Surgery complications

There is a slight risk from any general anesthesia. About one death occurs in every 250,000 anesthesia given to healthy people.
Other general complications, which may occur in breast implant surgery, are:

a) Infection
Infection is possible in any operation, but is more difficult to cure when a foreign object (such as an implant) is introduced into the body. If you develop an infection you may need to have a further operation to remove the implant until the infection has cleared and then have your implant replaced. Although most infections can be treated successfully, infections can cause serious problems and may result in increased scarring. Capsular contracture may be related to infection in the area surrounding the implant.

b) Scarring
You will have a scar where the surgeon has made the cut into your skin. The position, the length and the type of scar may vary according to a number of factors. Few patients may develop a thick, red scar known as a keloid scar. It is not always possible to predict which patients will develop these keloid scars. But most of the patients will have a nice inconspicuous scar.

c) Bleeding and haematoma formation
Bleeding can occur after any operation. It usually happens soon after surgery and this is why the surgeon may use drainage tubes for a short time. A haematoma or blood clot may also form where the implant has been placed. If this happens, the haematoma may disappear by itself or you may need to have it surgically removed.

d) Poor wound healing
Wound healing may take longer if any of the following things happen: infection, bleeding, fluid accumulation, too large an implant, diabetes, improper support and pressure against the scar tissue or if you are a smoker. A breakdown of skin, known as necrosis may occur due to thinness of the skin flap over the implant or trauma to the skin during surgery. This problem is more common in smokers. Sometimes this may require removal of the implant.

e) Wrinkling of the implant
Visible and palpable wrinkling may occur with all implants, especially saline-filled types. It occurs more commonly in thin women. This problem is a lot less with the cohesive gel implants.

In women with little breast tissue the implant may be obvious when looking at the breast or it may be easily felt as a foreign object. Submuscular placement should be advised in these cases.

f) Pain
As expected following any invasive surgical procedure, pain of varying intensity and duration may occur following breast implant surgery. In addition, very large implant size or capsular contracture may result in pain associated with nerve entrapment or interference with muscle motion. Very occasionally severe pain associated with arm movement has been reported.

g) Rupture/deflation
Patients should be advised that their implants might rupture, releasing silicone gel or saline, and require replacement or revision surgery. The chances of rupture or leaking are a lot less with the cohesive gel implants.

h) Rotation
Rotation of the implant may occur. Proper placement and pocket dissection reduces the risk of occurrence.

Capsular contracture

When any type of breast implant is inserted, the body reacts by forming a protective lining around it. This is referred to as the "capsule" or "tissue capsule." Some people refer to it as the "scar capsule" although it is not exactly the same as scar tissue. The capsule is formed by your own living tissue. It is normal and happens in everyone regardless of whether the implant is smooth or textured, silicone or saline. Anytime something is implanted, whether it is a knee joint, heart valve or breast implant, our body forms a wall of scar tissue around it. This wall is usually soft, thin and unable to be felt. But just like one child falls on the playground and cuts their chin and has a bad scar, and the next child with the same injury and same plastic surgeon has almost no scar to speak of, the scarring inside around an implant is unpredictable.

In some women, for reasons doctors don't understand completely, the capsule has a tendency to shrink, squeezing the implant. This is referred to as capsular contracture. The tighter the capsule becomes the firmer the breast feels. Capsular contracture is a random occurrence. It will occur in one breast and not the other, it can occur within a few months after surgery or years down the road. Only a relatively small percentage of women with implants develop capsular contracture severe enough to require surgical treatment. The rare patient develops repeated capsular contracture but in the majority of cases it can be successfully treated. It would seem logical that scarring inside could be predicted by past scarring from injuries or by their family history. Unfortunately, none of these help us predict who will form extra scar tissue inside. It is truly a random occurrence.

No matter the degree of capsular contracture, it is not the implant that gets hard. If the implant is removed it is as soft as when it was inserted. It is the interaction of the capsule with the implant that can make the breast feel firm. Capsular contracture alone does not cause implant rupture because the force is exerted evenly around the surface of the implant.

Non-Surgical Options:

• Capsular contracture may be treated with Vitamin E, antibiotics and aspirin based products. We recommend our patients to take 400-500 U of Vitamin E twice a day for one year after the surgery. This has made a significant difference in decreasing the number of capsular contracture in our practice.
• According to a recent study, the asthma drug Accolate, taken twice a day for 3 to 6 months, can often prevent contractures and soften existing ones.

Surgical Options:

• Only a relatively small percentage of women with implants develop capsular contracture severe enough to require surgical treatment. The rare patient develops repeated capsular contracture but in the majority of cases it can be successfully treated.
• In an "open capsulotomy" the surgeon scores, or cuts, the capsule to release its hold on the implant.
• In an "open capsulectomy", the entire capsule is surgically removed. The body then forms a new capsule but the hope is that it does not contract as the old one did. Capsulectomy usually has a higher rate of success in correcting contracture
  

Low rates of capsular contracture are associated with submuscular placement of the implant and with textured implants.

Severe capsular contracture with round implants	After open capsulectomy and anatomical implants