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Breast augmentation can give women with small or uneven breasts a fuller, better-proportioned look through the placement of saline breast implants or silicone breast implants, dramatically improving self-esteem and confidence. Any operation, though, including breast augmentation, poses some risks that can lead to complications or unfavorable results.

The most common complication is capsular contracture, or hard, firm scar that forms around the implant. Because the breast normally is soft, the development of scar tissue can make the breast feel and look hard, and in severe cases, can cause pain. With older silicone breast implants, capsular contracture was much more common. The frequency of capsular contracture has diminished with currently utilized silicone breast implants, so that the occurrence rate is now similar between silicone and saline breast implants. Mild capsular contracture is hardly perceptible, but severe contractures can be painful and unattractive. Treatment consists of surgery to remove the entire capsule and placement of a new breast implant. Placement of the implant in a pocket below the chest wall muscle results in a lower risk of capsular contracture than placement over the muscle.

Infection, if it occurs, usually does so within a few weeks of surgery. Infection occurs very rarely, but if an infection occurs it often requires antibiotics and the removal of the involved implant for several months.

Some women report that their nipples become oversensitive, undersensitive, or even completely numb. Some women also report small patches of numbness near their incisions. These symptoms usually disappear within time, but may be permanent in up to 15% of patients. If the possibility of having numb nipples is unacceptable to a patient, she should not have breast augmentation, as no plastic surgeon can predict which patients will develop this complication.

There is no evidence to indicate that breast implants will affect fertility, pregnancy, or the ability to breastfeed. If, however, a patient has nursed a baby within a year before breast augmentation, she may produce milk for a few days after surgery. This may cause some discomfort, which usually resolves within a few days. For women who get pregnant after having breast implants placed, in most cases, breast implants will not affect the fate of the breasts. After the breast tissue shrinks after pregnancy and breastfeeding, the breast skin may or may not shrink. If the skin does not shrink, the breasts will likely droop. Whether or not the skin shrinks is controlled by factors other than the presence or absence of breast implants.

Breast implants may break or leak. Most often, breast implant rupture is the result of normal wear and tear on the breast implant shell. If a saline-filled implant breaks, the implant will deflate within a few days and the salt water will be harmlessly absorbed by the body. To restore volume, another implant needs to be placed. If a break occurs in a silicone breast implant, silicone gel may move into surrounding tissue, provoking an inflammatory reaction which can lead to a severe capsular contracture. There may be a change in the shape of the breast, and the breast may become hard and painful. This will require a second operation to remove the breast implant shell and to replace the leaking implant.

No data exists suggesting that breast implants cause breast cancer. Silicone and saline breast implants, however, can alter surveillance for breast cancer. Breast implants can alter the amount of breast tissue visualized on a mammogram. When placed below the chest wall muscle, greater than 90% of breast tissue can be seen well on mammogram. When placed above the muscle, only about 75% can be visualized. Breast implants do not interfere with the ability to detect masses with self breast examination, regardless of position relative to the chest wall muscle. Self exam is the most successful way to discover new breast masses. Implants also do not interfere with ultrasound or MRI scans, which are helpful in the evaluation of breast masses.

Breast implants can move out of position anytime after breast augmentation surgery. If they move a lot, surgery may be needed them back into position. The larger the implant, the more likely it will displace downward.

Rippling or wrinkling of the implant is much more common with saline breast implants compared to silicone breast implants and in thin patients. The visualized wrinkles are the folds of the breast implant shell. Ripples can be particularly disconcerting if they occur on the upper pole of the breasts.

Because breast implants are manmade, mechanical devices, they are prone to problems over time. All women who undergo breast augmentation surgery should assume that, at some point in their lives, they will require a secondary procedure, whether it’s for capsular contracture, rupture, displacement, etc. Some women may never have problems, but it’s impossible to predict which patients will fall into this category.

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