Risks & Complications of Breast Implant Reconstruction
Every surgical procedure involves a certain amount of risk, and it is important that you understand the risks involved with the placement of a permanent breast implant or following tissue expansion breast reconstruction surgery.
An individual’s choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of women do not experience the following complications, you should discuss each of them with your plastic surgeon to make sure you understand the risks, potential complications, and consequences of placement of permanent breast implant following tissue expansion breast reconstruction. Problems associated with breast implants can be inherent to this type of implanted medical device or relate to complications of a surgical procedure. Additional advisory information regarding this subject should be reviewed by patients considering surgery that involves breast implants.
While every patient experiences her own individual risks and benefits following breast implant surgery, clinical data suggests that most women will be satisfied with the outcome of breast implant surgery despite the occurrence of problems inherent with the surgery.
Specific Risks of Breast Implant Surgery
Silicone Gel-filled Implants – Breast implants, similar to other medical devices, can fail. When a silicone gel-filled implant ruptures, the gel material is usually contained within the scar tissue surrounding the implant (intracapsular rupture). In some cases, the gel may escape beyond the capsule layer and go into the breast tissue itself (extracapsular rupture and gel migration) or to more distant locations. Migrated silicone gel may be difficult or impossible to remove. Rupture of a breast implant may or may not produce local firmness in the breast. Patients are advised to refer to individual manufacturer’s informational materials regarding the incidence of device rupture reported during pre-market studies. It is impossible to predict the biological response that a patient’s tissues will exhibit to the placement of breast implants or how you will heal following surgery.
Rupture can occur as a result of an injury, from no apparent cause or during mammography. Rupture of a silicone breast implant is most often undetected (silent rupture). It is possible to damage an implant at the time of surgery. Damaged or broken implants cannot be repaired. Ruptured or damaged implants require replacement or removal. Breast implants can wear out, they are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants.
An MRI (magnetic resonance imaging) study is advised to evaluate the possibility of implant rupture, yet it may not be 100% accurate in diagnosing implant integrity. It should be noted that regular screening MRI examinations are recommended. Specifically, patients are advised to follow recommendations for serial MRI examinations, starting at 3 years after surgery and then every 2 years thereafter.
Silicone Gel Bleed – The evidence is mixed regarding whether there are any clinical consequences associated with silicone gel bleed. Over time, extremely small amounts of silicone gel material and platinum can pass through the shell layer of the implant and coat the outside of the implant. Studies indicate that small amounts of platinum in its most biologically compatible (zero oxidation) state are contained within silicone gel. Microgram amounts of platinum in this state have been found to diffuse outside of breast implants. This may contribute to capsular contracture and lymph node swelling. The overall body of available evidence supports that the extremely low levels of gel bleed are of no clinical consequence.
Capsular Contracture – Scar tissue, which forms internally around the breast implant, can tighten, and make the breast round, firm, and possibly painful. Excessive firmness of the breasts can occur soon after surgery or years later. The occurrence of symptomatic capsular contracture is not predictable. The incidence of symptomatic capsular contracture can be expected to increase over time. Capsular contracture may occur on one side, both sides, or not at all. It is more common with implant placement in front of the chest muscle layer. Treatment for capsular contracture may require surgery, implant replacement, or implant removal.
Capsular contracture may reoccur after surgical procedures to treat this condition and it occurs more often in revision augmentation than primary augmentation. It may be helpful to take preventative antibiotics for dental treatments (cleaning, whitening strips, root canal treatment, and cavity treatments), sinus infection, or urinary tract infection among other bacterial potential infections. Discuss this with your surgeon.
Implant Extrusion / Tissue Necrosis – Lack of adequate tissue coverage or infection may result in exposure and extrusion of the tissue expander or implant through the skin. Tissue breakdown (necrosis) has been reported with the use of steroid drugs, after chemotherapy/radiation to breast tissue, due to smoking, microwave diathermy, and excessive heat or cold therapy. In some cases, incision sites fail to heal normally. A tissue expander or implant may become visible at the surface of the breast as a result of the device pushing through layers of skin. If tissue breakdown occurs and the tissue expander or implant becomes exposed, removal may be necessary. Permanent scar deformity may occur.
Change in Nipple and Skin Sensation – Breast reconstruction cannot restore normal sensation to the breast or nipple. Changes in sensation may affect sexual response or the ability to breastfeed a baby.
Skin Wrinkling and Rippling – Visible and palpable wrinkling of implants and breast skin can occur. Some wrinkling is normal and expected with silicone gel-filled breast implants. This may be more pronounced in patients who have silicone gel-filled implants with textured surfaces or thin breast tissue. Palpable wrinkling and/or folds may be confused with palpable tumors and questionable cases must be investigated.
Calcification – Calcium deposits can form in the scar tissue surrounding the tissue expander and may cause pain, firmness, and be visible on mammography. These deposits must be identified as different from calcium deposits that are a sign of breast cancer. Should this occur, additional surgery may be necessary to remove and examine calcifications.
Chest Wall Irregularities – Chest wall irregularities have been reported secondary to the use of tissue expanders and breast implants. Residual skin irregularities at the ends of the incisions or “dog ears” are always a possibility when there is excessive redundant skin. This may improve with time, or it can be surgically corrected.
Implant Displacement and Tissue Stretching – Displacement, rotation, or migration of a breast implant may occur from its initial placement and can be accompanied by discomfort and/or distortion in breast shape (visible rippling of the skin). Unusual techniques of implant placement may increase the risk of displacement or migration. Additional surgery may be necessary to attempt to correct this problem. It may not be possible to resolve this problem once it has occurred.
Surface Contamination of Implants – Skin oil, lint from surgical drapes, or talc may become deposited on the surface of the implant at the time of insertion. The consequences of this are unknown.
Unusual Activities and Occupations – Activities and occupations that have the potential for trauma to the breast could potentially break or damage a tissue expander or implant, or cause bleeding/seroma.
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
What is BIA-ALCL?
BIA-ALCL is a rare and treatable type of non-Hodgkin’s lymphoma, a cancer of the cells of the immune system, that can develop around breast implants.
Is BIA-ALCL breast cancer?
No. Even though BIA-ALCL is found in the breasts of some women with breast implants, it is not breast cancer. BIA-ALCL develops in the fluid around the breast implant and is usually contained by the fibrous capsule around implants it does not develop in the breast tissue.
What are the symptoms of BIA-ALCL?
The most common symptom is a persistent swelling of the breast 2 to 28 years after the insertion of breast implants, which may present as fluid collecting around the implant. It can also present as a lump in the breast or armpit.
What is the risk of developing BIA-ALCL?
As BIA-ALCL is a rare condition, it is difficult to be certain about the absolute risk of developing this condition.
However, the following report has been issued:
- BIA-ALCL affects approximately 1 in 50,000 to 300,000 patients with breast implants (January 2016)
- The lifetime risk for BIA-ALCL in previous epidemiological studies ranges from 1:30,000 to 1:50,000.
- The figure derived and issued by the Australian government was in the range of 1:1,000 to 1:10,000 for Australian/New Zealand patients with textured/polyurethane implants.
As a comparison, the risk of breast cancer is about one in eight women.
How is BIA-ALCL diagnosed?
If a woman develops swelling of the breast which has an implant, they are sent for an ultrasound scan, and if fluid is detected this will be removed and tested for BIA-ALCL. Specific tests are asked to exclude or diagnose BIA-ALCL. Most fluid collections around breast implants are not BIA-ALCL but proper testing will be able to tell them apart. Mammograms are not useful in diagnosing BIA-ALCL. In confirmed cases, MRI and PET/CT scans may be performed to help stage the condition.
How is BIA-ALCL treated and what is the prognosis?
Most cases are cured with the removal of implants and the fibrous capsule around them from both breasts. The majority of patients require no additional treatment.
Are some patients at greater risk than others?
It is not possible to predict who will develop BIA-ALCL, and while the Australian Government reports a higher risk of BIA-ALCL in those patients with textured/polyurethane implants, the data is not yet well established. This risk remains far less than those other known risks, such as capsular contracture. BIA-ALCL has been associated with both silicone and saline implants in aesthetic as well as reconstructive patients.
Should patients with breast implants be screened for BIA-ALCL?
Expert opinion is that asymptomatic women without breast changes do not require more than routine follow-up. If a patient experiences a change in her breasts – especially if there is swelling or a lump – she should undergo examination and appropriate imaging, including ultrasound and fine-needle aspiration of any peri-implant fluid.
Should patients have their implants removed?
Neither the FDA nor the Australian Government’s report suggests additional screening or removal of implants for asymptomatic women. Breast implants are not lifelong devices and in general, all will need to be removed or replaced at some point. The commonest reasons for implant removal or replacement are capsular contracture, implant migration, implant leakage, and rupture. Without symptoms or signs of BIA-ALCL routine implant removal is not required unless there are other concerns
What causes BIA-ALCL?
FDA, other international organisations, and implant manufacturers are working proactively to study BIA-ALCL. To date, no specific causal factors have been identified. Implant texturing, bacteriologic contamination, and genetic factors have been implicated and are undergoing further study. Bacteria have been identified within the lymphoma and around implants in affected breasts, and there is accumulating evidence that a long-term inflammatory response to the presence of these bacteria is one of the factors that may cause BIA-ALCL. Research is ongoing to investigate this condition and a better understanding of it.
Genetic factors may play a role. The Australia/New Zealand risk appears higher than other studies have indicated. Some geographic areas have reported very few cases. Ongoing data collection worldwide will help to determine whether or not there are any genetic propensities for this disease.
Do national and international plastic surgery organisations recommend against the use of textured implants?
At this point, the data suggest that BIA-ALCL occurs more frequently following textured than smooth breast implants however available data does not support discontinuance of textured implants and it is not possible to exclude the occurrence of BIA-ALCL in association with smooth implants either at this time.
The best practice is always for the physician to discuss with each patient the known risks and potential complications associated with any procedure. It is important for the patient and her doctor to frankly discuss all options available, and the risks involved.
Patients are offered options regarding breast implants in terms of sizing, shape, and surface. Textured implants may offer advantages in terms of lower risk of capsular contracture and lower risk of malrotation when an anatomically shaped implant is utilised. Depending on a particular patient’s needs, a textured implant may be preferable. The plastic surgeon must provide a frank and transparent discussion regarding the benefits and risks of implants, both smooth and textured.
The patient must then make an informed decision, based upon her assessment of her needs and the risks involved. It is critical that the patient makes a fully informed decision following a full discussion of the risks and benefits.
Can new breast implants be inserted when BIA-ALCL is treated?
Current treatment protocols indicate that the removal of both breast implants with the capsule around them (total capsulectomy) is required because a small number of cases have been diagnosed on both sides at the same time. Implants are not replaced at the same operation. Smooth implants have been re-inserted 12 months following the adequate treatment of BIA-ALCL without disease progression however the safety of this strategy is still being investigated
Where can I get more information?
More information can be found at:
- ISAPS: isaps.org
- ASPS: plasticsurgery.org/alcl
- ASAPS: surgery.org/professionals
- PSF: thepsf.org/research/clinical-impact/profile.htm
- FDA: fda.gov
What should I do if I am considering breast implants?
Women who are considering breast implant surgery should discuss the risks and benefits of the procedure with their Plastic Surgeon including the risks of BIA-ALCL. There are different implant types available and implant selection needs to take into account the risks and benefits of specific choices. Implant selection will be different from one person to the next. Breast implants are not lifetime devices and women with breast implants should all consider that they will require revision or replacement of the breast implants at some point.
General Risks of Surgery
Healing Issues – Certain medical conditions, dietary supplements, and medications may delay and interfere with healing. Patients with massive weight loss may have a healing delay that could result in the incisions coming apart, infection, and tissue changes resulting in the need for additional medical care, surgery, and prolonged hospitalizations. Patients with diabetes or those taking medications such as steroids on an extended basis may have prolonged healing issues. Smoking will cause a delay in the healing process, often resulting in the need for additional surgery. There are general risks associated with healing such as swelling, bleeding, and the length of surgery and anesthesia that include a longer recovery and the possibility of additional surgery, prolonged recovery, color changes, shape changes, infection, not meeting goals and expectations, and added expense to the patient.
There are nerve endings that may become involved with healing scars during surgery such as suction-assisted lipectomy, abdominoplasty, facelifts, body lifts, and extremity surgery. While there may not be a major nerve injury, the small nerve endings during the healing period may become too active producing a painful or oversensitive area due to the small sensory nerve involved with scar tissue. Often massage and early non-surgical intervention resolve this. It is important to discuss post-surgical pain with your surgeon.
Bleeding – It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood, or you may require a blood transfusion, though such occurrences are rare. Increased activity too soon after surgery can lead to an increased chance of bleeding and additional surgery. It is important to follow postoperative instructions and limit exercise and strenuous activity for the instructed time. Do not take any aspirin or anti-inflammatory medications for at least ten days before or after surgery, as this may increase the risk of bleeding.
Non-prescription “herbs” and dietary supplements can increase the risk of surgical bleeding. Hematoma can occur at any time, usually in the first three weeks following injury to the operative area. If blood transfusions are necessary to treat blood loss, there is the risk of blood-related infections such as hepatitis and HIV (AIDS). Heparin medications that are used to prevent blood clots in veins can produce bleeding and decreased blood platelets.
In breast implant surgery, hematoma may contribute to capsular contracture, infection, or other problems.
Infection in Breast Implant Patients – Subacute or chronic infections may be difficult to diagnose. Should an infection occur, treatment including antibiotics, possible removal of the implant, or additional surgery may be necessary. Infections with the presence of a breast implant are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the breast implant may have to be removed. After the infection is treated, a new breast implant can usually be reinserted. It is rare that an infection would occur around an implant from a bacterial infection elsewhere in the body, however, prophylactic antibiotics may be considered for subsequent dental or other surgical procedures. In extremely rare instances, life-threatening infections, including toxic shock syndrome have been noted after breast implant surgery. Individuals with an active infection in their body should not undergo surgery, including breast augmentation.
Although infection is unusual after this type of surgery, it may appear in the immediately post-operative period or at any time following the insertion of a breast implant. It is important to tell your surgeon of any other infections, such as ingrown toenails, insect bites, or urinary tract infections. Remote infections, infections in other parts of the body, may lead to an infection in the operated area.
Scarring – All surgery leaves scars, some more visible than others. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of a different color than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left sides of the body). There is the possibility of visible marks in the skin from sutures. In some cases, scars may require surgical revision or treatment.
Firmness – Excessive firmness can occur after surgery due to internal scarring. The occurrence of this is not predictable. Additional treatment including surgery may be necessary.
Cardiac and Pulmonary Complications – Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli), or partial collapse of the lungs after general anesthesia. Pulmonary emboli can be life-threatening or fatal in some circumstances. Inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that may result in death. It is important to discuss with your physician any past history of swelling in your legs or blood clots that may contribute to this condition.
Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms. If you experience shortness of breath, chest pain, or unusual heartbeats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
Venous Thrombosis and Sequelae – Thrombosed veins, which resemble cords, occasionally develop in the area of the breast or around IV sites and usually resolve without medical or surgical treatment. It is important to discuss with your surgeon any birth control pills you are taking. Certain high estrogen pills may increase your risk of thrombosed veins.
Change in Nipple and Skin Sensation – You may experience a diminished (or loss) sensitivity of the nipples and the skin of your breast. After several months, most patients have normal sensations. Partial or permanent loss of nipple and skin sensation may occur occasionally. Changes in sensation may affect sexual response or the ability to breastfeed a baby.
Skin Discoloration / Swelling – Some bruising and swelling normally occur. The skin in or near the surgical site can appear either lighter or darker than the surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent.
Skin Sensitivity – Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually, this resolves during healing, but in rare situations, it may be chronic.
Skin Contour Irregularities – Contour and shape irregularities may occur. Visible and palpable wrinkling of skin may occur. Residual skin irregularities at the ends of the incisions or “dog ears” are always a possibility when there is excessive redundant skin. This may improve with time, or it can be surgically corrected.
Major Wound Separation – Wounds may separate after surgery. Should this occur, additional treatment including surgery may be necessary.
Sutures – Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires suture removal.
Damage to Deeper Structures – There is the potential for injury to deeper structures including nerves, blood vessels, muscles, and lungs (pneumothorax) during any surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.
Delayed Healing – Wound disruption or delayed wound healing is possible. Some areas of the breast skin or nipple region may not heal normally and may take a long time to heal. Areas of skin or nipple tissue may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Individuals who have decreased blood supply to breast tissue from past surgery or radiation therapy may be at increased risk for delayed wound healing and poor surgical outcome. Smokers have a greater risk of skin loss and wound healing complications.
Fat Necrosis – Fatty tissue found deep in the skin might die. This may produce areas of firmness within the skin. Additional surgery to remove areas of fat necrosis may be necessary. There is the possibility of contour irregularities in the skin that may result from fat necrosis.
Seroma – Infrequently, fluid may accumulate between the skin and the underlying tissues following surgery, trauma, or vigorous exercise. Should this problem occur, it may require additional procedures for drainage of fluid.
Surgical Anesthesia – Both local and general anesthesia involve risk. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation.
Shock – In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death.
If surgical shock occurs, hospitalization and additional treatment would be necessary.
Pain – You will experience pain after your surgery. The pain of varying intensity and duration may occur and persist after surgery. Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue or due to tissue stretching.
Allergic Reactions – In rare cases, local allergies to tape, suture material, glues, blood products, topical preparations, or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur in response to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
Asymmetry – Some breast asymmetry naturally occurs in most women. Differences in terms of breast and nipple shape, size, or symmetry may also occur after surgery. Additional surgery may be necessary to attempt the improvement of asymmetry.
Persistent Swelling (Lymphedema) – Persistent swelling in the legs can occur following surgery.
Unsatisfactory Result – Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of the surgery. Asymmetry in implant/expander placement, displacement, nipple location, unanticipated breast shape and size, loss of function, wound disruption, poor healing, and loss of sensation may occur after surgery. Breast size may be incorrect and not match the opposite breast.
Unsatisfactory surgical scar location may occur. Tissue expander breast reconstruction may fail due to complications attributable to the mastectomy or from later chemotherapy/radiation therapy treatments. It may be necessary to perform additional surgery to improve your results, change size or remove and not replace tissue expander/breast implant.
ADDITIONAL SURGERY NECESSARY (Re-Operations)
There are many variable conditions that may influence the long-term result of the placement of a permanent breast implant following tissue expansion surgery. It is unknown how your breast tissue may respond to implants or how wound healing will occur after surgery. Secondary surgery may be necessary at some time in the future to replace your breast implants or to improve the outcome of surgery. You may elect to or be advised to have your breast implants removed and not replaced in the future. Should complications occur, additional surgery or other treatments may be necessary. Even though risks and complications occur infrequently, the risks cited are particularly associated with the placement of permanent breast implants following tissue expansion surgery. Other complications and risks can occur but are even more uncommon. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. In some situations, it may not be possible to achieve optimal results with a single surgical procedure.
ADDITIONAL BREAST IMPLANT ADVISORY INFORMATION
Deep Venous Thrombosis, Cardiac and Pulmonary Complications – Surgery, especially longer procedures, may be associated with the formation of, or increase in, blood clots in the venous system. Pulmonary complications may occur secondarily to blood clots (pulmonary emboli), fat deposits (fat emboli), or partial collapse of the lungs after general anaesthesia. Pulmonary and fat emboli can be life-threatening or fatal in some circumstances.
Air travel, inactivity, and other conditions may increase the incidents of blood clots traveling to the lung causing a major blood clot that may result in death. It is important to discuss with your surgeon any past history of blood clots of swollen legs that may contribute to this condition.
Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms. If you experience shortness of breath, chest pain, or unusual heartbeats, seek medical attention immediately. Should any of these complications occur, you might require hospitalisation and additional treatments.
Smoking, Second-Hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal Spray) – Patients who are currently smoking or use tobacco or nicotine products (patch, gum, or nasal spray) are at a greater risk for significant surgical complications of skin dying, delayed healing, and additional scarring. Individuals exposed to second-hand smoke are also at potential risk for nicotine exposure. Additionally, smoking may have a significant negative effect on anesthesia and recovery from anesthesia, with coughing and possibly increased bleeding.
Individuals who are not exposed to tobacco smoke or nicotine-containing products have a significantly lower risk of this type of complication.
It is important to refrain from smoking at least 6 weeks before surgery and until your physician states, it is safe to return, if desired. I acknowledge that I will inform my physician if I continue to smoke within this time frame, and understand that for my safety, the surgery, if possible, may be delayed.
Breast Disease – Current medical information does not demonstrate an increased risk of breast cancer in women who have breast implant surgery. Individuals with a personal history or family history of breast cancer may be at a higher risk of developing breast cancer than a woman with no family history of this disease. It is recommended that all women perform periodic self-examination of their breasts, have mammography according to UAE Cancer Society guidelines, and seek professional care should they notice a breast lump. Care must be exercised during breast biopsy procedures to avoid damaging the tissue expander.
Long-Term Results – Subsequent alterations in breast shape may occur as the result of aging, sun exposure, weight loss, weight gain, pregnancy, menopause, or other circumstances not related to your surgery. Breast sagginess may normally occur.
Medications and Herbal Dietary Supplements – There are potential adverse reactions that occur as the result of taking over-the-counter, herbal, and/or prescription medications. Aspirin and medications that contain aspirin interfere with clotting and can cause more bleeding. These include non-steroidal anti-inflammatories such as Motrin, Advil, and Alleve. It is very important not to stop drugs that interfere with platelets, such as Plavix, which is used after a stent. It is important if you have had a stent and are taking Plavix that you inform the plastic surgeon.
Stopping Plavix may result in a heart attack, stroke, and even death. Be sure to check with your physician about any drug interactions that may exist with medications that you are already taking. If you have an adverse reaction, stop the drugs immediately and call your plastic surgeon for further instructions. If the reaction is severe, go immediately to the nearest emergency room. When taking the prescribed pain medications after surgery, realize that they can affect your thought process and coordination. Do not drive, do not operate complex equipment, do not make any important decisions, and do not drink any alcohol while taking these medications. Be sure to take your prescribed medication only as directed.
Interference with Sentinel Lymph Node Mapping Procedures – Breast surgery procedures that involve cutting through breast tissue, similar to a breast biopsy, can potentially interfere with diagnostic procedures to determine lymph node drainage of breast tissue to stage breast cancer. If this is a concern, individuals considering breast augmentation by these approaches may elect to consider another surgical approach.
Breast and Nipple Piercing – individuals with breast implants or tissue expanders seeking to undergo body piercing procedures to the breast region must consider the possibility that an infection could develop anytime following this procedure. Should an infection occur, it is possible that it could spread to the breast implant space. Treatment including antibiotics, possible removal of the implant, or additional surgery may be necessary. Infections with the presence of a breast implant are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the breast implant may have to be removed. Individuals who currently wear body-piercing jewelry in the breast region are advised that a breast infection could also develop.
Breast Feeding – If a woman has undergone a mastectomy, it is unlikely that she would be able to breastfeed a baby on the side where the breast was removed. Although many women with breast implants and normal breast tissue have successfully breastfed their babies, it is not known if there are increased risks in nursing for a woman with breast implants.
Sun Exposure – Direct or Tanning Salon- The effects of the sun are damaging to the skin. Exposing the treated areas to the sun may result in increased scarring, color changes, and poor healing. Patients who tan, either outdoors or in a salon, should inform their surgeon and either delay treatment, or avoid tanning until the surgeon says it is safe to resume. The damaging effect of sun exposure occurs even with the use of sunblock or clothing coverage.
Travel Plans – Any surgery holds the risk of complications that may delay healing and delay your return to normal life. Please let the surgeon know of any travel plans, important commitments already scheduled or planned, or time demands that are important to you, so that appropriate timing of surgery can occur. There are no guarantees that you will be able to resume all activities in the desired time frame.
Female Patient Information – It is important to inform your plastic surgeon if you use birth control pills, estrogen replacement, or if you suspect you may be pregnant. Many medications including antibiotics may neutralize the preventive effect of birth control pills, allowing for conception and pregnancy.
Intimate Relations After Surgery – Surgery involves coagulating of blood vessels and increased activity of any kind may open these vessels leading to a bleed, or hematoma. Activity that increases your pulse or heart rate may cause additional bruising, swelling, and the need for a return to surgery and control bleeding. It is wise to refrain from intimate physical activities until your physician states it is safe.
Long-Term Results – Subsequent alterations in the appearance of your body may occur as the result of aging, sun exposure, weight loss, weight gain, pregnancy, menopause, or other circumstances not related to your surgery.
Mental Health Disorders and Elective Surgery – It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement rather than perfection. Complications or less than satisfactory results are sometimes unavoidable, may require additional surgery, and often are stressful. Please openly discuss with your surgeon, prior to surgery, any history that you may have of significant emotional depression or mental health disorders. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.
Radiation Therapy – Radiation therapy to the chest region before or after breast reconstruction with a tissue expander/breast implant can produce unacceptable firmness or other long-term complications.
Mammography – Breast implants and tissue expanders may make mammography more difficult and may obscure the detection of breast cancer. Any breast implant or expander can impair the detection of breast cancer, regardless of the type of implant or where it is placed in relation to the breast. Rupture can occur from breast compression during mammography. Inform your mammography technologist of the presence of breast implants or expanders so that appropriate mammogram studies may be obtained. Patients with capsular contracture may find mammogram techniques painful and the difficulty of breast imaging will increase with the extent of contracture.
Ultrasound, specialized mammography, and MRI studies may be of benefit to evaluate breast lumps and the condition of the expander or implant(s). Because more x-ray views are necessary with specialized mammography techniques, women with breast implants or expanders will receive more radiation than women without implants/expanders who receive a normal exam.
However, the benefit of the mammogram in finding cancer outweighs the risk of additional x-rays. Patients may wish to undergo a preoperative mammogram and another one after implantation to establish a baseline view of their breast tissue. You may be advised to undergo an MRI study in the future to verify the condition of your breast implants or expanders inside your body.
Second-Generation Effects – A review of the published medical literature regarding the potentially damaging effect on children born of mothers with breast implants or tissue expanders is insufficient to draw definitive conclusions that this represents a problem.
Removal / Replacement of Tissue Expander – Tissue expander breast reconstruction is a two-step process. Removal of the tissue expander, revision of the surrounding scar tissue envelope, or replacement of tissue expander with a permanent breast implant involves surgical procedures with risks and potential complications. There may be an unacceptable appearance of the breasts following the removal of the implant.
Immune System Diseases and Unknown Risks – A small number of women with breast implants and tissue expanders have reported symptoms similar to those of known diseases of the immune system, such as systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and other arthritis-like conditions. To date, after several large epidemiological studies of women with and without these implants, there is no scientific evidence that women with either silicone gel-filled or saline-filled breast implants/tissue expanders have an increased risk of these diseases. These diseases appear no more common in women with these implants than those women without implants. The effects of breast implants and tissue expanders in individuals with the pre-existing immune system and connective-tissue disorders are unknown. There is the possibility of unknown risks associated with silicone breast implants and tissue expanders.
Capsule Squeeze Procedures – Closed capsulectomy, the process of forcefully squeezing the fibrous capsule around a breast implant or tissue expander to break up scarring is not recommended. This may result in rupture of the device, gel migration, bleeding, or other complications.
Breast Implant Technology / Technologic Improvements – The technology of breast implant design, development, and manufacture will continue to progress and improve. Newer or future generations of implants may be better in some way than those currently available.
Large Volume Breast Augmentation – Patients who request an outcome of augmentation mammaplasty that produces a disproportionately large breast size must consider that such a choice can place them at risk for a less than optimal long-term outcome and the need for re-operation and additional expenses. The placement of excessively sized breast implants that exceeds the normal dimensions of the breast can produce irreversible tissue thinning, implant drops out, and visible/palpable rippling.