PROCEDURE GUIDE

Breast Augmentation Risks
and Long-Term Care

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Most women do not experience any serious complications as a result of having Breast Augmentation surgery or receiving breast implants, but a very small number do. It is therefore important to know about the potential risks and how to care for your implants in the long-term.

Surgical Complications

Although very rare, common risks associated with all surgeries are bleeding and infection. Dr. Jugenburg`s meticulous surgical technique and, if appropriate, the use of Bloodless Breast Augmentation, mean that problems associated with bleeding (e.g., a build-up of blood, known as a hematoma) are extremely unlikely.

To minimize the risk of infection, you will be given antibiotics before and after surgery, and continue to take antibiotic medication for a few days afterwards. In addition, during surgery, a carefully controlled sterile environment and the No-Touch Technique are used to further minimize the risk of bacterial contamination of your wounds and breast implants.

Other rare complications that can occur with augmentation surgery include:

Seroma – a relatively uncommon build-up of fluid around the implant, causing pain or swelling, which may need to be removed using a needle.

Hypertrophic Scarring – a very thick, raised, red scar that develops after surgery in 2 – 5% of patients and may require treatment.

Wound Separation (Dehitscence) – a very rare complication where the edges of the wound separate after surgery and will need to be treated.

Mondor’s Disease – temporary inflammation of the blood vessels under the surface of the breast that occurs in about 1% of patients.

Temporary changes in normal sensation of the nipple and breast, which normally resolve during the recovery after surgery.

Rashes on or around the breast.

Common effects of augmentation surgery that normally resolve quickly include:

Temporary bruising, swelling and/or discomfort

Pain affecting the nipple and breast

Breast Implant Specific Complications

Breast Implant Infection

The rate of Breast Implant Infection in the first year after surgery is about 1%, which is the same expected from any proper, clean surgery.

The most common source for a Breast Implant Infection is the skin or glands of the breast. Infections could potentially also spread through the blood from elsewhere in the body, such as the bladder, future surgeries, or from dental work. Awareness is important, and in the event of an infection occurring anywhere in the body, prompt medical care is required. The following steps must always be taken to further minimize your risk.

Before any surgical procedure, inform/remind your doctor that you have breast implants. They should prescribe you one dose of an oral antibiotic to be taken about an hour before your surgery.

If you ever develop an infection anywhere in your body (such as a bladder infection), treat it right away to prevent the infection from spreading through your blood to your breast implants.

If you ever think you may have an infection in your breasts, contact us immediately to be seen and assessed. Treating an infection before it becomes deep and involves the implant is essential. If the infection is untreated and the implant becomes infected, it must be removed and cannot be replaced for at least 9 months.

Breast Implant Associated ALCL

BIA-ALCL is not a breast cancer, it is a very rare blood cancer that has recently been reported to occur with textured implants. Although the incidence is extremely rare (there are only a few hundred cases described worldwide), it is something to consider when looking at textured implants.

At our clinic, over the past 10 years we have very rarely used textured implants and as such predominant majority of breast implant patient at our clinic should not need to worry about BIA-ALCL.

To read a comprehensive summary of BIA-ALCL visit the FDA page.

Breast Implant Illness

Breast implant illness is a term that has been floating in the cyberspace recently, as a vague term used by women to describe a collection of apparently unrelated symptoms. There is no actual medically defined ‘breast implant illness’, only anecdotal case. As such, I have never seen ‘Breast implant illness’. Fibromyalgia is a vague collection of symptoms that can happen in any woman, regardless of whether or not they have breast implants and may be related to this. At this time, there is no evidence known to the FDA or Health Canada that shows that breast implants cause any of these ‘illness’ that is described in social media. At the same time, it is always possible that some women may react to an implantable substance differently than the general population, and further studies will be required to clarify the existence of this condition.

For a comprehensive look at breast implant-related risks, please visit the FDA webpage on breast implants.

Breast Implant Rupture and Deflation

One of the risks with breast implants is rupture and/or deflation. A breast implant rupture refers to a process where the outer shell of the implant tears, creating a hole that allows the saline or silicone gel inside the implant to release. Ruptures can be caused by a number of different factors, such as physical trauma, general wear and tear, or by Capsular Contracture.

Complications from medical procedures, such as compression during mammography or biopsy, can also lead to implant ruptures. However, modern breast implants are highly durable and a damaged or ruptured implant is rare.

If a woman with breast implants receives any type of injury to the breast they should be evaluated by a physician. If you believe that damage may have occurred to one of your implants:

Silicone is not absorbed by your body. If your silicone implant ruptures, the appearance of your breast should stay about the same (i.e., the silicone will not leak/flow out into your body). If a ruptured silicone implant is left for an extended period of time, however, it is possible the breast may become firmer or misshapen as surrounding tissues thicken in response. Ultrasound and MRI scans can be used to determine if the implant remains intact.

Saline (salt water) is absorbed by your body, but is harmless. If your saline implant ruptures or leaks, it will deflate. If the appearance of your breast has not changed, your implant must therefore be intact.

In the rare event that a breast implant has ruptured, surgery will be required to remove and, if appropriate, replace the damaged implant as soon as possible. The procedure is known as an Implant Exchange (see below).

Rare Aesthetic Complications

As a highly experienced Cosmetic Breast Surgeon, Dr. Jugenburg`s surgical skill, trained eye and artistry have led to a beautiful breast enhancement for many women. By tailoring each breast enlargement procedure to the individual needs and goals of each women, the best possible aesthetic results can be achieved.

In very rare cases, however, and particularly with less skilled Plastic Surgeons, when Breast Augmentation is performed complications may lead to unfavorable aesthetic results:

Asymmetrical breasts (uneven shape, size or height)

An unattractive scar – most patients heal with virtually invisible scars, while some are more prone to prominent scarring (all scars are visible initially following surgery)

Stretchmarks – some women are genetically predisposed to stretchmarks; however, it is very rare and we have seen these develop in very few patients

Double bubble formation – where the position of the natural breast tissue and the implant causes the implant to visibly bulge through the skin above or below (bottoming out) the breast

Visible implant rippling/wrinkling (further information is given below)

Capsular Contracture (and Breast Massage)

Capsular Contracture is a rare contraction or tightening of the scar tissue that naturally forms around a breast implant and occurs in 1 – 5% of our patients (published rates elsewhere are 8%). When this happens, the implant may become compressed, deformed, and displaced, causing the breast to feel firm and sometimes look abnormally round or elevated. At times, this can be treated without surgery, but if more severe, may require further surgery.

Post-surgical breast implant massage may reduce the risk of Capsular Contracture formation by encouraging your body to form scar capsules that are slightly larger than your implants, and thereby having a softer feel. Breast implants also have a tendency to sit high on the chest after surgery and downward manipulation of the implants (through massage) will stretch out the chest muscle and help them descend into an optimal position more quickly.

At your second post-operative visit at the clinic, we will instruct you on the massage techniques that you should perform to help your implants to settle down and to obtain and maintain a naturally soft breast.

Further information on Capsular Contracture is given here and on breast implant massage here.

Natural Breast Implant Rippling/Wrinkling

To some extent, rippling/wrinkling occurs with every breast implant. Breast implants are soft and natural folds therefore commonly occur in the shell of an implant. This effect only becomes a problem if visible, but is more often felt and not seen (typically along the outer edge of the implant, below the armpit), especially when a woman leans forward. A similar pattern of skin folding occurs in women with naturally larger breasts (i.e., without implants). Saline implants are more prone to this effect, but it can also occur even in higher density silicone gel implants.

Breast Implant Exchange

In the unlikely event that your breast implants should need to be replaced, at the Toronto Cosmetic Surgery Institute an Implant Exchange procedure is as comfortable as possible.

The procedure is straightforward and always takes place in the Operating Room under general anesthesia for absolute sterility and safety. Following the surgery, there is no need for a prolonged recovery period, and most patients should be able to return to normal life the following day. All patients are given pain medications; however, since the surgery is minimal, most do not require these.

Breast Implants and Bra Support

Most women look forward to the prospect of shopping for brand new bras after their breast enlargement surgery. Bra support advice is, however, an area often overlooked in the post-operative care of Breast Augmentation patients.

Over time, without proper support, the weight of breast implants can create significant sagging and stretching of the breast tissue and skin. Bra selection can dramatically change after surgery, with the amount of bra coverage, presence of underwire and/or padding, and strap width, all important considerations besides fundamental bra size.

Wear Your Surgical Bra Continually During the Recovery Period

The first few weeks following breast enlargement are the most important stage of your recovery. It is therefore essential for all patients to wear their surgical bra throughout the first 2 – 4 weeks of recovery (if instructed to do so by Dr. Jugenburg). Your surgical bra is designed to provide adequate support to prevent your implants from falling to the sides or too far downward (an effect known as bottoming out). Most patients are also given an elastic strap that is used to support the breast fold or apply downward pressure, or both.

Avoid Wearing an Underwire Bra for the First Six Weeks

Wearing an underwire bra too soon after surgery could lead to unnecessary complications. Underwire bras may irritate or cut into the flesh underneath your breasts and press against tender incisions (if your procedure was carried out through the breast fold). It is generally okay to start wearing underwire-based support after 6 weeks. Until this time, you should also avoid wearing any bra that creates a push-up effect, as your breast implants must be given time to settle down into their proper position. However, thereafter, you may find that with the new enlarged and shapely appearance of your breasts, you no longer require or like the look of a push-up effect.

Shopping for New Bras

Women with augmented breasts will find that they have to greatly adjust their previous size and style choices when shopping for new bras. Most patients will also need to be re-measured to find their perfect fit. It is very likely that while certain bra types that were previously comfortable and flattering for you may no longer be so, bras that didn’t work for you before, may now do so.

Features that may determine bra fitting and selection include:

Position of the breasts on the chest wall

The width of the cleavage

The shape of the breasts

The size (width and projection) of the breasts

When picking a bra, women should keep in mind the following indications of a poor fit:

The center panel in the front does not rest against your skin. This is a sign that your breasts are too big for the given bra size, and that a larger size may offer a better fit.

A band that rides up your back and creates unattractive lumps in the skin and tissues of your back (known as back fat) is a sign of a poor fit. The band of the bra should remain parallel to, or slightly lower than, the front.

The straps dig into your skin or fall down your shoulders. Bra strap length should not need to be altered in order to achieve adequate, comfortable support; the band should provide 90% of the support

The cups are wrinkled and/or there is excess space between the cup edges and your breasts. If this is the case a smaller size may offer a better fit.

Breast Augmentation Care FAQ

Will becoming pregnant affect my breast implants?Will my breast implants prevent me from breastfeeding?When should my breast implants be re-evaluated?When should my breast implants be replaced?

Will becoming pregnant affect my breast implants?

Your breasts will likely become fuller around your breast implants during pregnancy due to natural hormonal fluctuations. This is normal and would have occurred irrespective of your augmentation surgery. For further information, please refer here.

Will my breast implants prevent me from breastfeeding?

No, your breast implants will not interfere with your ability to breastfeed. For further information, please refer here.

When should my breast implants be re-evaluated?

All Breast Augmentation patients are followed for a period of time after surgery according to their individual needs and in order to ensure proper healing and the best result. After this time, Dr. Jugenburg sees his patients only when necessary. If you continue to have the soft breasts that look and feel as good as 1 year after the surgery, there is no need for a routine evaluation.

However, all patients are encouraged to have an evaluation whenever they have a question or concern about their breast implants, or wish to have a routine check-up.

When should my breast implants be replaced?

Some people believe that breast implants need to be replaced every 10 years. This is not true. Most Breast Augmentation patients at the Toronto Cosmetic Surgery Institute have no problems with their implants and continue to enjoy having the breasts they have always desired. However, if any breast implant is found to be defective (leak or rupture), since all our implants come with a lifetime warranty, you will receive a brand new implant to replace the damaged one.

Breast Augmentation Risksand Long-Term Care