What are the main breast implant replacement risks and complications?
Before you consent to have a surgical procedure, it is important that you are educated and aware of all of the potential breast implant replacement risks and complications. If you smoke, have a high BMI or have any serious medical conditions it can increase the risk of complications occurring during and after surgery. Some of the potential breast implant replacement risks and complications include:
General surgical complications
All surgery carries some general risks. These include:
- Blood clots
- Anaesthetic risks
- Allergic reactions
- Nausea and vomiting
- Post-operative pain
This is the most common complication following breast implant surgery and is, in fact, a reason for having a breast implant replacement procedure. As previously described, a capsule of fibrous scar tissue forms around breast implants once they are inserted. This encapsulation occurs in all women. If, however, this capsule is particularly tough it can make the breast feel hardened. Additionally, if the capsule contains muscular tissue it can contract and can cause pain. The contractions can distort the shape of the breast implant which can then change the aesthetic of the breast.
Although this can be addressed with a capsulectomy procedure, it is important to note that having this form of breast implant revision does not remove the risk of future breast implants also having capsular contracture. Around 10% of women who have breast implants are thought to have problems with capsular contracture.
Many women will be happy with the cosmetic outcome of their implant replacement procedure. However, in some cases, they may wish they had kept their old implants in place. It is important that you think carefully about whether or not to have a revision for cosmetic reasons. Your surgeon will discuss the options available to you and help you to decide what is right for you. It may be useful to see before and after pictures of other breast implant replacement procedures that your surgeon has done. In addition, make sure you are open and honest with your surgeon about your expectations from surgery. This will help them tell you if what you want to achieve is possible.
Need for further revisions
In most cases, an implant replacement procedure will achieve the desired effect. However, some women may find that they are unhappy with the outcome or suffer from more complications. As a result, further revision surgery may be required. Choosing an experienced BAPRAS/BAAPS affiliated surgeon will help reduce this risk. Importantly, it is beneficial to share with your surgeon exactly what you are hoping to achieve so they can confirm whether your goals are realistic before the surgery.
Implant rupture and leakage
If you are having a breast implant replacement, there is a risk that the new implant may rupture or leak. This is unlikely to occur as implants are now designed to be long-lasting, however, there is always the risk that the implant can fail. Rupture occurs when the implant splits open, leaking its contents. The contents are contained within the capsule that surrounds the breast implant. The contents, therefore, do not spill out into the breast tissue and beyond. Rupture is more likely to occur with a saline implant, however, silicone implants can also rupture. If a silicone implant ruptures, the contents do not leak out as rapidly and this is known as a “silent rupture”. Features to look out for in the case of implant rupture, include:
- Change in breast shape
- Swelling of the breast
- A lump in the breast
- Redness and discomfort
After an implant has ruptured or leaked, it requires removal. It can later be replaced with a new breast implant.
Over time, the breast tissue becomes less firm and can begin to droop downwards. This occurs in both natural breasts and those with implants. Larger implants will cause a greater amount of drooping. If you feel that your breasts are beginning to droop too much, this can be treated with surgery. In most cases, a breast uplift is performed to lift the breasts upwards and correct the effects of gravity.
This occurs when the breast implant pocket, the area in the breast where the implant is placed, becomes too loose. As a result, the breast tissue moves towards the armpits. This leads to a reduction or loss of cleavage. Some women will choose to have an implant revision to treat lateralisation. However, it remains to be a complication even with a new implant inserted. It is also more likely to occur in women with a small amount of natural breast tissue who then choose to have larger implants.
Loss of sensation
After having surgery, you may experience an altered sensation over the chest area. This will generally get better with time but can take up to several months. The most common symptoms include increased or reduced sensitivity around the surgical scar and nipples. In rare cases, nerve damage during surgery can cause permanent numbness.
A rare complication of breast implant replacement surgery involves damage to the blood vessels which supply the breast. If these vessels are damaged then there will be a lack of blood supply to the breast tissue and skin. This lack of blood supply can cause the tissue to die, also known as tissue necrosis. This process is much more common in smokers as smoking can cause damage to the inner lining of blood vessels. Diabetes and obesity also increase the risk.
Features of tissue necrosis include the skin turning a darker colour, and possibly turning black. Wounds can also develop. You may notice that your breasts feel lumpy, hard and painful. If you experience any of these symptoms you should get in touch with your surgeon as soon as possible. If the area of tissue necrosis is small it may heal by itself. However, if the area is larger then you may need further surgery to repair the wounded area of tissue.
BIA-ALCL stands for Breast Implant-Associated Anaplastic Large Cell Lymphoma. This is a rare type of lymph node cancer that has been associated with breast implants. It is a cancer of immune cells, not of the breast. Only a small number of cases have occurred worldwide and, as a result, the risk of BIA-ALCL is not clear. Estimates of its incidence vary from 1 in 4,000 to 1 in 300,000. Therefore, this lymphoma arising from breast implants is very rare.
Regardless of how rare BIA-ALCL is, it is important to be aware that the risk is still there. Additionally, knowing about the symptoms is very important. Signs of BIA-ALCL include swelling of the breast, a thickened mass in the breast and fluid collection around the implant. Treatment would include the removal of the implant and capsule as the cancer is usually well confined within the capsule itself. In some cases, chemotherapy would be required to treat cancer.
Bruising and bleeding
Most women experience some bruising and bleeding after surgery. This is to be expected following any procedure. However, sometimes this bruising and bleeding can be more severe. This usually happens soon after surgery, but can occur in the weeks afterward. You may notice symptoms such as the breast becoming very swollen and tight. If you experience these symptoms, you should contact your surgeon as soon as possible. You may need further surgery to treat the bleeding; if this is done promptly the outcome is usually very good.
All surgery carries a risk of infection. If you are affected, this will become apparent in the first two to three weeks after surgery. In most cases, the infection will be mild and can be treated with antibiotics. However, if you have any of the following symptoms, you should speak to your surgeon promptly:
- Temperature above 38° C
- Redness at the incision line that is beginning to spread away
- Yellow, pus-like fluid coming from the incision site or drains
- Pain or discomfort that can’t be controlled with painkillers