While every patient experiences their own individual advantages and disadvantages following breast implant surgery, clinical data suggests that most women will be satisfied with the outcome of breast implant surgery despite the occurrence of problems inherent with the surgery.
1. Implants – Breast implants, similar to other medical devices, can fail. When a silicone gel-filled implant ruptures, the gel material is usually contained within the scar tissue surrounding the implant (intracapsular rupture). In some cases, the gel may escape beyond the capsule layer and go into the breast tissue itself (extracapsular rupture and gel migration) or to more distant locations. Migrated silicone gel may be difficult or impossible to remove. Rupture of a breast implant may or may not produce local firmness in the breast. Rupture can occur as a result of an injury, from no apparent cause or during mammography. Rupture of a silicone breast implant is most often undetected (silent rupture). It is possible to damage an implant at the time of surgery. Damaged or broken implants cannot be repaired. Ruptured or damaged implants require replacement or removal. Breast Implants can wear out, they are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. A Magnetic Resonance Imaging study (MRI) is advised to evaluate the possibility of implant rupture, yet it may not be 100% accurate in diagnosing implant integrity.
2. Capsular Contracture – Scar tissue, which forms routinely internally around the breast implant, can tighten and make the breast round, firm, and possibly painful. Excessive firmness of the breasts can occur soon after surgery or years later. The occurrence of symptomatic capsular contracture is not predictable. The incidence of symptomatic capsular contracture can be expected to increase over time. Capsular contracture may occur on one side, both sides or not at all. It is more common with implant placement in front of the chest muscle layer. Treatment for capsular contracture may require surgery, implant replacement, or implant removal. Capsular contracture may reoccur after surgical procedures to treat this condition and it occurs more often in revision augmentation than primary augmentation.
3. Calcification – Calcium deposits can form in the scar tissue surrounding the implant and may cause pain, firmness, and be visible on mammography. These deposits must be identified as different from calcium deposits that are a sign of breast cancer. Should this occur, additional surgery may be necessary to remove and examine calcifications.
4. Implant Extrusion/Tissue Necrosis – Lack of adequate tissue coverage, wound healing problems, or infection may result in exposure and extrusion of the implant through the skin. Tissue breakdown (necrosis) has been reported with the use of steroid drugs, after chemotherapy/radiation to breast tissue, due to smoking, microwave diathermy, and excessive heat or cold therapy. In some cases, incision sites fail to heal normally. Atrophy (weakening) of breast tissue may occur. An implant may become visible at the surface of the breast as a result of the device pushing through layers of skin. If tissue break down occurs and the implant becomes exposed, implant removal may be necessary. Permanent scar deformity may occur.
5. Skin Wrinkling and Rippling – Visible and palpable (discernible to touch) wrinkling of implants and breast skin can occur. Some wrinkling is normal and expected with silicone gel-filled breast implants. This may be more pronounced in patients who have silicone gel-filled implants with textured surfaces or thin breast tissue. Palpable wrinkling and/or folds may be confused with palpable tumours and questionable cases must be investigated.
6. Chest Wall Irregularities – Chest wall irregularities have been reported secondary to the use of tissue expanders and breast implants, including rib deformity.
7. Implant Displacement and Tissue Stretching – Displacement, rotation, or migration of a breast implant may occur from its initial placement and can be accompanied by discomfort and/or distortion in breast shape (visible rippling of the skin). Unusual techniques of implant placement may increase the risk of displacement or migration. Additional surgery may be necessary to attempt to correct this problem. It may not be possible to resolve this problem once it has occurred.
8. Surface Contamination of Implants – Skin oil, lint from surgical drapes, or talc may become deposited on the surface of the implant at the time of insertion. The consequences of this are unknown.
9. Unusual Activities and Occupations – Activities and occupations which have the potential for trauma to the breast could potentially break or damage breast implants, or cause bleeding/seroma.
10. Silicone Gel Bleed – The evidence is mixed regarding whether there are any clinical consequences associated with silicone gel bleed. Over time, extremely small amounts of silicone gel material and platinum can pass through the shell layer of the implant and coat the outside of the implant. Studies indicate that small amounts of platinum in its most biologically compatible (zero oxidation) state are contained within silicone gel. This may contribute to capsular contracture and lymph node swelling. The overall body of available evidence supports that the extremely low levels of gel bleed is of no clinical consequence.
11. Change in Nipple and Skin Sensation – You may experience a diminished (or loss of) sensitivity of the nipples and the skin of your breast, in one or both breasts. Partial or permanent loss of nipple and skin sensation may occur occasionally. Changes in sensation may affect sexual response or the ability to breast feed a baby.
12. Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) – I understand that there is a small risk for me to develop Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a cancer of the immune system. BIA-ALCL is a type of lymphoma that develops on or around the scar capsule that surrounds the breast implant. I understand that the symptoms of BIA-ALCL include breast swelling, lumps, pain, and asymmetry that develop after surgical incisions are completely healed, usually years after implant surgery. Treatment for BIA-ALCL includes removal of the implant and scar capsule, and, if not treated early, may include chemotherapy and radiotherapy.
12a. Breast Implant Associated Squamous Cell Carcinoma (BIA-SCC) – I understand that there is an emerging risk of Breast Implant Associated Squamous Cell Carcinoma (BIA-SCC), a rare but aggressive type of cancer that has been reported in association with both textured and smooth breast implants. BIA-SCC develops in the scar capsule surrounding the implant. Symptoms may include a lump, swelling, or skin changes around the implant. Treatment may include implant and capsule removal, mastectomy, chemotherapy, or radiotherapy. I understand that long-term follow-up and reporting of any changes to my Consultant is important.
12b. Immune System Diseases, Breast Implant Illness (BII), and Unknown Risks – A small number of women with breast implants have reported symptoms similar to those of known diseases of the immune system, such as systemic lupus erythematosus, rheumatoid arthritis, scleroderma, and other arthritis like conditions. To date, after several large epidemiological studies of women with and without implants, there is no scientific evidence that women with either saline-filled or silicone gel-filled breast implants have an increased risk of these diseases. Some patients report a collection of systemic symptoms they attribute to their breast implants, commonly referred to as Breast Implant Illness (BII). These symptoms may include fatigue, joint pain, muscle aches, cognitive difficulties (sometimes described as "brain fog"), skin rashes, and other systemic complaints. While scientific evidence has not established a definitive causal link between breast implants and these symptoms, some patients report improvement after implant removal. There is the possibility of unknown risks associated with silicone breast implants and tissue expanders.
13. Breast Disease – Breast disease and breast cancer can occur independently of breast enlargement and lift surgery. It is recommended that all women perform periodic self-examination of their breasts, have mammography, and seek professional care should a breast lump be detected. Individuals with a personal history or family history of breast cancer may be at a higher risk of developing breast cancer than a woman with no family history of this disease.
14. Interference with Sentinel Lymph Node Mapping Procedures – Breast surgery procedures that involve cutting through breast tissue, similar to a breast biopsy, can potentially interfere with diagnostic procedures to determine lymph node drainage of breast tissue to stage breast cancer.
15. Future Pregnancy and Breast Feeding – This surgery is not known to interfere with pregnancy. If you are planning a pregnancy, your breast skin may stretch and offset the results of surgery. You may have more difficulty breast feeding after this operation.
16. Delayed Healing – Wound disruption or delayed wound healing is possible. Some areas of the breast skin or nipple region may not heal normally and may take a long time to heal. Areas of skin or nipple may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Smokers have a greater risk of skin loss and wound healing complications. Individuals who have decreased blood supply to tissue from past surgery or radiation therapy may be at increased risk for wound healing and poor surgical outcome. Certain medical conditions, dietary supplements and medications may delay and interfere with healing, such as massive weight loss, Diabetes, tobacco use, and need for medications like steroids on an extended basis. Wounds may separate after surgery. Should this occur, additional treatment including surgery may be necessary.
17. Bleeding – It is possible, though unusual, to experience bleeding during or after surgery. If postoperative bleeding occurs, it may require emergency treatment to drain accumulated blood (haematoma). Blood transfusion is rarely required. Increased activity too soon after surgery can increase the risk of bleeding. It is important to follow all postoperative instructions and avoid strenuous activity for the advised period. I have stopped taking aspirin, anti-inflammatory medications, and any herbal or dietary supplements that may increase the risk of bleeding, as advised by my Consultant.
18. Infection – Infection, although uncommon, can occur after surgery. Should an infection occur, additional treatment including antibiotics, hospitalisation, or additional surgery may be necessary. If the infection is severe, the implants may become infected and need to be removed. It is important to tell your Consultant of any other infections, such as a history of MRSA infections, an open wound, recent upper respiratory infection/pneumonia, ingrown toenail, insect bite, tooth abscess, or urinary tract infection. Infections in other parts of the body may lead to an infection in the operated area. Postoperative infections often result in more extensive scarring and predispose to revision surgery.
19. Scarring – All surgery results in scars. Although good wound healing is expected, scars may be wider, thicker, or more prominent than anticipated. Scar colour and texture may differ from surrounding skin, and scars may appear different on each side of the body. Hypertrophic or keloid scarring may occur, particularly in patients of Asian or Afro-Caribbean descent. Visible suture marks are possible. In some cases, further treatment such as steroid injections, silicone products, or surgical scar revision may be required. If the areola is very large or poorly defined, there is a risk that some areola will be left behind on the lower half of the lifted breast.
20. Firmness – Excessive firmness can occur after surgery due to internal scarring or scarring around the breast implant. The occurrence of this is not predictable. Additional treatment including surgery may be necessary.
21. Pain – Some degree of pain and discomfort is expected after surgery, which is usually well controlled with prescribed painkillers. In rare cases, chronic pain may develop due to nerves becoming trapped in scar tissue or tissue stretching. Small nerve endings may become overactive during healing, producing areas of tenderness or heightened sensitivity, which typically resolves with massage and time. If pain persists, I will inform my Consultant.
22. Sutures – Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires suture removal.
23. Asymmetry/Deformity – Some breast asymmetry naturally occurs in most women. Differences in terms of breast, areola, nipple shape, size or symmetry may also occur after surgery. Additional surgery may be necessary to revise asymmetry after breast lift.
24. Damage to Deeper Structures – There is the potential for injury to deeper structures including nerves, blood vessels, muscles (weakness), and organs like lungs (pneumothorax) and intestines during any surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.
25. Fat Necrosis – Fatty tissue found deep in the skin might die. This may produce areas of firmness under the skin. Additional surgery to remove areas of fat necrosis may be necessary. There is the possibility of contour irregularities in the skin that may result from fat necrosis.
26. Persistent Swelling (Lymphoedema) – Persistent swelling of soft tissue can occur following surgery and may become permanent.
27. Shock – In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalisation and additional treatment would be necessary.
28. Allergic Reactions – In rare cases, local allergies to tape, suture material and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur in response to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment. It is important to notify your Consultant of any previous allergic reactions.
29. Surgical Wetting Solutions – There is the possibility that large volumes of fluid containing dilute local anaesthetic drugs and epinephrine that is injected into fatty deposits during surgery may contribute to fluid overload or systemic reaction to these medications. Additional treatment including hospitalisation may be necessary.
30. Fat/Air Embolism – In rare cases, fat particles or air can enter the vascular system and can travel to the heart, lungs or brain. This can result in significant complications including death.
31. Unsatisfactory Result – Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. The body is not symmetric and almost everyone has some degree of unevenness which may not be recognised in advance. You may be disappointed with the results of surgery. Asymmetry, unanticipated shape and size, loss of function, wound disruption, poor healing, contour irregularity, deformity, and loss of sensation may occur after surgery. Breast size may be too big or too small, or not meet your expectations in terms of bra size. Unsatisfactory surgical scar location or appearance may occur. It may be necessary to perform additional surgery to improve your results. Unsatisfactory results may NOT improve with each additional treatment. The appearance of breasts changes with time and those that have been enlarged and lifted are no exception. Breast tissue may descend off the implant, a phenomenon known as "waterfall deformity". With advancing age breast skin will age, stretch, and become thinner even without an implant. Adding any implant to a breast adds weight and will result in the stretching and irreversible thinning of breast tissues over time. The larger the implant, the greater the amount of breast tissue stretching that will occur.
32. Acellular Dermal Matrix (ADM) or Mesh – If acellular dermal matrix (ADM) or surgical mesh is used to provide additional support for the implant, I understand that this carries additional risks including increased risk of seroma (fluid accumulation), infection, and the possible need for removal of the ADM or mesh material. The use of ADM or mesh will be discussed with me by my Consultant prior to surgery.
33. Long Term Results – Subsequent alterations in the appearance of your body may occur as the result of ageing, sun exposure, weight loss or gain, pregnancy, menopause or other circumstances not related to your surgery.
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