Breast augmentation is a highly successful and sought after method of body contouring. But like all surgical procedures, it does have a risk of specific complications. While breast augmentation does have some typical risks associated with any surgery, like hematoma and infection, by far the majority of complications are more long-term and are largely aesthetic in nature. This has everything to do with the fact that it is a completely implant-dependent operation. Without an implant, there would be no breast enlargement result.
The list of potential short and long-term breast implant complications is lengthy. It includes capsular contracture, rippling, rupture, asymmetry, scarring, elective size change, elective style change and ptosis. While this list can be found on any breast augmentation surgery consent form, and the most significant ones discussed in a consultation, most patients pay little attention to them. This is understandable as the emotional nature of this cosmetic procedure has most women caught up in the euphoria of the potential results.
In the March 2011 issue of Plastic and Reconstructive Surgery, an excellent study was reported that looked at the long-term breast implant revision rate. (which is used to treat whatever complication has occurred) In the hands of very experienced plastic surgeons a large private practice in Atlanta, a total of over 800 patients that had breast augmentation from 1994 to 2009 for reoperation rates. The study included 482 patients with saline implants and 330 patients with silicone implants. The most common complications included capsular contracture, rippling, rupture, infection and hematoma. The rate of reoperation at 1 year after breast implant surgery was 14.1%.
What this study illustrates is a stark reality that an implant-driven operation like breast augmentation has a higher rate of complications than most patients would ever think. With a reoperative risk of 14% in the first year of surgery (according to this one single group practice), the 3 or 5 year reoperation risk will be higher. How much higher is not precisely known but a 20% to 30% reoperation risk in the first ten years after implantation is very realistic. (between 10 to 20 years after initial breast augmentation that risk must surely be 50% to 70%) Most breast implants (> 90%) will be revised/replaced by the 20 year implantation date.
A discussion on such complication/reoperation rates may make breast augmentation seem like a bad operation. It is not and this is supported by the extremely high satisfaction rates of women with breast implants, even those that have had revisional surgery. Once implanted, the vast majority of women are not willing to part with their breast implants even if it means multiple revisional operations.
What is relevant is that patients understand that these breast augmentation risks are not rare. Many patients who need revisional surgery feel that they are the one unlucky patient or that this is just their typical bad luck. With revision rates of 10% to 30% in the first five years or so after surgery, it is not bad luck but just a pure function of being caught up in the statistics of the risks of breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana