How to prevent complications in breast augmentation

Breast augmentation is a fairly routine procedure in most plastic surgeons offices.  There are risks associated with every procedure.  There are a number of steps that can be taken with breast augmentation to help to minimize these risks.

1) Unhappiness with size.  This one is largely the responsibility of the patient.  Although your plastic surgeon can recommend a certain size based on his perception of your goals and your body frame, in reality your goals may change after surgery.  Many women have fears about going too large before the surgery and as a result are conservative with their choice.  After surgery many feel they should have gone larger.  My recommendation would be to go as large as you feel comfortable.

As an editorial side note, I actually believe that most augmented patients choose a size that is too big for their frame.  Symmetry in nature is beautiful.  The circumference of the breast matching that of the hips is what I would consider ideal for any patient (take a tape measure and try for yourself).

2) Deflation/ rupture.  Saline implants deflate if they fail whereas silicone implants rupture.  For saline implants this risk can be minimized by overfilling the implant.  The deflation rate has been found to be much less significant in fully filled or over filled implants.  Under-filling or filling to only the minimum fill volume can lead to a “fold flaw” similar to a crease on a newspaper where the implants simply wear out from the repeated folding.

3) Rippling.  Rippling is a visible or palpable irregularity of an implant through the breast or skin.  Silicone implants are less likely to ripple because they hold their own shape better.  Additionally, overfilling saline implants helps avoid rippling as well.  Thin patients with small breasts generally have a higher risk of rippling and in some cases are better candidates for silicone implants to help prevent this

4) Capsular contracture.  There are a number of factors that lead to hardening of the breast over time.  Silicone implants are more likely to have contracture.  Low grade infection, hematoma, and placement above the muscle are also risk factors.  I prefer to give patients antibiotics before and after breast augmentation and I place the implants in an antibiotic solution before augmentation to help minimize infection risks.

5) Implant displacement.  The key is proper pocket formation.  For this reason I do not prefer the “remote” incisions; armpit or particularly the belly button.  They are simply less accurate.  Success should be measured in terms of millimeters with this operation.  The patient has some responsibility in this one as well.  In the first few weeks after surgery, over doing it can cause implant displacement and limiting aggressive physical activities for 6 weeks is important.

6) Nipple numbness.  This is actually quite uncommon in my practice.  Avoiding cutting along the course of the nerves to the nipple is the key.  Occasionally there will be temporary numbness from stretch of the implant over particularly large implants.

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