Breast Augmentation Complications & Breast Implant Removal FAQ

[doctor]

1. If one of my implants deflate, will I know it? Will I become flat immediately?
2. If I choose to have my implants taken out, will I need a lift from possible tissue stretching?
3. What is Symmastia/Synmastia (uniboob)?
4. What is Capsular Contracture and how often does it occur? Is it painful, what can be done about it?
5. What are keloids?
6. What is bottoming out? How do I know if I have it?
7. If I have a complication, what is covered and will I have to pay for surgery again?
8. One of my breast implants is in my armpit, what happened??
9. What is a hematoma, or a seroma, and how do I know if I have one?
10. My suture popped and if open slightly? What should I do?
11. My sutures have been out for a few days and my wound has opened back up? What does this mean and what should I do?
12. My temperature is elevated, how can I tell if I have an infection?
13. It has been a few weeks and my breast has become tender, red and swollen all over again? What is going on?
14. My arm(s) has been numb ever since my surgery - is this caused from my breast implants?
15. I have red lines coming up from my breasts to my neck - what is this from?
16. I am very asymmetrical and I am 6 months post-op, is it going to get better?
17. I have clear or milky fluid coming out of my nipples! Is this an infection or am I lactating or something??
18. Why do I look like I have 4 breasts? Does this go away?
19. What is Mondor's cord and how do I know I have it?
20. I have lumps and wrinkles all on the sides of my breasts - what causes this and does this go away?
21. Is it true the replacement of implants is fairly minor?
22. I have been feeling very fatigued and "under the weather" lately, are my implants making me sick?
23. I have heard of fungus growing in the saline of a saline filled implant, is this true and can it cause an infection?
24. I have heard that the silicone shell of a saline implant can cause silicone toxicity or silicosis, is this true?
25. Will I have stretch marks? How can I keep this from happening?

[doctor]

1. If one of my implants deflate, will I know it? Will I become flat immediately?

This is very individual as well. It is reported that most saline implants deflate within 4 hours of a tear or hole. However it is possible to deflate over a few months if the hole is very small. Silicone implants deflate a lot slower and you may never know if it is a silent rupture where the silicone is contained within the capsule and no local complications arise. This is usually found out if there is loss of augmentation but more than likely though mammograms or MRI's.

[poster]

2. If I choose to have my implants taken out, will I need a lift from possible tissue stretching?

More than likely, if you had larger implants and had them in for a while, yes, a lift may be necessary. The force of the implant on the natural breast tissue can cause tissue loss and of course the increase weight and size can stretch the breast envelope. Removal of the breast implant will result in less augmentation of the envelope, stretched tissues and a need for mastopexy.

[poster]

3. What is Symmastia, or Synmastia (uniboob)?

Main Entry: syn-
Variant(s): or sym-
Function: prefix
Etymology: Middle English, from Old French, from Latin, from Greek, from syn with, together with
1 : with : along with : together <synclinal> <sympetalous>
Merriam-Webster

This is where the implants cross the breast bone, where the breasts separate and actually touch under the tissues. This results in a tell-tale sign of no cleavage and conjoined breasts. This can happen when the surgeon over-dissects the tissues over the sternum to further bring the breasts closer together to result in more cleavage. The surgeon should not disturb the natural barriers of the breast in this area unless there is a definite natural wide area between the breasts and he is very skilled in doing so. If your surgeon suggests this, inquire as to how many times he or she has performed this particular technique and ask to see photos of patients and to possibly speak with them as well.

Although you may not know it at first, it becomes apparent after a few days to weeks and sometimes, months. As the swelling and binding ace bandages and bras, etc. exert the pressure on the sides of the implants (or when you try to lie on your side during your sleep) and they move to the center of your chest, crossing this natural barrier.

Unfortunately the only way to correct this is for a re-operation. This means possible implant removal, correction and replacement (if applicable). Not to mention many weeks of immobility, wearing an uncomfortable, backwards T-back sports bra with rolled up gauze or an ACE bandage to apply pressure on the sternum.

This revision surgery entails suturing the tissue that needs to be rolled out from the sternum to give it something to hold onto. Your surgeon will most likely have to use permanent sutures and pocket the breast area as though it were an actual pocket on a garment, that way the implant will not be able to cross this barrier. The cleavage area will will re-attached to the sternum internally with dissolvable sutures so that once it heals there are no obvious lumps or filaments. Be advised this area may not look attractive directly afterwards but when it fully heals, it should be undetectable.

The possibility of a failed correction is very much a reality.

[poster]

4. What is Capsular Contracture and how often does it occur? Is it painful, what can be done about it?

Capsular Contracture (CC) is caused by the tissue that forms around the implant contracting and squeezing the implant. It is quite normal for tissue to form around a foreign body. This how your body naturally reacts to such a thing. The problem is when the encapsulated implant is squeezed by this tissue. Some women's bodies do not react well to implants and will develop CC. When the tissue squeezes the implant it becomes compacted and very round, resulting in the tell tale look and feel of "baseball breasts." Your breast can look extremely, for lack of a better word, deformed, not to mention, it can be very painful.

Capsular Contracture may happen repeatedly to one breast over and over or to both only once. Some surgeons still attempt to remedy CC by literally squeezing your breast and implant. This can result in a lot of pain, possible deflation and minor internal bleeding of the breast. Still other surgeons prefer to make an incision and lance the contracted tissue surrounding the implant and even injections of steroids into the pocket have been known to remedy CC. Before these techniques were utilized the only remedy was thought to be removing the implant, resituating and removing residual scar tissue.

Now, it is quite possible to develop CC again. Most patients that do get CC start having symptoms at 3 months post-operatively. Although for any time in the life span of the implant or your choice in keeping them, you may develop CC if trauma to the breast occurs, a bodily bacteria infection occurs or for simply no reason at all. For instance, if you get hit in the chest or perhaps by a seatbelt if you are in a car wreck, you can possibly develop CC because of it. This doesn't mean don't wear your seatbelt in fear of harming your implants; you can always have an additional surgery, you can't have an additional life.

You are more likely to have Capsular Contracture with sub-glandular placement so you should adhere to the breast implant 'exercises' if instructed by your surgeon. Those who have hematoma within the breasts or infections, even when successfully eradicated with antibiotics, may develop CC.

[poster]

5. What are keloids?

Keloids are when the collagen network which makes up scar tissue forms outside the barrier of the original wound or skin injury. They appear like thick, ropey looking scars and are usually darker than the surrounding skin. It is difficult to revise keloids because the actual removal incision may also trigger a keloidal response.

Silicone Sheeting has been shown to significantly help prevent and lessen the appearance of keloidal and hypertrophic scarring.

[poster]

6. What is bottoming out? How do I know if I have it?

This is when the lower poles (halves) of the breast have lost their tissue support and the natural crease is slowly lowering itself. This can be somewhat avoided with full sub-muscular coverage with the abdominus rectus fascia and serratus muscles supporting the lower pole of the breast. The surgeon may incorrectly predict where the new crease will be when lowering the natural crease either surgically or by force with The STRAP. Especially if the surgeon is overzealous when making the pocket. Be wary of the surgeon using the electro-cautery technique in making the pocket, not everyone can do this correctly.

Correction for this complication requires re-operation although it can usually be remedied by slowly resorbing or permanent sutures and a firm band supporting the lower poles of the breast for many weeks.

[poster]

7. If I have a complication, what is covered and will I have to pay for surgery again?

It is your responsibility to determine this before scheduling a surgery or handing over any money. Not all surgeons require that you pay for your revision (especially if it is their mistake), some surgeons will ask that you may the medication costs and the lab work fees but will cover the O.R. and anesthesia. Even still there are surgeons who have you pay only the anesthesia fees and still others who make you pay full price. Determine this in advance and have it in writing so that you will have documentation should the need arise.

[poster]

8. One of my breast implants is in my armpit, what happened??

This is called implant displacement and the repair depends upon the original implant placement. If your implants were subglandular (over) this happens rarely and your tissue has been dissected away at your ribcage. Your surgeon will suture your tissue together so that your pocket closes on the side and your implant will be in its intended pocket. Be advised you will need to take it easy and wear a good supportive bra with cups so that your implant doesn't get forced back to the side.

If your implant was placed sub-pectorally (under) this was more than likely caused by the contractions of of your pectoral muscle and has forced your implant out of the pocket where your muscle is now trying to return to its former position. Your surgeon will re-dissect your pectoral muscle if needed and resituate the implant back behind it. If your tissue under your armpit has bee dissected by the force of the displaced implant you will need sutures to help re-adhere your skin. Be advised you will need to take it easy and wear a good supportive bra with cups so that your implant doesn't get forced back to the side.

Now, don't be alarmed if your implants fall into your armpit when you are lying down--this is normal. All breasts usually call towards the armpit when the body is in this position.

[poster]

9. What is a hematoma/seroma and how do I know if I have one?

Although extremely rare, it is possible to bleed post-operatively resulting in another surgery to control and drain the collected blood. Hematoma (a collection of clotted blood), or a seroma (a collection of the watery portion of the blood) and thrombosis (abnormal clotting) are possible.

If you have either, you will notice a very swollen and tender area that is possibly darkened like a very dark bruise. It may feel almost watery or even hard like a lump underneath. If you have any concerns, alert your surgeon immediately.