Cosmetic Surgery

Breast Augmentation/Implant Risks

Breast augmentation is a relatively safe procedure. But, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

After breast augmentation the development of a layer of scar-like tissue round the breast implant is a natural process. This is called capsule formation. The body is probably attempting to extrude the implant which it perceives as a foreign body.

Usually this layer is quite thin and soft but in some people it can become thick and hard, making the breast feel and look unnatural. When this occurs it is called a capsular contracture.
When capsular contracture is present the breasts may become hard, change in shape or even be painful. There are 4 grades of capsular contracture: Baker Grades I – IV. The Baker grading is as follows: -

• Grade I – The breast is normally soft and looks natural
• Grade II – The breast is a little firm but looks normal
• Grade III – The breast feels firmer than normal and looks somewhat abnormal (change in shape)
• Grade IV – The breast is hard, may be painful and clearly look abnormal (greater distortion).

The cause of capsular contracture is unclear. Many surgeons feel it is more likely after infection or bleeding.

It is more common when the implant is placed above the pectoral muscle and when smooth implants are used. It is less common with textured implants.

Most contractures develop within the first six months. Whilst late contractions can occur, they are usually preceded by an injury or infection.

When the capsule is examined under the microscope it shows a layer of collagen intermingled with collagen making cells (fibroblasts). When these fibroblasts are examined under the electron microscope many are myofibroblasts which are a special type of cell which can contract much like muscle.

The treatment depends on the severity of the contracture and ranges from observation and no active treatment to surgical release of the capsule.

About 10% of people may develop some noticeable capsule formation but, for most of them, it is not a significant problem. However, in 1 to 2% of people, the capsule becomes very hard and interferes with their enjoyment of the results. Treatment often begins with non-surgical methods such as vitamin E, anti-inflammatory medication, massage and pressure. In most people, this is successful. However, a small group continue to have discomfort and problems.

Three options exist:-

• The capsule can be surgically released so that it re-forms slightly larger.
• The implant can be replaced with a smaller implant so that the space around the implant is larger.
• If the problem persists a decision should be made about removing the implant. Multiple operations are rarely successful and, in the end, often produce a poor cosmetic result without solving the problem.

An infection following breast augmentation is unusual, in the range of 0 to 4% in cosmetic augmentations and between 2 to 25% in breast reconstruction surgeries utilising an implant. An infection may appear shortly after surgery or at any time following the insertion of the implant. A low level infection may be difficult to diagnose. However, infection around a breast implant is more difficult to treat than an infection in normal body tissues. If an infection occurs, antibiotics are usually prescribed but, if the infection does not respond to antibiotics, the implant may have to be surgically removed. After the infection is treated, a new implant can usually be inserted several months later.