Overview: possible risks and complications of breast augmentation

Anyone thinking about breast augmentation usually starts with research. This includes not only the different methods (e.g. implants or fat transfer) and the search for reputable specialists in plastic and aesthetic surgery nearby, but also the possible risks.

Breast augmentation is one of the most sought-after procedures in plastic surgery, but like any other operation it carries risks that you should know about before you decide. In Germany, doctors are therefore legally obliged to inform patients about all relevant risks before surgery.

Below we give a comprehensive overview of the possible risks of breast augmentation, divided into:

• General surgical risks
  • General risks of surgical procedures
  • Risks of general anaesthetic
  • Risks of local anaesthetic
• Risks of breast augmentation with implants
  • Implant-related risks
  • Changes in sensation and appearance
  • Long-term risks and rare conditions
• Risks of fat transfer breast augmentation
  • General risks of fat transfer
  • Risks associated with liposuction

General surgical risks

Every operation carries certain basic risks, however rare some of them may be. These can occur during or after the operation.

General risks of surgical procedures

• Temporary haematomas (bruising)
• Temporary sensory disturbances in the surgical area, such as numbness or tingling
• Allergic reactions, e.g. to medication, plasters or the anaesthetic
• Bleeding and secondary bleeding, so that in rare cases emergency surgery or a blood transfusion has to be carried out.
• Seromas (fluid collections), which can also occur independently of an implant and may need to be drained with a needle to remove the wound fluid.
• Wound healing problems
• Infection of the wound or the implant area; the implant may have to be removed
• Conspicuous or altered scarring (e.g. hypertrophic scars or keloids)
• Thromboses and pulmonary embolisms (rare, but after surgery or longer periods without movement, blood clots can form which, in the worst case, lead to a pulmonary embolism)

Possible risks of general anaesthetic

Even though anaesthetic technique is far advanced today and complications are statistically unlikely, possible risks remain. These include:

• Circulatory problems, dizziness and a drop in blood pressure
• Allergic reaction to the anaesthetic
• Breathing problems (shallow breathing or irritated airways) during or after the anaesthetic
• Nausea and vomiting after the anaesthetic
• Extremely rare: neurological reactions and disturbances of consciousness

Possible risks of local anaesthetic

Local anaesthetic is rarely used for a conventional breast augmentation. Where it is, for example for very small procedures or corrections, there are certain risks there too:

• Allergic reactions to the local anaesthetic
• Incomplete numbing, which can lead to pain during the procedure
• Cardiovascular reactions, e.g. a drop in blood pressure or trembling

Risks of breast augmentation with implants

Breast implants are ultimately foreign materials, to which the body reacts individually. Over time, or directly after the breast augmentation, various complications can therefore occur. Many of them are rare, but should be considered when making the final choice of method and, where applicable, of implants.

Implant-related risks

• Implant displacement or rotation, which is particularly noticeable with teardrop-shaped implants.
• Capsular contracture: The body naturally forms a capsule of connective tissue around the implant. If this thickens or hardens, however, capsular contracture develops, which can be accompanied by pain, deformation or a visible shift of the implant. Several studies already document links between its frequency, the implant, its position and the surgical technique.
• Implant rupture or leakage: Over time in particular, the implant shell can show signs of material fatigue, or external influences play a part, so that the implant ruptures or leaks.

Good to know: Most people assume that the gel simply runs out. With modern cohesive silicone gels in particular, however, the gel keeps its shape in the event of a rupture and does not literally leak. An intracapsular rupture is therefore often the result. The gel does not spread freely in the body and stays within the surrounding scar capsule. With an extracapsular rupture, on the other hand, the gel enters the surrounding tissue or lymph nodes, which often makes surgery necessary. With saline implants, the saline that escapes is generally harmless, as it is absorbed by the body. Because changes in shape or volume can occur, the implants usually still have to be replaced.

• Visible or palpable edges, wrinkles (rippling) or double contours (“double bubble”), particularly in very slim patients or when implants that are too large have been chosen
• Seromas (fluid collections), as fluid can collect around the implant through friction or irritation.

Method-related risks

With breast augmentation using implants, the method-related risks differ depending on the surgical approach. With the conventional method under general anaesthetic, with a skin incision and full preparation of the implant pocket, more tissue is inevitably divided. As with all surgical procedures, this brings an increased risk of bruising, swelling, temporary changes in sensation of the breast or nipple, and a somewhat longer recovery period. More on this in the next section. The Preservé method from Motiva takes a tissue-sparing approach under local anaesthetic: nerves, vessels and glandular structures are largely preserved, which can reduce the risk of sensory disturbances, marked pain and longer healing. At the same time, this technique requires very precise patient selection and surgical experience, as the working space is more limited. Regardless of the method: factors such as individual anatomy, choice of implant, placement and surgical expertise significantly influence the risk profile and are carefully weighed up in the consultation.

Changes in sensation and appearance with implants

Some side effects and risks also affect how the body feels and looks after breast augmentation. These include

• sensory disturbances (numbness or hypersensitivity of the nipples or skin, usually temporary),
• asymmetries and dissatisfaction with the shape, so that in some cases corrective surgery is necessary, as well as
• striae (stretch marks), e.g. with implants that are too large or thin skin.

Long-term risks and rare conditions with breast augmentation using implants

Even though breast implants are much more durable today than they used to be, they are often not a lifelong solution. Over time the material and the body can change, so some complications only appear many years after the operation. These include, for example

• capsular contracture, material wear and changes in shape that develop over time, which make a further procedure necessary, as well as
• BIA-ALCL (breast implant-associated anaplastic large cell lymphoma), which is very rare and is predominantly associated with certain textured implants.

Good to know: The absolute risk of developing the disease is considered very low depending on the implant type and, for textured implants, is in the range of about 1:3,817 to 1:30,000.

In individual cases, patients also report systemic complaints such as persistent fatigue, joint pain or non-specific symptoms, often grouped together under the term “breast implant illness”. The scientific evidence on this is, however, not yet clear and is still being studied.

Risks of fat transfer breast augmentation

For many, breast augmentation with your own fat is the preferred, natural alternative to implants. But this method also carries possible risks. Complications can occur both during the liposuction and when the fat is injected.

General risks of fat transfer

• Partial reabsorption of the fat and, where applicable, an uneven result: A certain proportion of the fat is broken down again by the body, so that volume loss or asymmetrical results can occur. In some cases, several treatments are therefore advisable.
• Calcifications and the formation of nodules or cysts: Generally harmless, but they should be checked.

Risks associated with liposuction

As fat always has to be removed by liposuction for a fat transfer breast augmentation, there are risks here too that you should be aware of.

• Haematomas, dents and unevenness, mostly temporary
• Infections and scars at the donor sites
• Asymmetries, particularly if too much or too little fat was taken from certain areas. This can usually be corrected, but sometimes a second procedure is necessary.

Regulation and patient information in Germany on the risks of breast augmentation: the essentials at a glance

To help patients assess the risks better, the so-called duty to inform applies in Germany to aesthetic surgical procedures such as breast augmentation as well. Before the procedure, patients must therefore be informed in detail about the possible risks, the different methods, the procedure and the aftercare. If this does not happen, the procedure is not legally permissible.

Anyone who wants further information can also turn to national bodies such as the Federal Institute for Drugs and Medical Devices (BfArM). It regularly publishes information on the possible risks, capsular contracture and the cancer risk associated with breast implants.

Good to know: In the EU and Germany, implants are subject to strict legal requirements. Among other things, they must carry a CE mark and meet the requirements of the Medical Devices Act. Only implants that meet these safety and quality standards may be used at all.

Our specialists in plastic and aesthetic surgery at Innerform are also happy to advise you on the possible risks and to answer the most important questions about breast augmentation.