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Breast Augmentation Risks: What You Need to Know

By Luke J. Curtsinger, III, MD

By Luke J. Curtsinger, III, MD

Breast augmentation is the most common cosmetic surgery performed in this country. The vast majority of women who have breast augmentations are quite thrilled with the results. According to the cosmetic surgery review site RealSelf, 98% of people who have breast augmentation surgery are satisfied with their results and say the surgery is worth having.

Like any surgical procedure, there are some risks and complications associated with breast augmentation. However, most of these are general risks that come along with any surgery. While the chance of experiencing serious complications is low, it is important to understand them.

What Factors Affect Your Level of Risk?

For most people, the risks of breast augmentation surgery are low, but there are factors that can increase the chances of experiencing complications. They include behavioral factors and health problems that can make any surgery riskier.

  • The older you are, the higher your level of risk.
  • Having a blood disorder, such as hemophilia, increases bleeding risks.
  • High blood pressure increases the risk of stroke after surgery – This risk increases in people who have previously had a stroke.
  • People with diabetes may heal more slowly after surgery.
  • The risk of breast augmentation complications is higher in people with heart disease and COPD.
  • Asthma, heart disease, and obstructive sleep apnea increase the risk of anesthesia-related complications.
  • Smoking can slow down wound healing.
  • Alcohol or drug addiction may cause unpredictable reactions to anesthesia.

If you experience any of the above, bring it up with your surgeon during your consultation, so they can take it into account as they determine whether a breast augmentation is safe for you or whether one type of breast augmentation would be better than another.

What Are the Risks and Complications of Breast Augmentation Surgery?

Once you’ve decided to have a breast augmentation, your surgeon will discuss the risks and complications with you. In fact, this is a requirement of having the surgery. Before your procedure, you must sign a surgical consent form that says you’ve been informed of the risks and consent to the surgery. Your surgeon will be happy to answer any questions you have.

When you have a surgical procedure, there are two kinds of risks involved:

  1. The risks that are associated with almost any kind of surgery
  2. The risks associated with the specific type of surgery you’re having

1. General Surgical Risks and Complications

The following are general risks and complications that can occur with any kind of surgery. These are all rare occurrences, but because there is a risk—even a small one—it’s important to know about it before you have a surgical procedure.

  • General anesthesia – It’s safe for most people, but there is a small risk of a dangerous reaction. Between 1 in 5,000 and 1 in 10,000 people have allergic or sensitivity reactions to anesthesia. If you’ve had anesthesia before without problems, you’re unlikely to have issues.
  • Infection – After having any kind of surgery, there’s around a 1% to 3% chance that the incision site becomes infected. Keeping incisions clean and dry helps prevent infection. It’s also important to take any antibiotics your surgeon prescribes.
  • Blood clots – Your body’s clotting reaction is amplified after surgery. This leads to a temporarily heightened risk of deep vein thrombosis (DVT) and blood clots. However, the risk that this might happen after implant surgery is still low: 02%, or 1 in 5,000.
  • Hematoma and/or bleeding – Less than 1% of people develop a major hematoma after having aesthetic surgery. If it does develop, it is more likely to happen in people who’ve had multiple or complex surgeries.

2. Risks and Complications Specific to Breast Surgery

Breast Augmentation with Fat Transfer

In this procedure, your breasts are augmented with excess fat taken from other parts of your body, such as your hips or thighs. The fat is removed via liposuction and then injected into your breasts.

The risks and complications of this procedure are mostly things that can happen as a natural result of transferring body fat. They are rarely harmful.

Necrosis (Cell Death)

Not all the transferred fat “takes” after the procedure is performed. Some of the fat cells die off naturally, in a process called necrosis. This is very common and happens in virtually all women who have breast augmentation with fat transfer. The amount of fat that dies after transfer varies, ranging from 2% to 18%.

Most of the time this doesn’t cause any problems. In some cases, however, necrosis may cause scar tissue to form, which can feel lumpy and painful. Necrosis doesn’t cause physical harm, and it does not lead to cancer or increase the risk of cancer. The scar tissue can be removed if it changes how the breast feels.

Cysts

Women can develop breast oil cysts at any stage of life, but having breast surgery increases the chance that a cyst may form. These are lumps of liquid fat tissue, surrounded by a thin layer of calcified tissue. Oil cysts are benign lumps and don’t affect your risk of breast cancer. Like necrosis, a cyst may change how the breast feels. Cysts can also be painful.

If you have a cyst, it can be treated with aspiration, where the fluid is removed via a fine needle. If the cyst isn’t suitable for aspiration, it can be removed via surgery.

Microcalcification

This is another issue that may arise due to death of fat cells. Microcalcification is when tiny calcium lumps form within breast tissue. They’re typically too small to be felt, and they’re not harmful in themselves. If you have microcalcification, it won’t affect how your breasts look or feel or cause any health problems.

Microcalcification doesn’t cause cancer, but it can be an early warning sign of breast cancer. If your mammogram detects microcalcification, you may need another scan to rule out cancer.

Movement of Fat Cells

After a breast augmentation with fat transfer, there is a risk that some fat cells may move out of the treatment area.

Movement and necrosis of fat cells both pose the risk of altering the desired result of surgery. For instance, fat cell movement or necrosis may mean that the breasts are smaller than desired. But it won’t cause pain or increase your risk of future health problems. If it does happen, having a second surgery may help you achieve the result you want.

Risks of Breast Augmentation with Implants

These issues are specific to augmentation with implants.

Breast Implant Rupture

Implant rupture is a risk with both saline and silicone implants, but thanks to advances in implant technology, rupture is less likely to cause other complications.

With saline implants, the risk of rupture is up to 5% three years after surgery and up to 10% ten years after surgery. The rupture of a saline implant poses no health risks, as the saline is absorbed into the body. It does mean that a revision surgery is needed to replace the deflated implant.

For silicone implants, the risk of rupture ranges from 1.1% at 6 years after surgery to 9% at the 10-year mark. The rupture risk also depends on the brand and type of implants chosen. Silicone implants don’t deflate because silicone is a thick gel that stays inside the implant capsule. However, there is still a risk that the rupture may cause:

  • Breast pain
  • Scarring
  • Changes to how the breast looks or feels

If a ruptured implant causes problems, the best option is typically to remove it and place a new implant.

Scarring

It’s normal for a small amount scar tissue to develop inside the breast, around the implant. In some women, the scarring is extensive enough that it can lead to other problems.

Having an autoimmune or inflammatory illness can increase the risk of scarring. Post-surgery complications, such as infection, seroma, and hematoma, also increase the risk.

Because the scarring is internal, it doesn’t always affect how the breasts look and feel. But in some cases, it can be enough to cause problems, such as capsular contracture.

Capsular Contracture

Capsular contracture is a breast augmentation complication that develops when tissue scarring forms a tight capsule around the implant. This causes the implant to contract, which may move it from its intended location. Capsular contracture is often painful, and it may also alter how the breast looks and feels.

Having breast implant surgery gives you an overall risk of capsular contracture of 3.6%, or around 1 in 28. For most women who experience this problem, it develops within the first two years after surgery. Capsular contracture can be repaired by removing the affected implant and replacing it with a new one.

Changes in Sensation

Many women experience some changes in sensation as their breasts heal after surgery. In most cases, these changes are temporary, lasting only a few weeks or months.

In rare cases, some women may find they experience long-term changes. If this occurs, it’s more likely after a procedure where incisions are made around the nipples or areolae, or if a woman chooses implants that are too large for her body frame.

Rare Risks of Breast Augmentation with Implants

Seroma - This is a buildup of fluid around the breast implant. However, since drainage tubes are placed to prevent fluid buildup, seroma doesn’t occur often, and it’s rarely a serious issue. In almost all cases, it goes away on its own as healing continues. It’s rare for seroma to cause any lasting problems.

Breast Implant Illness - Some women are affected by breast implant illness after having augmentation surgery. This illness includes a range of symptoms, such as:

  • Muscle and joint pain
  • Fatigue
  • Depression
  • Anxiety
  • Sleep disturbances
  • Gastrointestinal problems

The exact cause of the illness is unknown, but many women who have the condition find that their breast implant problems are relieved if the implants are removed.

Learn more about breast implant illness here.

Breast-Implant-Associated Lymphoma (BIA-ALCL) - BIA-ALCL is a rare non-Hodgkin’s lymphoma that can be triggered by breast implants. Symptoms include:

  • The formation of a mass near the breast implant site
  • Breast pain
  • Persistent swelling

Treatment involves surgical removal of the implant and surrounding scar tissue. Some women may also have chemotherapy and radiation therapy.

BIA-ALCL can develop any time after breast implant augmentation. Once you’ve had implants, it’s important to have regular checkups to ensure your breasts stay healthy.

The overall lifetime risk of BIA-ALCL is between 1 in 2,000 and 1 in 86,000. Of all the hundreds of thousands of breast implant surgeries performed, there have so far been 573 cases and 33 known deaths due to BIA-ALCL. Ninety-three percent of people diagnosed with BIA-ALCL remain cancer-free three years after treatment.

Why It’s Important to Understand the Risks of Breast Augmentation Surgery

Having surgery can be risky, but by choosing an experienced surgeon, you’re already doing a lot to reduce the level of risk. With a good surgeon and a commitment to following their instructions for post-surgical care, you’re less likely to be affected by complications that might impact your health or surgery results.