Overview: Possible risks and complications associated with breast augmentation
Anyone considering breast augmentation usually starts by doing research. This includes not only the various procedures (e.g., implants or autologous fat) and the search for reputable plastic and surgical specialists in the area, but also the possible risks.
Although breast augmentation is one of the most popular plastic surgery procedures, like any other operation, it carries risks that you should be aware of before making a decision. In Germany, doctors are therefore legally obliged to inform patients about all relevant risks before the operation.
Below, we provide a comprehensive overview of the possible risks associated with breast augmentation, divided into:
- General surgical risks
- Risks associated with breast augmentation using implants
- Risks associated with breast augmentation using autologous fat
General surgical risks
Every operation carries certain basic risks, however rare they may be. These risks can occur during or after the operation.
General risks associated with surgical procedures
- Temporary hematomas (bruises)
- Temporary sensory disturbances in the surgical area, such as numbness or tingling
- Allergic reactions, e.g., to medications, plasters, or anesthetics
- Bleeding and secondary bleeding, meaning that in rare cases, emergency surgery or a blood transfusion may be necessary.
- Seromas (fluid accumulations), which can also occur independently of an implant and may need to be punctured to drain the wound fluid.
- wound healing disorders
- Infection of the wound or implant area; the implant may need to be removed.
- Noticeable or altered scarring (e.g., hypertrophic scars or keloids)
- Thrombosis and pulmonary embolism (rare, but after surgery or prolonged periods without movement, blood clots can form, which in the worst case can lead to pulmonary embolism)
Possible risks associated with general anesthesia
Even though anesthesia techniques are highly advanced today and statistically unlikely, there are still potential risks. These include:
- Circulatory problems, dizziness, and drop in blood pressure
- Allergic reaction to the anesthetic
- Breathing problems (shallow breathing or irritated airways) during or after anesthesia
- Nausea and vomiting after anesthesia
- Extremely rare: neurological reactions and disturbances of consciousness
Possible risks associated with local anesthesia
Local anesthesia is rarely used in traditional breast augmentation procedures. However, if it is used, for example in very minor procedures or corrections, there are certain risks involved:
- Allergic reactions to the local anesthetic
- Incomplete anesthesia, which can lead to pain during the procedure
- Cardiovascular reactions, e.g., drop in blood pressure or tremors
Risks associated with breast augmentation using implants
Breast implants are ultimately foreign materials to which the body reacts individually. Various complications can therefore arise over time or immediately after breast augmentation. Many of these are rare, but should be considered when making the final decision on the procedure and, if applicable, the implants.
Implant-related risks
- Implant displacement or rotation, which is particularly noticeable with teardrop-shaped implants.
- Capsular contracture: The body naturally forms a connective tissue capsule around the implant. However, if this thickens or hardens, capsular contracture can occur, which can be accompanied by pain, deformation, or visible displacement of the implant. Several studies have already been conducted that demonstrate correlations between frequency, implant type, location, and surgical technique.
- Implant rupture or leakage: Over time, the implant shell may show signs of material fatigue, or external influences may cause the implant to tear or leak.
Good to know: Most people think that the gel simply leaks out. However, modern cohesive silicone gels are dimensionally stable in the event of a rupture and do not literally leak out. This often results in an intra-capsular rupture. The gel does not spread freely in the body and remains in the surrounding scar capsule. In the case of an extracapsular rupture, however, the gel enters the surrounding tissue or lymph nodes, which often requires surgical intervention. In the case of saline implants, on the other hand, the escaping saline solution is usually harmless as it is absorbed by the body. However, as changes in shape or volume can occur, the implants usually have to be replaced anyway.
- Visible or palpable edges, rippling, or double contours ("double bubble"), especially in very slim patients or when implants that are too large are selected.
- Seromas (fluid accumulations), as friction or irritation can cause fluid to accumulate around the implant.
Method-related risks
In breast augmentation with implants, the risks associated with the method vary depending on the surgical approach. The classic method, performed under general anesthesia with an incision and complete preparation of the implant pocket, inevitably involves more extensive tissue dissection. As with all surgical procedures, this is associated with an increased risk of bruising, swelling, temporary changes in sensitivity of the breast or nipple, and a slightly longer recovery period. More on this in the next section. Motiva's Preservé method takes a tissue-sparing approach under local anesthesia: nerves, vessels, and glandular structures are largely preserved, which can reduce the risk of sensory disturbances, severe pain, and longer healing times. At the same time, this technique requires very precise indication and surgical experience, as the working space is more limited. Regardless of the method, factors such as individual anatomy, implant choice, placement, and surgical expertise significantly influence the risk profile and are carefully weighed during the consultation.
Changes in sensation and appearance with implants
Some side effects or risks also affect how you feel about your body and your appearance after breast augmentation. These include
- Sensory disturbances (numbness or hypersensitivity of the nipples or skin, usually temporary)
- Asymmetries & dissatisfaction with shape, meaning that corrective surgery is necessary in some cases, as well as
- Striae (stretch marks), e.g., due to implants that are too large or thin skin.
Long-term risks and rare diseases associated 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, causing some complications to arise many years after the operation. These include, for example
- Capsular fibrosis, material wear, and changes in shape over time, making further surgery necessary, as well as
- BIA-ALCL (breast implant-associated anaplastic large cell lymphoma), which is very rare and predominantly associated with certain textured implants.
Good to know: The absolute risk of disease is considered very low depending on the type of implant and ranges from approximately 1:3,817 to 1:30,000 for textured implants.
In individual cases, patients also report systemic complaints such as persistent fatigue, joint pain, or nonspecific symptoms, which are often summarized under the term "breast implant illness. " However, the scientific data on this is currently still inconclusive and is being further investigated.
Risks associated with breast augmentation using autologous fat
For many, breast augmentation with autologous fat is the preferred, natural alternative to implants. However, this procedure also carries potential risks. Complications can arise during both liposuction and fat injection.
General risks associated with autologous fat treatment
- Partial absorption of fat and, in some cases, uneven results: A certain amount of fat is broken down by the body again, which can lead to a loss of volume or asymmetrical results. In some cases, multiple treatments are therefore recommended.
- Calcifications and nodule or cyst formation: Usually harmless, but should be monitored.
Risks associated with liposuction
Since breast augmentation with autologous fat always requires liposuction, there are also risks to be aware of.
- Hematomas, dents, and unevenness, usually temporary
- Infections and scars at the extraction sites
- Asymmetries, especially if too much or too little fat has been removed from certain areas. This can usually be corrected, but sometimes a second procedure is necessary.
Regulation and education in Germany regarding the risks of breast augmentation: the most important information at a glance
In order to better assess the risks, the so-called duty to inform also applies in Germany to cosmetic surgery procedures such as breast augmentation. Before the procedure, patients must be informed in detail about the possible risks, the various procedures, the process, and aftercare. If this does not happen, the procedure is not legally permissible.
Anyone wishing to obtain further information can also contact national authorities such as the Federal Institute for Drugs and Medical Devices (BfArM). This institute provides regular updates on the potential risks, capsule contractures, and the risk of cancer associated with breast implants.
Good to know: Implants are subject to strict legal requirements in the EU and Germany. Among other things, they must have a CE mark and comply with the requirements of the Medical Devices Act. Only implants that meet these safety and quality standards may be used.
Our specialists in plastic and aesthetic surgery at Innerform will be happy to advise you on the possible risks and answer the most important questions about breast augmentation.
