Complications of Breast Implant Surgery
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
about the complications of breast augmentation. 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
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.
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.
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
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.
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.
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 on my
website for more information.
Al Rosenthal, MD, is a board certified plastic surgeon practicing
cosmetic and reconstructive surgery in the northern Atlanta suburbs.
a purely marketing blog, his blog truly is a random musing about the
art and business of plastic surgery. Feel free to post any comments and
he will happily respond. Also, questions can be asked on the main
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