Breast Augmentation

Breast Implant Augmentation

Breast Augmentation Cost

Types of Surgical Procedures

           - Areola (Nipple)

           - Transaxillary (Underarm)

           - Inframammary Fold (Crease)

           - Trans-Umbilical (Belly Button)

           - Submuscular (under the muscle)

           - Subglandular (over the muscle)

Candidates For Breast Implant Surgery

Types of Breast Implants

           - Saline-Filled

           - High Profile / Standard

           - Expandable

           - Smooth / Textured

           - Round / Tear-Drop

Choosing The Right Implant Size

Breast Augmentation Consultations

           - Preparing For Your Consultation

           - What To Expect

Risks of Surgery

Before Your Surgery

During The Procedure

After Breast Augmentation Surgery

           - Massage and Compression

           - Mammograms and Self-Exams

Finding The Right Cosmetic Surgeon

Before Breast Augmentation Surgery

Removing Breast Implants

Breast Implant Glossary of Terms

Breast Implant Complications

           - Re-Operations

           - Removal  

           - Rupture / Deflation

           - Capsular Contracture

           - Breast Pain

           - Breast Sensation Changes

Highland Plastic Surgery Centers is a division of Highland Medical Centers

OTHER RESOURCES:

Highland Pain Institute

Highland Bariatric Institute

Highland Sleep Institute

Highland GERD Institute

Breast Implant Complications

Key points to consider whether you are undergoing breast augmentation, reconstruction, or revision:

• Breast implants will not last a lifetime. Either because of rupture or other complications, you will likely need to have the implants removed.

• You are likely to need additional doctor visits and reoperations because of one or more complications over the course of your life.

• You are likely to have the implants removed, with or without replacement, because of one or more complications over the course of your life.

• Many of the changes to your breast following implantation may be cosmetically undesirable, as well as irreversible (cannot be undone).

• If you later choose to have your implants removed, you may experience unacceptable dimpling, puckering, wrinkling, loss of breast tissue, or other undesirable cosmetic changes of the breast.

Potential local breast implant complications are bulleted below. You may need non-surgical treatments or reoperations (including removal of your implant) to treat any of these local complications. Potential local complications include, but are not limited to:

• Asymmetry
• Inflammation/irritation
• Breast pain
• Malposition/displacement
• Breast tissue atrophy
• Necrosis
• Calcification/calcium deposits
• Nipple/breast sensation changes
• Capsular contracture
• Palpability/visibility
• Chest wall deformity
• Delayed wound healing
• Redness/bruising
• Extrusion
• Rupture/deflation
• Galactorrhea
• Scarring
• Granuloma
• Seroma
• Hematoma
• Unsatisfactory style/size
• Iatrogenic injury/damage
• Wrinkling/rippling
• Infection, including Toxic Shock Syndrome

Reoperation

As stated above, 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.

Reasons for reoperations could include any of the potential local complications bulleted above, such as capsular contracture, wrinkling, asymmetry, rupture/deflation, implant malposition, etc.

The type of surgical procedure performed during the reoperation depends on the local complication involved. More than one procedure may be performed in a single reoperation. Examples of the types of surgical procedures that may be performed in a reoperation include:

• implant removal with or without replacement

• capsule procedure (e.g., removal or surgical release of the capsule)

• scar or wound revision (e.g., surgical removal of excess scar tissue)

• drainage of a hematoma (e.g., inserting a needle or tube through the skin to drain the collection of blood)

• repositioning of the implant (e.g., surgically opening the incision and moving the implant)

• biopsy/cyst removal (e.g., inserting a needle through the skin or cutting through the skin to remove a lump).

Multiple reoperations to either improve the appearance of the breasts, to remove ruptured/deflated implants, or both may result in an unsatisfactory cosmetic outcome.

A retrospective study by Gabriel, et al. showed that 24% of women with breast implants had complications resulting in a reoperation during the first five years after implantation (silicone and saline implants were studied together).  According to this study, about 1 in 3 women getting breast implants for reconstruction needed a reoperation within five years, and about 1 in 8 women getting breast implants for augmentation needed a reoperation within five years.

Breast Implant Removal

Removal of the implants, with or without replacement, is one type of surgical procedure that may be performed in a reoperation. As stated above, you are likely to have your implant removed at some time over the course of your life because of one or more local complications.

Reasons for removal could include any of the potential local complications bulleted above, such as capsular contracture, wrinkling, asymmetry, unsatisfactory size/style, etc. Many women decide to have the implants replaced, but some women do not. Women who do not have their implants replaced may have cosmetically undesirable dimpling, puckering, or sagging of the breast following removal of the implant, or both. Recall that some health insurance companies may not cover implant removal or implant replacement even though the first implant surgery was covered by health insurance.

Prospective studies of saline-filled breast implants approved by FDA in May 2000 showed implant removal rates of 8% at 3 years and 12-14% at 5 years for augmentation patients. The same studies showed implant removal rates of 23-27% at 3 years and 28-30% at 5 years for reconstruction patients.

In a retrospective study of augmentation patients with silicone gel-filled breast implants, 33% of women reported that they had at least one reoperation in which their implant were removed or replaced. The average time to removal, as reported by those who remembered the date of their surgery, was 11.5 years.

Rupture / Deflation
Breast implants do not last a lifetime. Some breast implants rupture/deflate 14 in the first few months after being implanted and some deflate after several years. Others may take 10 or more years to rupture or deflate.

The following surgical practices are not recommended for the approved saline-filled breast implants because they are known to cause rupture/deflation:

• closed capsulotomy (technique used to relieve capsular contracture involving manually squeezing the breast to break the hard capsule)
• placement of drugs/substances inside the implant other than sterile saline
• any contact of the implant with Betadine® 15
• injection through the implant shell
• alteration of the implant
• stacking of the implants (more than one implant per breast pocket).

In addition to the surgical practices above that have been shown to cause rupture/deflation of saline-filled breast implants, there are other reasons for rupture/deflation of breast implants. Companies are currently studying what these other reasons are. Some possible reasons for rupture/deflation of breast implants include:

• normal aging of the implant
• damage by surgical instruments
• too much handling during surgery
• damage by procedures to the breast, such as biopsies and fluid drainage
• compression during mammographic imaging
• stresses such as trauma or intense physical pressure
• capsular contracture
• overfilling or underfilling of saline-filled breast implants
• placement through an umbilical (belly button) incision site because it involves too much handling of the implant.

Doctors usually recommend removal of the implant if it has ruptured, regardless of whether it is saline-filled or silicone gel-filled.

Capsular Contracture

Capsular contracture happens when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant. It can happen to one or both of the implanted breasts. There are four grades of capsular contracture - Baker grades I through IV. The Baker grading is as follows:

Capsular contracture may be more common following infection, hematoma, and seroma. However, it is not known for sure why capsular contracture happens. The literature also discusses other factors, such as a textured implant surface and submuscular placement of the implant, which may decrease the capsular contracture rate.

A reoperation may be needed to correct capsular contracture, usually for grade III or IV capsular contracture. The surgical procedures range from removal of the implant capsule tissue with or without replacement of the implant itself. Capsular contracture may happen again after this reoperation.

Breast Pain
Women may feel pain of varying degrees and length of time following breast implant surgery. In addition, improper size, placement, surgical technique, or capsular contracture may result in pain. You should tell your doctor if you have pain.

Breast Sensation Changes
Sensation (feeling) in the nipple and breast can increase or decrease after implant surgery. The range of changes varies from intense sensation to no sensation in the nipple or breast following surgery. Changes in sensation can be temporary or permanent and may affect sexual response or the ability to nurse a baby.