Breast Augmentation
Breast Augmentation Risks and Complications in New York
What could go wrong?
All surgery carries some uncertainty and risk. When a breast augmentation is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable. These include infection, hematoma, and skin necrosis. Infection can occur despite our normal routine of administering antibiotics at the time of surgery as well as post-operatively. This happens about one percent of the time. Signs such as pain, redness, swelling, or fever, following augmentation should be reported immediately to the hospital. Infection not reported could easily compromise the success of any surgery. If infection was to be serious and fail to respond to antibiotics, removal of the implants would be required and replacement would not be effected until such time as the infection had cleared.
Bleeding, as a result of a leak in a blood vessel will give rise to swelling and bruising of the breast. If this is slight then your body will be able to absorb it in time. If it is significant (termed hematoma, and occurs 1% of the time) then it may be necessary to drain this. Your surgeon will be able to assess this.
Skin necrosis or skin decay occurs when there is not enough blood to supply the skin. This could happen if the surgeon were to select an implant size too that was too large for the pocket created. This is extremely rare and in fact, Dr. Klapper has not experienced this problem and nor does he expect to.
Capsular Contracture (Hardening)?
This is the most common complication of breast implants. A capsule or capsule formation is a layer of scar tissue that normally forms around any artificial material placed in the body. It is important to realize that this is the natural response of the body to foreign material. Most times this capsule is so soft that it is virtually undetectable and therefore does not affect the implant in any way. Capsular contracture or hardening occurs when this layer of scar tissue shrinks around the implant, squeezing it so that it starts to feel firm, or in some cases, quite hard. Most capsular contractures experienced today stem from the smooth shell silicone implants placed some years ago. The capsule contracture rate in the past was 30-35%.
With the onset of textured shell implants, the problem of capsular contracture has been significantly reduced, now being between 6-8%.
The cause of capsular contracture is not totally clear, but seems to be multifactorial. It is important to realize that there are degrees of contracture and that the majority of women, who do develop this hardening, develop it only to a mild extent. In the minority however, it may be severe enough to be bothersome, even painful and may cause distortion of the breast. The condition may occur in one or both breasts and to a different degree either side.
It may develop any time, even years later although it is most likely to happen in the first 3 years after surgery. Unfortunately at this time there is no effective way to prevent capsular contracture if it is going to occur. However as mentioned previously, encapsulation is no longer the problem that it was. Having mentioned all the above, it is important to note that capsular contracture is not in itself a health risk other than its possible interference with mammography.
There are two ways to reduce or relieve the firmness of a contracture. These are the closed and open capsulotomy. In the closed capsulotomy, the firm implant is manually squeezed tightly from the outside, in an attempt to disrupt or tear the scar envelope. When successful the result is instantaneous and the implant immediately feels soft. The tear resistance of the scar envelope however varies from woman to woman. Some tear easily but in others the scar is so tough that it cannot be torn. In others, only a partial tear is possible which can lead to a small outpouching of the implant, with a resultant unsightly appearance. A closed capsulotomy may also result in bruising, bleeding, or even rupture of the implant itself. If rupture occurs then you will need surgery to remove and replace it. In light of these unpredictable outcomes, closed capsulotomy is infrequently done.
The other method, which is much more controlled and thus the preferred method, is the open capsulotomy, performed under general anaesthesia. In this procedure the old incision is reopened and the thickened capsule is removed or loosened. The implant is then reinserted again into the breast pocket. Unfortunately, even after a successful capsulectomy, there is always the possibility of recurrent hardening.