implant, and reduce the chance of capsular contracture, one of the main reasons for re-operation in the first place. A material called Strattice is proving very useful.
Repeated and complicated breast augmentation
Fortunately there are not large numbers of these patients and so there is not alot of research on this subject but the brief answer to your question is yes. Re-operations on BA patients have a higher rate of complications when compared to primary BA patients but not as frequent as radiation treated patients. This data is easily found on the BA brochure for silicone implants provided by the implant companies through your plastic surgeon and has detailed percentages and rates of specific complications. IF your condition is severe enough it may warrant approaching your augmentation as a reconstruction with correction by your own tissue.
These are all very good questions with long complex answers--probably a bit too involved to get into in this forum. The short answer is that a history of prior radiation puts you at a significantly high risk of breast implant failure, just as prior complications with normal breast augmentation does as well. However, the reason for the increased risk is for completely different reasons. Paper thin skin certainly puts you at a high risk for future failure, but that does not mean you a guaranteed a failed procedure. I suggest you find a board-certified plastic surgeon with experience in both cosmetic breast augmentation as well as breast reconstruction. The only way to find out the answers to these questions as it pertains to you is to get a thorough evaluation and physical exam. Good luck!