Friday Figure Fix: Making them bigger, part 3

This week's Friday Figure Fix wraps up "Breast Augs 101" for all you rabid MPL fans out there. We covered some common questions, the technical aspects (and more), and today we'll discuss some of the complications of breast augmentation. With this kind of surgery, in a skilled plastic surgeon's hands, complications are fortunately uncommon; but they do happen. This week's post is not necessarily to scare anyone off, but to be realistic, provide you with as balanced a picture as possible, and help you become a better informed consumer.

To begin with, breast augmentation (as I keep harping) is still surgery, so all the common risks inherent to surgery apply: bleeding, infection, scarring, need for revision, etc. Some of these standard surgical risks do merit a deeper discussion in the case of breast implants.

Bleeding. We'll include hematomas and seromas in this part of the discussion. But first, some bleeding is expected; we are talking about putting surgical steel to the skin and parts beneath, right? Surgeons, and especially plastic surgeons, have a love/hate relationship with bleeding. On the one hand, bleeding is good - it reassures you that the tissue you're working with is alive; on the other hand, bleeding is bad - blood belongs on the inside, not where you're working...

Anyhow, when we're dealing with breast implant surgery, the rate of bleeding complications is fairly low; we're generally working in an easily identifiable layer where a lot of pesky blood vessels are not typically encountered. So hematomas (collections of fresh or clotted blood) and seromas (collections of clear fluid created by the body) do happen after breast augmentations, but rarely. A few surgeons place drains (tubes to help evacuate fluid from the body) to prevent hematomas and seromas from developing after breast augmentations, but most (including us at Duet) usually don't.


Infection. A lot of times in surgery, wound infections can be dealt with in a fairly straightforward matter; throw some antibiotics at the problem, and things get better. In plastic surgery when we're dealing with implants, we take any hint of infection much more seriously. Because if those implants become infected, surgery often needs to be performed urgently to remove them. If that happens, the body has to be allowed to heal - for several weeks to months - before you can put implants in again.


Asymmetry. Most women are not perfectly matched to begin with. One breast is often larger than the other, and sometimes the alignment of the nipples/areola can be off. Although plastic surgeons do their best to achieve symmetry, if you started out uneven you might still see some of that after a simple breast augmentation surgery. Sometimes the difference seems more exaggerated, because the size of the implants.


Scarring. Again, all surgery causes scarring. As we discussed a few weeks ago, there are ways to disguise the incisional scars necessary to place the implants in the right place. Rarely, those scars can become unsightly, itchy, or even painful. Some of that is caused by surgical technique, but a lot of it depends on your genetics and personal history (some folks, unfortunately, are just prone to scar worse than others).

Capsular contracture. This is a particular kind of scarring specific to implants. Whenever something foreign is placed in the human body, the body reacts by forming a capsule, or scar, around the non-self matter. It's sort of like oysters creating a pearl around an irritating grain of sand.

Sometimes the body overreacts to the foreign body, however, and capsular contracture can develop. The scar capsule that naturally forms around the breast implant is usually soft, pliable, and unnoticed by the patient. When it becomes a problem, that capsule becomes hard, contracted, distorted, and in the worst case, painful. This requires additional surgery to remove the capsule and sometimes even the implant.


Need for revision/replacement. Unfortunately, breast implants are not lifetime devices. On average, a woman who gets breast augmentation can expect to have some sort of surgery every 10 years. Surgery may be needed to remove scar capsule, as mentioned above, or replace the implant, which can leak, rupture, or deflate. This is not to say that surgery should be scheduled regularly, like a yearly physical or oil change. I've seen some women need their implants replaced within a few months, and others (who had the very first implants, in the 1960s) who have never had a problem.

But once you have breast implants, you do need to be vigilant about your breasts - self exams, mammograms, and just an awareness of what normal looks and feels like for your breasts. If you have saline-filled implants, it's relatively easy to know if the implant is leaking (you'll notice that one boob is smaller than the other, because the leaking saline is simply absorbed by your body). It's a little tougher to tell with the silicone-gel filled implants, since the cohesive gel doesn't run, so regular screening MRIs to look for leaks and ruptures are necessary.

And of course, while the vast majority of patients are very happy with the results of their breast augmentation surgery, a few women wish they had gone bigger, smaller, or not at all. Revisional surgery - to upsize, downsize, or remove the implants - can be performed.


More questions? Feel free to email me - AngelineLimMD [at] DuetPlasticSurgery [dot] com.