Complications and Side Effects

In spite of due care the results of cosmetic surgery are not as predictable as we expect. Every procedure involves obvious inherent risks. Every patient can be dissatisfied with some aspect of the results of their operation. Your aesthetic result cannot be guaranteed as surgery is not an exact science. A happy outcome is when the benefits outweigh the drawbacks and limitations.

The surgeon cannot predict the following:
  
Genetic characteristics of the patient’s tissue that allows excessive stretching even with well-considered size of implants and surgery options.

Rapid descent: Some patients’ tissue is unable to hold the implants in their position and the implants move down on the chest wall. The scar rides up on the breast which looks bottom heavy. This is regardless of wearing adequate support bras. Drooping of the nipple, areolar and breast tissue, even after a breast lift, will be accelerated in patients who have poor tissue.

Detectability: The implant edge may become palpable and obvious with crinkling, particularly with weight loss.

Stretch marks.1:500 cases. If you already have stretch marks on your body you are susceptible to this risk.

Nipples and Areolars: They may change in size, shape and colour after augmentation. Slight breast asymmetry in the nipple areola complex position is magnified with breast augmentation. Breast augmentation can distort the nipple areola complex and it can enlarge a lax area.

Asymmetry: Chest wall and breast asymmetry may not be obvious at the time of consultation but after augmentation, with equal size implants, asymmetry may become more obvious.

Capsular contracture: 2% chance in sub pectoral pocket and 4% in sub glandular pocket.

Scars: Thickening, hyperpigmentation, puckering and keloid formation occurs in a small percentage of patients. The scar location is at best a very good estimate. It is impossible to site this perfectly at the time of surgery.

Inflammatory and infective conditions: Very rare.

Sudden haemorrhage: early or late: 1% chance.

Seroma: fluid formation is a 2 % chance.

Implant rupture: Although silicone implant prothesis have improved tremendously with the advent of cohesive gel. Implants can still rupture and leak and silicone can migrate though breast tissue. This is however  extremely rare, at about 1 :1000.

Nerve damage: permanent nipple numbness: 1:500. Some localised numbness and sharp pulling sensations are common. Each breast will feel different.
    
Privacy: The benefit of cosmetic surgery involves privacy.  The objective is established in a private contract between the patient and the surgeon. Maintaining the privacy protects the anticipated outcome. The privacy contract
is broken when the patient enters into conversations with a third party, seeking comments and assurances. This will lead to disappointment and dissatisfaction.       

Tightness: This will ease as the breast tissue envelope relaxes to accommodate the implants. 

Swelling: Swelling is often uneven and may subside more quickly on one side. Most swelling will be resolved in 2 weeks.

Detectability, Wrinkling, Palpability: Many implants wrinkle in the body. You may feel some wrinkling and may feel the implant. This does not indicate a need for further surgery. Detectability depends considerably on subcutaneous fat. A completely natural looking and feeling result is possible only with greater than 15 mm of subcutaneous fat.

Extremely slim body and thin tissue: not suitable to have implants because of extreme detectability, unnaturalness and weakness of tissue.

Active breast deformities: Sub pectoral placement causes 1:20 patients to develop an active breast due to the adhesion of the scar tissue between the breast implant and the pectoral muscle. With the muscle action there is associated movement of the breast. This can be very obvious in the gym etc. An active scar is usually permanent.

Veins: Pre operative breast veins can become more apparent post operatively in the breast skin across the chest. It can become very disconcerting for patients.

Asymmetry: Where there is noticeable asymmetry of the nipple and areolar, breast shape and position, correction cannot be achieved with only breast augmentation. Other procedures may be necessary and should be discussed. Correction of unequal breast sizes with different size implants is an attempt to improve the results. It is not accurate and cannot achieve perfect symmetry.
Even when looking for asymmetry in physical examination and reviewing photos, asymmetry can still go undetected until after the operation. It can typically be far more obvious.

Recovery: The healing of each side of the breasts is always different due to the biological variations in the nerve supply and your individual response. The breasts will naturally feel different.

Cleavage: Skinny patients are unable to achieve a good cleavage with breast
augmentation. The space between the breasts remains wide.                                          

Symmastia: Is the joining together of the breasts in the middle and the loss of cleavage. Patients with soft subcutaneous tissue and large implants risk symmastia.

Double Bubble: Can occur where the base of the natural breast is smaller than the base of the implant i.e. smaller breast on top of bigger implant.

Breast checks: It is recommended that you attend a specialist clinic for breast scanning because some clinics do not carry out competent checks on patients with implants.

Breast-feeding: Pregnancy can alter the normal size and shape of your breasts with or without augmentation. Breast implants will not affect your ability to breast-feed. Often after breast feeding the breast needs lifting to correct droop.

Activity: Movements should be within your comfort limit. You are encouraged    to move your arms the day after surgery. Wash your hair and have a shower and gently increase your arm movements. Regular exercise can be commenced at two weeks.

Subpectoral Placement: After surgery you may find it difficult to continue with push ups, chin ups or any pectoral major exercises.

Over-activity: In the first 2 weeks can lead to an incision wound rupture.
                                                                       
Choosing your size: There are a percentage of patients who will be unhappy, whatever size they choose, for what ever reason.

Rotation: It is very rare for implants to turn around or flip.

Mondor’s Band: Are extremely rare 1: 1000. They are an uncomfortable vertical band that stretches under the skin from below the incision to the navel. These bands spontaneously resolve in 3 months without treatment.

Partners: Are important and need to be involved in the understanding of side effects and anticipated results. You are encouraged to bring your partner to accompany you at consultation as we would like to address his concerns too. When you are in a relationship you must inform your partner that you have breast implants to avoid losing trust within the relationship. Partners objection can lead to distress that may manifest as real physical pain in the breast.

Career Change: Requirements for breast augmentation specific to your career may change as your career changes.
                                       
Unacceptable new body image: You may discover larger breasts may not be to your liking after all. They may feel too heavy, are obvious and may attract unwanted attention.

Unacceptable foreign body: Over a period of time there is a 1% chance of you developing an aversion to the presence of a foreign object in your body. You may request its removal.

Secondary effects: When complications occur you may risk significant adverse effects in your life. Eg, social, sexual, physical, financial and emotional areas. Ambitions for cosmetic surgery to achieve social and modelling, professional goals may not be achieved.

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