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Complications of Breast Augmentation

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Evidence-Based Cosmetic Breast Surgery

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Abstract

Core studies find that the rate of capsular contracture is between 8% and 19%. Some researchers claim that bacterial biofilm infections cause capsular contracture. However, there are problems with a purely infectious etiology. Positive and negative bacterial cultures from implants and capsules have been obtained from women with and without capsular contractures. If an infected capsule were the cause of contracture, capsular preservation would virtually guarantee treatment failure. Yet, open capsulotomy alone is 77% effective after one release. The recurrence rate of 23% overall after open capsulotomy (and 14% for patients with intact implants) compares favorably with recurrence rates reported after capsulectomy, which can range from 25% to 53.4%.

Some investigators use acellular dermal matrix (ADM) to reduce recurrence risk, but this material comes with additional risks, including seromas and infection. Many investigators using ADM receive financial support from the manufacturer.

Core studies using magnetic resonance imaging reveal rupture rates in the range of 13–17.7% for round and shaped silicone implants respectively, at odds with early claims that highly cohesive implants are less likely to leak. Folds still occur. Form-stable implants can be too firm, and may rotate.

Importantly, textured implants are linked to anaplastic large cell lymphoma. The patient should be informed of the added risk with texturing so she can participate in implant selection and possibly select a smooth device. Some investigators recommend a 14-point risk-reduction plan that includes nipple shields and triple-antibiotic irrigation. However, these extra measures have little scientific foundation. Saline implants should not be overlooked in view of their safety, lower cost, and high patient satisfaction.

Individual risk stratification and chemoprophylaxis do not prevent venous thromboembolism. SAFE (Spontaneous breathing, Avoid gas, Face up, Extremities mobile) anesthesia maintains pulsatile blood flow in the calves. Ultrasound surveillance is highly accurate for detecting thrombi.

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    Eric Swanson MD

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Swanson, E. (2017). Complications of Breast Augmentation. In: Evidence-Based Cosmetic Breast Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-53958-4_4

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