Guide to Breast Implant Complications

You Should Be Aware of

Guide to Breast Implant Complications
Guide to Breast Implant Complications
Guide to Breast Implant Complications
Guide to Breast Implant Complications
Guide to Breast Implant Complications
Guide to Breast Implant Complications

Though breast implants can help you attain the breast appearance you desire, it’s important to appreciate that your breast implants are not permanent and may require replacement during your lifetime.

Plus, several problems may arise as a result of using implants. These may occur soon or many years after your breast augmentation.

Familiarize yourself with the possible complications of getting breast implants so that you can make an informed decision before your plastic surgery.

Read on to find out more.

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orange county breast augmentation revision patient 1 front Newport Beach, CA
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What are Breast Implant-Related Complications?

Breast implants are human-made devices created by three USA manufacturers: Allergan, Mentor, and Sientra.

Although breast implants are extremely safe and used by about 350,000 patients annually in the US, they are not without their own set of related issues and problems. Like any other human-made implantable medical device (such as heart valves and artificial joints), some patients will require revisions or reoperations.

Before and After

Guide to Breast Implant Complications

This is a 27-year-old female who exchanged her saline implants with silicone implants and had her right nipple asymmetry corrected by Dr. Agha.

The post-operative picture was taken at one year.

Dr. Siamak Agha of The Aesthetic Centers uses a systematic approach to breast augmentation, minimizing implant-related complications while improving patient outcomes and satisfaction ratings. He feels that the real focus should be on the prevention of these problems as much as possible.

Still, it won’t hurt to know about these possible complications, which are as follows:

Capsular Contracture

Capsular contracture is the leading cause of breast augmentation complications. It occurs when the scar tissue or capsule that usually forms around the implant tightens and squeezes the implant.

This can cause the implant to migrate or get displaced, resulting in a tight-looking and deformed breast. It can also be painful.

Capsular contracture happens over time in one or both of the implanted breasts. It may be more common following infection, hematoma, and seroma. Plus, the chances of it happening may increase over time.

Capsular contracture is believed to be caused by contamination of the implant with bacteria normally residing in breast glands. The bacteria form a biofilm around the implant to which the human body reacts by thickening the usually paper-thin capsule.

Symptoms of capsular contracture range from mild firmness and mild discomfort to severe pain, distorted shape of the implant, and palpability — the ability to feel the implant.

Before and After

Guide to Breast Implant Complications

This 31-year-old female developed capsular contracture about four months after her submuscular breast augmentation with saline implants.

The patient underwent a complete capsulectomy and implant exchange by Dr. Agha six months after her first surgery.

The post-op picture is shown three months after reoperation.

Capsular Contracture Levels

Capsular contracture is graded into four levels, depending on its severity.

  • Baker Grade I: the breast is normally soft and looks natural
  • Baker Grade II: the breast is a little firm but looks normal
  • Baker Grade III: the breast is firm and looks abnormal
  • Baker Grade IV: the breast is hard, painful, and looks abnormal

Baker Grade II is usually observed or treated medically with Aspen ultrasound protocol. Baker Grades III and IV are considered severe and often need additional surgery to be corrected.

How Does Dr. Agha Treat Capsular Contracture?


Since it is believed that subclinical bacterial contamination of the implant is the cause of the capsule, Dr. Agha performs a capsulectomy — an en-bloc resection of implant and the capsule for his patients, thus removing the entire capsule and the implant together.

The procedure is often combined with the placement of new implants into the cleaned out breast pocket. A textured surface implant may be used since they have a lower rate of capsular contracture.

Unfortunately, capsular contracture may happen again after capsulectomy and implant exchange.

According to Mentor’s Core Study, women receiving augmentation implants for the first time has an 8% risk of developing severe capsular contracture through three years. On the other hand, women receiving revision-augmentation implants have a 19% risk of the same.

How Does Dr. Agha Reduce Capsular Contracture Rates?

Unfortunately, there is no way to eradicate the chances of getting capsular contracture completely.

However, in Dr. Agha’s practice, the capsular contracture rate is 1.73% — five times lower than the national capsular contracture rate of 8%. He can reduce the risks by:

  1. Washing the implant pocket with Betadine.
  2. Washing the pocket afterward with a triple antibiotic solution consisting of Ancef, Gentamicin, and Bacitracin. This solution has been shown to decrease capsular contracture rates in large scale studies.
  3. Using the “no-touch” technique, where only Dr. Agha handles the implant during preparation in triple antibiotic solution and insertion. These measures ensure that the implant is kept as clean and sterile as possible.
  4. Submuscular implant placement, which reduces the risk of capsular contracture by an average of 8% to 10%. Implants placed over the muscle come into contact with the breast tissues known to harbor bacteria. Having the implants placed below the muscle helps to prevent this. The muscle also “massages” the implant constantly, which may reduce the risk of capsular contracture.
  5. Textured breast implants, which were developed in hopes of reducing the incidence of capsule contracture. However, several studies have shown that when the implants are placed under the muscle, there is no difference in capsular contracture rates between smooth implants and textured implants. When implants are placed over the muscle in a subglandular plane, a textured implant may be advantageous.
  6. Early and continuous breast massage, which may prevent the capsule from tightening around the implant. Dr. Agha will instruct you on the appropriate breast massage at the first post-operative visit. He advocates regular massage for at least the first six months after the surgery.

Are There Other Treatments for Capsular Contracture?

Accolate, a drug used in asthma treatment, has been used in several studies to reduce capsular contracture. Accolate works best on early capsular contractures but may also reverse existing capsules.

If the capsule is well-formed, it can take several months to treat it successfully. Prophylactic treatment may be used in women at a higher risk for capsular contractures, such as those who have previously had it.

Similarly, the medication Singulair has been shown to be effective against early capsular contracture.

Multiple studies have shown promising results with the use of an extracellular matrix to prevent recurring capsular contracture. Dr. Agha has used both AlloDerm and BellaDerm to cover the implants in these matrices and reduce capsular contracture recurrence.

The procedure involves complete en-bloc excision of the implant and capsule, suturing of extracellular matrix to cover the pocket, and placing new implants within the extracellular matrix so that the implant is essentially encased within it.

Read more about AlloDerm and BellaDerm here.

Breast Implant Rupture or Deflation

Breast implants rupture when the implant shell develops a tear or a hole.

Rupture may occur any time after implantation, but they are more likely to do so the longer it is implanted.

According to a study by the Institute of Medicine, the following procedures may contribute to breast implant rupture or deflation, which is why Dr. Agha strictly avoids them:

  • Closed capsulotomy, a technique used to relieve capsular contracture that involves manually squeezing the breast to break the hard capsule
  • Placement of drugs or substances inside the implant other than sterile saline
  • Injection through the implant shell
  • Alteration of the implant
  • Stacking of the implants, which happens when more than one implant is used per breast pocket

Other reasons for the rupture or deflation of breast implants include:

  • Normal aging of the implant
  • Damage caused by breast procedures, such as biopsies and fluid drainage
  • Significant compression during mammographic imaging
  • Stresses, such as trauma or intense physical pressure
  • Capsular contracture
  • Under-filling of saline-filled breast implants

Dr. Agha recommends removing the implant if it has ruptured, regardless of whether it is saline-filled or silicone gel-filled.

Before and After

Guide to Breast Implant Complications
This is a 50-year-old female presented to Dr. Agha with left saline implant deflation over a few weeks.

The patient underwent an exchange of both saline implants.

The post-op picture is shown three months after reoperation.

Saline Implant Rupture or Deflation

Saline-filled breast implants deflate when the saline solution leaks either through an unsealed or damaged valve or a break in the implant shell. You’ll notice this as a loss of implant size or shape.

Implant deflation usually happens immediately, but sometimes, it happens slowly over days. Patients typically present with breast deflation over a few days on one side.

Although the body harmlessly absorbs the saline, implant replacement should be performed within a few weeks to keep the pocket from shrinking.

The average deflation rate in the medical literature across many studies was about 7% at seven years.

Silicone Implant Rupture or Deflation

Because silicone gel is thicker than saline, the gel may remain within the capsule when a silicone gel-filled implant ruptures. This is called an intracapsular rupture.

An intracapsular rupture is usually silent, so it happens without a visible change or feel by the patient. It’s also not evident in a physical examination, with plastic surgeons only detecting it 30% of the time.

A ruptured silicone gel implant can go entirely unnoticed for many years. Sometimes, the rupture is discovered only when the implant is removed.

MRI is currently the most sensitive method for detecting rupture of a silicone gel-filled breast implant in women with silent ruptures. It can detect the condition by as much as 89%, so you will need regular screening MRI examinations over your lifetime to determine if silent rupture is present.

For more obvious silicone implant ruptures, women may notice the following symptoms:

  • decreased breast size
  • change in breast implant shape
  • hard lumps over the implant or chest area
  • uneven appearance of the breasts
  • pain or tenderness
  • tingling
  • swelling
  • numbness
  • burning
  • changes in sensation.

Ruptures of this type are called symptomatic ruptures and usually extracapsular, with the gel outside the capsule. However, some extracapsular ruptures can be silent as well.

According to European studies, about ¾ of implant ruptures are intracapsular, and the remaining ¼ is extracapsular.

It is crucial to have ruptured silicone gel implants removed as soon as possible. The longer the silicone is allowed to remain in the body, the more time it has to migrate to other body parts, like your lungs or lymph nodes, where it can’t be removed.

Diagnosing silicone breast implant rupture is important because the release of silicone gel and fluid into the tissues may result in local complications.

An intracapsular rupture may become extracapsular in about 10 % of cases, and both are generally agreed to indicate the need for implant removal. It may also be necessary to remove the tissue capsule, which will involve additional surgery.

Implant Rippling and Implant Show

Most breast implants ripple. However, this becomes a problem when implants are placed in a subglandular pocket in a thin person who does not have enough breast tissue to cover the implant.

The rate of implant rippling and show is lower when the implant is placed under the chest muscle. It is also less likely to happen when a silicone implant is used.

Read more about implant rippling here.

Breast Pain

About 5% to 15% of women may feel breast pain of an unknown cause following breast augmentation. Wrong size, placement, surgical technique, and capsular contracture are just some of the possible reasons why you experience breast pain.

Removal of the implant has been shown to improve pain in some patients. Make sure to tell your doctor if you experience any pain post-breast augmentation.

Breast Implant Illness

Breast implant illness (BII) refers to a wide range of symptoms that might develop after breast augmentation or breast reconstruction surgery.

To learn more about BII, proceed to this blog post.

BIA-ALCL

BIA-ALCL stands for breast implant-associated anaplastic large cell lymphoma — a rare type of cancer associated with Allergan’s textured breast implants.

Although related to breast implants, it is a cancer of the immune system and is associated with the implant capsule.

Though it is rare for this type of cancer to metastasize, some patients choose to undergo implant removal as a preventive measure or treatment.

Learn more about BIA-ALCL in this post.

Get Your Breast Augmentation Done in Orange County and Los Angeles

When selecting a plastic surgeon to perform your breast augmentation, it is important to understand their complication and re-operation rates and choose a board-certified plastic surgeon who can deal effectively with any complication.  

Fortunately for you, Dr. Agha fits the role well. His reoperation rate is significantly lower than those published in the plastic surgery literature.