Breast Augmentation Gone Wrong
There are two things you can do to increase the chance of beautiful results:
- Educate yourself so you can make informed decisions.
- Find a great plastic surgeon with a proven track record of safety and excellent results.
Bad results, by and large, come in two categories:
- Surgical complications
- Poor cosmetic results
Let’s start off with the complications.
Breast Implant Complications
Capsular contracture is the most common complication of breast augmentation. It occurs when the scar tissue that normally develops around the breast implant becomes abnormally hardened, resulting in pain and an unnatural appearance of the breast.
Possible causes: Capsular contracture cannot be predicted or controlled by the surgeon. Risk factors include above-the-muscle placement, a periareolar incision, incorrect sizing (implants that are too large), and development of bleeding and infection after surgery, although patients with zero of these risk factors may still experience the problem.
Fix: Capsular contracture correction may be performed by releasing or removing the scar tissue surrounding the implant, and (often) replacing the implants in the process. When there is no significant breast tissue remaining to cover the new implants, tissue support material like Strattice™ may be used.
Breast implant malposition happens when the implants are not in the correct position, such as too high or too low.
Malposition can happen over time, as happens with capsular contracture, or quickly as a result of trauma. During breast augmentation surgery, pockets are created to hold the implants. If the pockets are not created properly, the implants may drift out of position.
There are four main types of malposition:
This is the most common malposition. It can occur when the implant pocket is created too high on the chest, or when an implant “settles” too high in a properly created pocket. Breast implants commonly sit high on your chest until they settle (“drop and fluff”) lower during healing, but some implants don’t drop.
Differences in healing may contribute to malposition, but so can wearing an underwire bra during recovery. Underwire bras can compress the lower part of the breast, preventing the implants from settling into their proper position. Capsular contracture may also cause high malposition, months or years after surgery.
An implant that sits too low, called bottoming out, can occur when the implant pocket is formed too low on the chest. It can also occur when an implant pushes down on the breast tissues, despite a properly placed pocket. This can occur if the breast lacks strong support attachments in the breast fold or if these attachments were released too much during surgery. Large implants have a greater risk of bottoming out due to their weight.
Sideways or laterally malpositioned implants occur when the implant shifts to the sides of the body. Lateral displacement can be caused by a poorly formed pocket. It can also occur with a pocket that is created properly if the breast tissue is too weak to keep the implant in the proper position. The problem can be aggravated if a patient’s chest wall curves and does not help support the implant, or if overly large or wide implants are selected.
Sleeping on your chest during healing can also contribute to lateral malposition. If continued for a long time, the pocket edges near the center of the chest may heal shut, preventing the implants from settling in their proper position. Capsular contracture can also cause lateral malposition.
Symmastia, also called “uniboob,” occurs when implants sit too close together in the center of the chest, albeit rarely, and the skin between the implants lifts up. This can happen with improperly positioned pockets or overly large pockets. However, it can also happen when implants push towards the center in pockes that are created properly. The shape of the ribs and the choice of implant can also contribute to the problem. Larger implants and high profile implants, especially in thin patients, can be a factor in forming a uniboob.
Possible causes of malposition: Implant malposition may be caused by a variety of factors, some preventable and some not. Preventable factors include improper pocket creation and selection of overly large implants. Non-preventable factors include improper settling, weak support tissues, the occurrence of capsular contracture, curvature of the chest, and trauma. Creating the implant pockets with care and finesse is very important.
Fix: Correcting implant malposition typically requires revision breast augmentation. Ideally, revision surgeries should be performed by experienced plastic surgeons, as the procedures are more complicated.
Breast implants are mechanical devices that are designed to last many years. However, they may eventually fail resulting in rupture. Ruptured saline implants are usually obvious as the implant will deflate. Ruptured silicone implants may be difficult to see, so regular MRI examinations every 3 years are recommended to examine the integrity of silicone implants.
Possible causes: Excessive trauma, compression to the breast, or natural aging of the implant.
Fix: Implant removal and replacement
As its name implies, implant rippling occurs when surface wrinkles of the implant are visible through the skin. Rippling is more common along the outer edges of the breast and in thinner patients.
Possible causes: Poor tissue coverage (eg. Thin patients), over-the-muscle placement, overly large implants, and overfilling or under-filling of saline implants.
Fix: Implant removal and replacement, fat grafting, and/or placement of new support tissue (eg. Strattice).
Despite the good news it brings, a pregnancy can “make a mess of” previous breast augmentation.
Possible causes: After pregnancy, regardless of a woman’s decision to breastfeed, a woman’s breasts will change significantly over the course of pregnancy and afterwards due to hormone changes. The skin may become stretched as a result of volume that is rapidly gained and lost. The end result is that the breast tissue around the implants often changes.
Fix: A breast lift or a customized breast revision surgery can help correct breast implant issues following pregnancy.
Less-Common Breast Augmentation Complications
- Double bubble deformity – Double bubble deformity occurs when a second breast fold appears in addition to the original native fold of the breast. Possible causes include underdeveloped breasts, constricted breasts, poor skin tone, and poor implant placement.
- Rock-in-a-sock deformity (snoopy ear deformity or waterfall deformity) - This can happen when breast implants are inserted into droopy breasts without performing a complementary breast lift.
Poor Breast Augmentation Results
Suboptimal cosmetic results in breast augmentation may not be considered as “botched” per se, but you can definitely prevent them from occurring (and accomplish flawless results) if you find a reputable plastic surgeon.
Examples of suboptimal cosmetic results include:
- Obviously fake-looking breasts
- Implants that are overly large or small for a woman’s body type/frame
- Uneven-looking breasts
- Unshapely breasts
Steps to the Best Results
How do you prevent breast implant complications and suboptimal cosmetic results?
Do your homework when it comes to choosing a plastic surgeon. Check if the surgeon is in good standing, qualified to perform breast implant surgery, and most of all, board certified. Reputable, board-certified plastic surgeons, are well-versed in breast augmentation, and if something goes wrong, they have a better understanding on how to fix the issue.
Need help in gauging a prospective plastic surgeon’s knowledge and skills in aesthetic breast enhancement? Everything you need to know to become a wise, discerning patient, and how to recognize mediocre surgeons, is laid out in this free plastic surgeon evaluation guide.