1. Asymmetry (difference in size or shape between breasts) – Most breast are asymmetric before breast augmentation, and all breasts remain (at least to some degree) asymmetric after the operation. Usually, the differences between the breasts can be improved during surgery, but occasionally the breast can become even more asymmetric after the operation and additional surgery may be required to improve this problem. For problems with sinking implants or implants placed off center, the wound is opened and the implant is moved. Sometimes if the first procedure is done in a subglandular approach, fixing the asymmetry can be done with submuscular implant placement.
2. Contour problems – These may be seen before or after breast augmentation. Although implants usually improve breast shape, contour irregularities may persist or worsen after the operation requiring additional surgery to correct them.
3. Capsular Contracture –
o Definition – Once an implant has been placed, cells called fibroblasts make scar tissue to surround the surface of the implant. This occurs around every implant in the body, including artificial joints, pacemakers, or shunts. The scar tissue that forms around the implant is called “connective tissue” or the “fibrous capsule” and is responsible for keeping the implant in place. This capsule, for reasons which are poorly understood, can sometimes thicken and contract. This squeezing of the implant can cause shape changes, hardening, or pain.
o Preventing Contracture – A number of factors may reduce the occurrence of capsular contracture. These include submuscular implant location, use of textured implants, and prevention of post-operative infection or bleeding. Sometimes doctors will also ask patients to start massaging the breast 5 days after surgery to reduce hardening of the capsule surrounding the implant. It should be noted, however, that massaging with textured implants is discouraged.
o Treatment For Capsulars Contracture – For severe capsular contractures, the treatment of choice is re-operation. During this procedure, scar tissue lining the implant pocket is removed. Subglandular implants may be moved to a submuscular position.
4. Altered Sensation or Feeling – Most women have some decrease of breast/nipple feeling or sensation following surgery. For women with these changes, feeling often returns after 6-12 months. Unfortunately, 15% of patients have loss of nipple sensation in at least one of their breasts. Loss of feeling to areas besides the nipple is common as well, though within a year most patients return to normal. Rarely, symptoms such as itching and tingling occur, but like the others, these normally end in 6 months.
5. Deflation or Rupture – The rate of deflation was published in one large, well-controlled study at 8.3%, though in the past this has often been a largely debated number. Implants that are placed in the subglandular position and implants larger than 450cc are at greatest risk for deflation. If this complication occurs, additional surgery is required to replace the implant. The cost of replacement usually is the responsibility of the patient.