The most common complications after breast augmentation include bleeding and infection. Bleeding, in fact, or hematoma, is the most common complication after any surgery. There is approximately a 1% risk of bleeding after a breast augmentation surgery. Infection is second to bleeding and can be associated with Staphylococcus aureus with an abscess, or Staphylococcus epidermis from a skin infection. Later side effects of breast augmentation can include ruptured implants, silicone or saline, malposition of the implant, severe encapsulation or scar tissue contracture, referred to as capsular contracture. Other complications can include loss of sensitivity of the nipple-areolar complex, usually less than 5%, and/or inability to lactate, also less than 4% to 5%.
Our patients are given preoperative instructions before they undergo breast augmentation. Instructions include having the patients no longer take aspirin-containing products, also Advil, Motrin, Excedrin, ibuprofen. We want to maintain good clotting during the operation and postoperative. Patients are also taken off their oral contraceptives or estrogen products one week prior to surgery to reduce risk of deep venous thrombosis and pulmonary embolus due to venostasis. Our patients are also told to stop drinking alcohol within 72 hours of the surgery and are made n.p.o., that means nothing per mouth, the midnight before their operation to prevent general anesthetic reflux. Postoperatively, the patients are given pain medication as well as antibiotics for seven days to prevent or reduce risk of infections and incisions are kept dry with 4 x 4 gauze and surgical or athletic bras are used. Our patients are instructed not to lift for 3-4 weeks post augmentation to prevent bleeding or hematomas as well.
Breast augmentation procedures should be performed under general anesthesia in an accredited ambulatory facility. Board certified plastic and reconstructive surgeons perform breast augmentations daily. I personally perform many breast augmentations weekly. The majority of patients have either saline or silicone implants placed in the dual plane or the subpectoral pocket. In other words, the implants are placed at least two-thirds underneath the pectoralis major muscle with the lateral third of the implant often placed behind the glandular tissue. The approach to breast augmentation can include an incision made through the inferior areola under the nipple, the inframammary approach under the crease, or under the armpit known as transaxillary. Saline and silicone implants are now FDA approved. Patients must be 22 years of age in order to have silicone gel implants placed. Implants can be placed either subglandular or retromammary, above the muscle, or submuscular or behind the muscle. In general, we most often place the implants behind the muscle in order to reduce visibility, capsular contracture, and palpability of the bags. Once again, breast augmentation should be performed by board-certified plastic surgeons who have trained and have the experience and judgment to understand the anatomy of the chest wall.