What to consider before deciding to have breast augmentation done

Some important things to note about breast augmentation and that should be taken into consideration before opting to have the procedure done include:

• Breast implants will not prevent your breasts from sagging. Sagging can still occur as you age or go through body changes due to pregnancy, but can be corrected with a breast lift procedure. A breast lift can be done at a later stage or at the same time as a breast augmentation procedure.
• Breast implants are not guaranteed to last a lifetime. Breasts will continue to age after augmentation. Other factors such as weight gain or loss can also change the way breasts look. The implant can rupture at any time too, causing internal complications. Any of these issues can be corrected with additional surgery. For many women, at least one more related breast surgery will be needed in their lifetime (breast lift, second breast augmentation or breast implant removal).
• Your body may ‘reject’ the implants. This is highly irregular and rare, with many believing that it is almost entirely a misconception. There is a greater chance of capsular contraction (internal scar tissue forming a tight or constricting capsule around a breast implant. This reaction by the body’s immune system forms a membrane that contracts until the implant becomes misshapen and hard) or infection. These conditions are easily misinterpreted as a rejection, but are merely the body’s way of showing ‘mild irritation’ to the foreign object and not necessarily medically considered as such. Either complication should be treated swiftly by your surgeon. He or she will examine the issue and determine if further procedures are necessary. Any strange sensations should be checked as soon as possible, such as pain, hotness or unexpected / unexplained swelling.
• Mammograms may require additional or more specialised tests. It may be more complicated to detect any problems such as abnormal breast tissue or breast cancer during a routine mammogram. Cancerous tissue can also resemble scarring and calcium deposits around the implant, making it more difficult to interpret the results of a mammogram. During a mammogram, the breast needs to be tightly squeezed to get detailed images. It is rare, but it can happen that an implant ruptures or leaks during this process. For any and every mammogram, a woman with breast implants should inform the technician. He or she will also need to know what type of implants were used and where they have been place (behind or in front of the chest muscle). A technician may take more views than is normal and may even recommend an MRI scan, in some cases, to get a clearer and more accurate image in addition to the mammogram.
• MRI scans may be recommended for women with silicone breast implants every 2 years, at least 3 years after the augmentation procedure. The MRI is done to check that the implants are still intact and that the breast tissue is still healthy. An MRI for these purposes may not be covered by your medical health insurance, so it is best to check this before deciding to have the procedure and whether it is affordable for you if it becomes necessary.
• Breast implants can hamper breastfeeding for some women. Depending on the manner in which the breast augmentation was performed, many women can breastfeed normally. For others, breastfeeding successfully may be a challenge.
• Medical health insurance may not cover breast augmentation. As the procedure is cosmetic, most medical health insurers will not cover the cost of the surgery. If the procedure is medically necessary, such as a reconstruction after a mastectomy, some medical health insurance companies will cover the costs. You must ensure that you are prepared to cover all expenses of the procedure, as well as any potentially related surgeries or imaging tests not covered by your medical health insurance.
• Additional surgery may be needed after breast implant removal. A breast lift or corrective surgery may be needed after implants are surgically removed to help maintain an aesthetically pleasing appearance. Natural breasts may become wrinkly or develop dimples once implants are removed.
• It is important to have realistic expectations. Breast augmentation will change the size and shape of your breasts, but the results may not improve your self-esteem or body image as you may have hoped or expected.
• It is also important to be 100% comfortable with your plastic surgeon. Breast augmentation is a very personal cosmetic procedure. It is invasive (surgical) and will have a permanent effect, which you will ultimately have to live with. It’s important that you feel comfortable with the surgeon you have chosen and that you are confident they can give you the desired results. You shouldn’t feel shy to request before and after visuals of their previous work.

Other things to be mindful of include reviewing all documentation carefully (and keep copies of pertinent information for your records), and arranging for someone to safely drive you home and stay with you for at least the first night following surgery.

Risk factors and complications associated with breast augmentation

As with any surgical procedure, breast augmentation can have some risks and potential complications. If you opt for more than one surgery at a time, such as a breast augmentation and breast lift, the level of risk increases.

Possible risks and complications include:

• Breast pain, shortness of breath or a warm sensation in the breast area. If any pain or discomfort is accompanied by a fever, you may have an infection which will need medical treatment as soon as possible.
• Sensation changes in the breast and / or nipple (hypersensitivity or hyposensitivity). This can often happen after having implants, but typically doesn’t last for very long. In some cases, the change in sensation is more permanent.
• Capsular contracture. The formation of scar tissue and or / hardening in the area around the implant. The hardened scar tissue begins to squeeze the implant. Surgery would be required to clear away the scar tissue or replace the implant.
• Bleeding (haematoma – a collection of blood within the breast under the skin, causing swelling and pain)
• Abnormal scarring
• Seroma (a thin fluid collection around the implant)
• Problems with the size and shape of the implants (after surgery). The results may not meet the expectations originally agreed on.
• Implant rupture and leaks. Saline ruptures or leaks are usually safely absorbed by the body. The shell will typically begin to deflate. A silicone leak may remain inside or spill outside of the shell, and may not cause any obvious symptoms. The capsule of fibrous tissue that forms around the implant once it is fitted holds any leaked material when rupture occurs. This is often referred to as a silent rupture. A rupture can cause breast pain or changes in the contour or shape of the implant if the fibrous tissue becomes inflamed (and may even form additional scar tissue). A surgeon will be able to determine a rupture with an imaging test (such as an MRI). The course of action will be determined by both you and your surgeon. You may both opt to replace the ruptured implant even if you aren’t experiencing symptoms of discomfort. If you are experiencing symptoms, your surgeon will recommend removing or replacing the implant. In some cases, your surgeon may recommend a breast lift or corrective surgery as well.
• Changes in the implant. It can happen that, over time, the implant may harden, develop ripples or change in shape or shift position. Surgery may be required to remove or replace the implant.
• Difficulties in detecting breast cancer. It may be difficult to detect breast cancer in some women with implants and other screening or testing processes may be required.