Breast Augmentation Possible Complications

Since 1962, breast augmentation has continued to evolve and improve as our understanding of the devices themselves, surgical techniques, and patient selection criteria have increased.

Current breast implants are manufactured with better implant shells and filler materials and are available in a variety of shapes and sizes. Surgical techniques emphasize the importance of absolute sterility, meticulous homeostasis, and proper dissection techniques. Patient selection has focused on ideal proportions, optimizing approach, and ensuring realistic expectations.
As a result of these advancements in primary breast augmentation, clinical outcomes have improved; however, they are not always perfect.

Many of these imperfections are related to symmetry based on the contour, position, and volumen of the breast or nipple areolar complex. These maybe appreciated early in the postoperative period or later. Some are relatively common and others are not.

As with all surgical procedures, there are inherent risks of bleeding and infection. Fortunately, these morbidities constitute less than 2% of prosthetic breast augmentation procedures. Prevention is for the most part related to proper surgical technique; however, there are situations in which complications occur that are outside of the control of the operating surgeon.

Hematoma formation is an uncommon complication following breast augmentation with an incidence that ranges from 1% to 2%. Its prevention dictates meticulous intraoperative hemostasis and the judgmental use of postoperative drains. Possible bleeding sources include perforating vessels based off of the internal mammary, intercostal, and lateral thoracic vascular systems that may be injured during the pocket dissection
phase

Despite adequate intraoperative hemostasis, postoperative bleeding can sometimes still occur. Reasons for this may include undiagnosed coagulopathies such as von Willebrands disease or platelet dysfunction. Although drains are not routinely used in our practice, their use is considered when there is a generalized oozing that is beyond what is normally seen.  Diagnosis of a hematoma may be obvious or subtle depending on the degree of swelling.

The occurrence of a late hematoma many years after initial breast augmentation has been reported. This will usually manifest as a relatively rapid, unilateral swelling of the breast without signs of infection. The affected breast will be firm and usually not affected with ecchymosis. This is because the hematoma is usually intracapsular. The etiology of the bleeding is not always obvious but is often because of capsular erosion into the surrounding tissues. The bleeding  continues until it tamponades as a result of the increased pressure. The management of late hematoma is operative and includes removal of the device and total removal of the capsule.

Infections following breast augmentation are not common with a reported incidence of 1.2%  Postoperative infections typically manifest with erythema, swelling, and pain and may be come evident a few days following the operation and in extreme cases months to years following the operation. Reported organisms have included Staphylococcus aureus and epidermidis, Streptococcus, Pseudomonas aeruginosa, and Mycobacteria.
Treatment must be prompt and aggressive.

Women are usually assessed at various intervals during the initial 24- to 48-hour period. If the signs and symptoms improve, then the antibiotic therapy is continued usually for a 2-week period based on the recommendation of an infectious disease specialist. If the signs and symptoms do not improve, surgical exploration is considered.  Reaugmentation is considered no sooner than 6 months following the infection, if the breast implant has been removed.

Many of the common problems that we as plastic surgeons encounter are ultimately related to asymmetries in volume, contour, and position of the breast or nipple areolar complex.

These asymmetries are oftentimes evident preoperatively; however, when they are not recognized preoperatively, they can be exacerbated postoperatively.

Oftentimes these asymmetries will be self-limiting and improve spontaneously; however, there are situations when secondary procedures may be needed.