Possible Complications

 

POSSIBLE RISKS AND COMPLICATIONS

AWAKE BREAST AUGMENTATION

  • ______ SWELLING:(edema) this occurs to some degree after surgery.  It may last days, or weeks.  You will be given special instructions or treatment if appropriate.

 

  • ______BLOATING/FLUID RETENTION:  Most women experience bloating, especially in the tummy. This is normal, and will dissipate on it's own, under normal circumstances, and usually doesn't require diuretics.  Do not take diuretics without your surgeon's approval.

 

  • ______CONSTIPATION: is usually a result of the pain medications. Most all of them have a tendency to cause this, some more so than others. If you experience constipation, you might want to try a mild laxative, or drink prune juice. Ask your doctor about this at your doctor before taking anything if you are experiencing this.

 

  • _____ BLEEDING: This is controlled at the time of surgery by sutures, cautery or pressure.  Hematoma may require removal.  Some bloody drainage or dressings is normal.  If bleeding occurs, phone our office.  If we can not be reached promptly, and there are no problems that are of concern go to the nearest hospital emergency room and tell our answering service where you are going.  In a very rare case, extensive bleeding or other complications could require hospitalization and blood transfusions with most surgery there is bleeding or other complications could require hospitalizations. 

 

  • _____INFECTION: This may require implant removal and replacement with a new implant at a later time.  Infection may occur with any break in the skin or with operation, or following pregnancy.  When infection occurs around a breast implant, then the implant will probably have to be removed.  It may occur on only one side.  When the implant is removed it is necessary to leave it out for a period of months to be sure that the tissues are completely free of infection before it is replaced.  It is sometimes necessary to wait six months or more before replacing the implant.

 

  • _____ SCARRING: Some scar will result wherever there is a cut.  We make every effort to place scars in areas where they will be minimal or invisible.  Healing and tendency to scar varies in different persons and in different areas of the body of the same person.  How well a person will heal cannot be exactly predicted or controlled.  Extensive wide or thickened scars (hypertrophic or keloid) may occur if you are prone to them.

 

  • _____ NUMBNESS: In cutting the skin, small nerve endings are also cut that result in numbness around or adjacent to the surgical area.  Rarely is an area permanently numb but can occur.  Most numbness or weakness goes away in time.  It is unequal on the sides of the body.

  • _____ MUSCLE SPASMS: Common in women with breast implants placed in the submuscular plane. Your doctor will prescribe muscle relaxants to help with this.

 

  • _____ PAIN/SHARP STABBING SENSATIONS: Sometimes after  breast augmentation patients complain of sharp stabbing pains which is quite common. These pains usually indicate nerve regeneration. So, while they may not be something you enjoy experiencing, keep in mind that nerve regeneration is a good thing. Also remember that as you the further you are post-op, the less intense the feeling becomes.  Rarely they are permanent but can occur. Most of the time pains are very short-lived. 

 

  • ______DOUBLE CREASE/SORE CREASES: This is yet another common feeling after breast augmentation surgery. Many times, the crease has to be lowered when there is not enough room for the implant, in order for it to be centered behind the nipple/areola.   In some cases, the tissue of the original crease has not loosen/relaxed, therefore creating the look of a double crease.   Additional surgery may be required to correct this at an additional cost.   A new crease can also cause it to be more tender and sore after surgery.

 

  • _____TIGHTNESS/PRESSURE IN THE CHEST; If your implants were placed under the muscle, you are pretty much guaranteed to experience this on some level. Your pectoral muscles now have breast implants underneath them.  The muscles need time to stretch out over the implants. As these muscles gradually stretch, the feeling of tightness will gradually dissipate. Some women, and surgeons as well, describe this feeling as an elephant being on your chest.  Others describe it as badly pulled muscles, or how one might feel one day after doing a thousand pushups.

 

  • _____ITCHY AND DRY/FLAKING SKIN ON BREASTS: You may or may not experience this. It is nothing to be alarmed over. Sometimes, the stretching of the skin causes it to become itchy, dry, and flaky. Using a lotion on your breasts will help make you more comfortable. You should always be careful NOT to get any lotion on your incisions until you are sure that they are completely closed, or until your surgeon tells you that it is okay to apply it to those areas.

 

  • _____PHOTOGRAPHS:  I consent to be photographed before, during and after the treatment.  I agree that these photographs become the property of the doctor, to be used as he deems proper.

 

  • _____FOLLOW UP CARE AND APPOINTMENTS:  I agree to keep the doctor informed of any change of address and phone numbers, and I agree to cooperate with the doctor in my care after surgery until completely discharged.  I will make and keep follow up appointments, take medications and follow other instruction as prescribed.

 

  • _____ HARD IMPLANTS:  Hardness may be caused by the excessive swelling, aggravation to the tissues from surgery, or increased fluid (edema) around the implant.   It is normal to experience this. After a period of time your doctor will recommend to massage your breasts and lay on a flat floor for 10 min. a day to help soften the breast implants.

 

  • _____ CAPSULAR CONTRACTURE:  The most common problem with any type of breast implant . This occurs  when the body makes excess scar tissue around the implant, causing the breast to feel hard and the implant to appear displaced or malpositioned.  The incidence of capsular contracture has dropeed to about 1 in 100.   With steroids, massage, decompression, sub-muscular position, saline textured and polyurethane implants there may be less capsule firmness but there can be other problems that may outweigh the advantages.  Surgical intervention generally entails removal of the capsular contracture and implant replacement.  This usually eliminates the problem but capsular contracture  may return, although rare.

 

  • _____ INCISION SITE, LOCATION, SIZE, SHAPE AND IMPLATN SIZE AND TYPE:  Though these factors may be discussed and the patient’s wishes may be followed as much as is prudent and reasonable, the patient must agree to whatever can be done for the patient with respect to all of and during the operation.  Permission is granted for other incisions, implants or treatments as may be needed.  No certain preconceived appearance or result can be obtained.  Other incisions sites may be needed later if there are problems especially with the underarm incisions.

 

  • _____ REJECTION OR EXTRUSSION:  The body may recognize the implant as a foreign object and try to reject it.  The capsule contracture problem of becoming too hard may be part of rejection phenomenon.  Occasionally the implant may be pushed from the inside by rejection process against the skin causing it to become very thin and a blue window may occur.  The implant may be pushed against the skin until the skin over the implant breaks and the implant becomes exposed.   When this occurs the implant extrudes or is removed.  It may be necessary to wait several months before putting a new implant back in.

 

  • _____IMPLANT RUPTURE:  Implants may rupture at any time following surgery even without apparent cause.  The most common cause of rupture is injury.  A ruptured gel implant may result in gel migration, inflammation, and formation of silicon granulomas.  Additional surgery may be required to remove the implant and the gel.  The long term effects of silicon gel on the body with a ruptured implant are unknown.

 

  • _____SKIN NECROSIS:  Skin over a portion of the implant may become very thin and break.  The implant may become exposed and require removal.  Then it may be best to wait six months for replacement with a new implant.

 

  • _____CHANGE IN NIPPLE SENSATION:  Some numbness is expected with each operation.  The numbness is most often in the lower portion of the skin below the nipple.  Usually is some numbness of the nipples from breast implant surgery.  Most of the numbness goes away in a period of months or years.  Some numbness may be permanent and unequal.

 

  • _____ INTERFERENCE WITH MAMMOGRAPHY:  The presence of breast implants of any type interferes with mammography and early detection of breast cancer.  Mammograms may be more uncomfortable since they require squeezing the breast with pressure.  The pressure of mammography may rupture an implant or cause implant deflation with saline implants.  The standard recommendations of the American Center Society should be followed for when to have mammography.  ACS recommends that at age 35 to 40 a base line for mammograms, you should have a mammogram every year.

 

  • _____AUTOIMMUNE DISEASE:  Some women with breast implants have developed scleroderma, which is a serious disabling and potentially fatal connective tissue disease.  Some women have developed arthritis like diseases such as, lupus and rheumatoid arthritis after breast implants surgery.  According to the federal drug Administration, September 26, 1991, “there is no conclusive evidence at preset that women with breast implants have an increase risk of developing arthritis-like diseases or other autoimmune diseases.  Women with breast implants who have developed such diseases or autoimmune diseases may have done so regardless off their implants”.

 

  • _____BREAST FEEDING:  Many patients have become pregnant and have breast fed infants after breast implant surgery.  Breast implants may interfere with breast feeding in many different ways.  There may be numbness or hypersensitivity of the nipples.  There may be tenderness or inadequate milk production.  Pregnancy after breast implant surgery may cause stretching of the skin and deformity of the shape of the breast or stretch marks of the skin.  It is possible that there could come some harm to the infant who is breast fed from breasts with implants potential harmful effects are unknown.

 

  • _____AXILLARY INCISION:  The axillary incision, under the arm or in the armpit, may cause more tenderness and discomfort after the operation, especially with movements of the arms, than the incisions on the breast or chest wall.  In addition there may be numbness of the arms around the incision or of part of the upper arms, or fore arms or the hands and fingers. There also could be interference with circulation of the upper arms or hands than may cause a tendency to have numbness, tingling or swelling of the hands.  These problems are uncommon but could occur even when the surgery is perfectly performed.  Another incision site may be necessary if there are problems with this surgery or a later surgery. 

 

  • _____BREAST CANCER AND IMPLANTS:  Breast implants interfere with early detection of breast cancer.  This could mean that women with breast implants have reduced healing rate with breast cancer.  Approximately two million American women have breast implants.  While women with breast implants have not been shown to have an increased risk of breast cancer, and according to FDA “there is no evidence at present that women with breast implants are at increased risk.  Studies are still in progress and results may not be known for many years to come.”

 

  • _____ALLERGIC REACTIONS/SKIN IRRITATION:  In rare cases, local allergies to tape, suture material, or topical preparations has been reported.  Allergic reactions may require additional treatment.  In rare cases, the brace (bra) that is used post surgery for the first few days, can irritate the skin as it is placed firmly.  On rare occasions can also cause a rash and/or strap burns.

 

  • _____SYMETRY OR ASYMMETRY:  It is understood that the two sides or our body are different and asymmetrical and this includes the chest, breast, nipples, and all other parts of our faces and bodies.  This physician will strive to obtain symmetry, however, if if the breasts are uneven before the operation, they may remain so after the surgery.  No two breasts are alike and in some women they are different.  Breast implant surgery may make the unequal appearance of the breast better or worse.  The breasts can not be made equal or alike.  If the breasts are not the same size or shape before the surgery, it is unlikely that they will be completely symmetrical afterward.

 

  • _____ DEFORMITIES OF APPEARANCE:  Many deformities and disfigurements of appearance occur after breast implant surgery.  Among there are a stuck on appearance, nipples, sagging, as well as too much or too little cleavage and many others. The shape and size of the breast prior to surgery will influence both the recommended treatment and the final results. 

 

  • _____ RIPPLING:Breast implant rippling is the term for indentations at the edges of the breast implant that look like scallops.  Silicone-gel-filled breast implants tend to ripple and wrinkleless. Rippling may be visible, especially among women with little breast tissue who choose over-the-muscle implant placement. Rippling may also occur in women who have significant breast tissue if the implant shifts.The presence of rippling is not caused by the type of incision used, the suture used or wheter the implant is placed above or below the muscle. Unfortunately, ripples do not go away.

 

  • _____STRETCH MARKS OR STRIAE:   The elasticity of skin varies from person to person. Some individuals never develop stretch marks and others may be prone to them. Moisturizing the skin with shea nut butter or olive oil may help prevent stretch marks. Retin A (tretinoin) may help erase red lines or early stretch marks.  

 

  • _____MUSCULAR MOVEMENT:  Implants that are placed below the pectoral muscle may move whenever the muscle is contracted in normal movements of the arms.  This may also cause visible distortion of the appearance of the breasts with movement of the arms.  Occasionally the movement is so annoying the women has further surgery to pout the implants above the muscles because of these problems.

 

 

  • _____UNDER THE MUSCLE:

 

  1. _____MUSCLE WEAKNESS: Whenever the implants are placed below the muscles, there is some weakness of the muscle because of the injury o the muscle itself or the nerve and blood supply to the muscle.  The muscle is partly detached from the ribs and is otherwise injured by the surgery.
  2. _____DOUBLE FOLD OR BUBBLE: A fold in addition to the new inframmamary fold may occur in the lower part of the breasts.  This due to a persistence of the normal inframmamary fold or crease.  It can cause a double bubble appearance which may or many not improve in time.

 

  • _____IMPLANT DURATION:  Implants lasts many years in some women and have to be replaced more frequently in others.  The person choosing breast implants should expect to require further surgery to repair the implants in the future, especially if they are saline filled.

 

  • _____UNKNOWN RISKS:  Although there are many risks that are known that can be described, most risks are still unknown.

 

  • _____SATISFACTION:  Cosmetic surgery is inexact and can be complicated.  To achieve an improvement in appearance we undergo serious risks of discomfort and the possibility of looking worse than we did before with severe disappointment.  There can be NO GUARANTEE that either YOU OR ANYONE ELSE WILL BE SATISFIED OR PLEASED WITH THE RESULT.

 

 
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