RISKS AND COMPLICATIONS

Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. The incidence is approximately 8%. This squeezing of the soft implant can cause the breast to feel hard and may distort the shape. In severe cases it may also be painful. It tends to occur within 6 - 12 months following surgery. Capsular contracture can be treated in several ways, and sometimes requires either removal or "release" of the scar tissue or replacement of the implant. The chances of developing a capsular contracture depend on several factors and are not predictable.

Unsightly, thickened scars at the site of the skin incisions can occur in 2 - 5% of patients.

As with any surgical procedure, excessive bleeding following the operation may cause swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood. Postoperative bleeding occurs in approximately 1% of all breast augmentations. It tends to happen within 48 hours but occasionally it may happen up to 3 weeks after surgery.

Approximately 1% of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Up to 15% of women will have permanent alteration of nipple sensation. You may also notice small patches of numbness near your incisions. The loss of feeling may improve with time, but may be permanent in some patients. If nipple sensation is critical to your enjoyment of sex you should discuss this issue carefully with your partner and with me.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to breastfeed. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. The PVP filling gel in the hydrogel implants will be eliminated in the urine, unmetabolised.

If a break occurs in a silicone gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body such as the lymph glands in the armpit. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all silicone gel in the breast tissue if rupture should occur. Leakage of silicone gel may cause lymph glands in the armpit area to enlarge and feel firm.

A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain, or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as "connective - tissue disorders".

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology centre where radiographers are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Since the breast is compressed during mammography, it is possible for an implant, or the capsule around it, to rupture. An experienced radiographer should know how to push the implant away from the breast tissue to get the best possible views of the breast. Even when this special technique is used, some breast tissue may be missed. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience these complications, you should discuss each of them with me to make sure you understand the risks and consequences of breast augmentation.

Should complications occur that require early reoperation I will not charge an additional surgical fee but you will be required to pay for the theatre, anaesthetic and hospital costs.