Immediate problems that can occur

As with any surgical procedure, breast augmentation can occasionally result in bleeding. Because a rather large space is created under the breast to allow placement of the implant, postoperative bleeding, if it does occur under the surface of the skin, can accumulate to a significant amount and cause painful swelling that requires urgent treatment. This usually involves a return to the operating room, which may mean admission to hospital.

Although infection is highly unusual, it can occur, and may require removal of the implant for a period of several months until everything is completely settled, followed by re-augmentation.

Loss of breast and nipple sensation

Loss of feeling or reduced feeling of the breast and nipple occurs in about 15% or more of patients. Although feeling usually gradually returns, it may not, or it may result in increased sensitivity for several months.

Ability to breast-feed is rarely altered

There is usually no interference with the function of the breast gland. Therefore, as long as there is some sensation to the nipple (complete loss of sensation rarely occurs), nursing is possible. However, not all new mothers are successful at nursing even without implants, so no guarantees can be made.

Capsular contracture: a problem that occurs with some implants

What is capsular contracture?
Capsular contracture refers to the shell of the implant contracting around the material inside and becoming hard. This problem occurs only in some women.

The reason this occurs has to do with introducing a "foreign" substance into the body. Whenever a foreign material, be it a sliver, piece of glass, shrapnel, or a breast implant, is placed under the surface of the skin, the body recognizes it as foreign. If the body cannot remove it by "digesting" it, it reacts by forming a wall around it. This wall, which we call a "capsule," is very much like scar, and may be thin and soft, or tough and thick.

In the early phases of healing, all scars contract. If the capsule contracts tightly around the implant, the implant comes under pressure, is forced into a more rounded shape, and becomes firm or even hard. This condition is called "capsular contracture," and is by far the most common problem that occurs with breast augmentation surgery.

Who gets capsular contracture?

We cannot explain why one patient will get contractures and another will not, nor why some patients will develop a contracture in one breast and not in the other. Although capsular contraction poses no major health risk to the patient, it may sometimes cause enough firmness to be uncomfortable or even painful. Certainly, the more severe the contracture, the less natural the breasts appear and feel.

In general, 75% to 80% of patients have a very good to excellent result, with little or no contracture, and about 20% to 25% have an acceptably soft breast result. About 5% to 10% may require another operation to help improve the result, and a very small number have persistent problems despite all efforts. Yet, incredibly few patients are troubled enough to want to have their implants removed for treatment of contracture. When saline-filled implants are placed under the muscle, contracture rates may be substantially reduced.

Research to overcome the problem
Over the years, different solutions to this problem have been tried. Many surgeons and their patients believe that contracture can be warded off by daily exercises to keep the implant moving and to maintain a large, relaxed space around it. In the early 1980s, some surgeons felt that placing the implant beneath both the breast and the underlying pectoral muscle would accomplish the same thing.

Another method of reducing contracture was tried with the development of a foam (polyurethane) covering. Although this seemed to reduce the contracture rate to 1% or less for the first 5 to 7 years after surgery, concerns were raised about the long-term health risks of the foam, since the body slowly "digested" it. This product (Meme or Replicon) was withdrawn from the market in 1991.

Based on the theory that it was the rough surface of the foam-covered implant that reduced the contracture rate, a new, rough-surfaced silicone rubber shell implant was developed and is widely used in the US (it has only recently been approved for use in Canada). Although this implant has met with some success over the past 5 years, opinions vary as to how reliably it results in soft breasts. In addition, there are other problems with its use.

 
Benjamin Gelfant, MD, 
in association with the MediResource Clinical Team