Partial or full skin flap loss (necrosis )
This is a rare but serious complication which may result in the implant and the affected skin having to be removed. If the circulation to the skin over the reconstruction is compromised, then some or all of the skin may not be healthy enough to survive. In some cases with appropriate dressings healing may occur but in more serious cases the skin and reconstruction cannot be saved.
Infection
If the implant becomes infected it is not usually possible to save it with antibiotics and it will need to be removed. On average in the UK this is seen to occur in 5-10% of patients within the first 6-weeks after surgery. Mr Turton’s techniques have reduced the rates of this occurring to his own patients to under 5%.
Seroma
This is a collection of plasma like fluid under the skin or around the implant. If the seroma persists for a number of weeks post drain removal it may be necessary for the fluid to be drained but this will be at the discretion of your surgeon. Too much movent too early will encourage seroma. Seroma can increase the risk of infection and losing your implant due to complications.
Red breast syndrome
Occasionally there is a transient immune reaction to the acellular dermal matrix causing the skin to become red, whilst this is not an infection it is best treated as such in order to reduce the risk of implant loss- It is not initially obvious if infection is causing the redness or a reaction.
Numbness
The tiny nerves and nerve endings, which supply the skin’s sensation are divided or disturbed by surgery when the breast tissue is removed. It is therefore common to experience numbness, which is often permanent, though usually lessens over the first few years.
Nipple complications
If your nipple has been preserved it will be numb and unable to become erect when cold or touched.
If your nipple has been preserved there is sometimes a partial loss of colour and it often becomes flatter.
The majority of nipples survive well but in the early post-operative weeks the nipple tip and areola have the potential to develop some scabbing or discolouration. Surgical intervention is not usually required and will settle within a month. If the nipple or areola does not survive it may be possible to perform a nipple construction or tattoo at a later date. Where the nipple does not survive it may need to be removed to prevent it from becoming infected and then deeper infection spreading to the implant and the ADM.
Implant complications
No breast reconstruction can replace the breast you have lost in terms of feeling and movement and on touching the breast you may be able to feel the implant edges under the skin and muscle. The implant will move a little when the chest wall muscles are tensed and return to its normal position when relaxed again. Because the chest wall muscle is just under the skin this looks odd as it happens. Subtle rippling of the implant surface may also be noticeable with softer implants and in general a firmer gel implant that has an tear drop shape is used to minimise this. The temperature of the breast often feels cooler.
Implant Rotation and malposition
Sometimes an implant will move out of its best position. A tear drop implant can sometimes rotate. It is better not to sleep on your front if you have an implant. If malposition occurs you may need further surgery.
Capsular contracture
A contracture is a tight fibrous capsule that the body forms around the implant causing the breast to look less natural and feel hard. This is one of the more frequent problems in the long term and affects around 1-2% of patients per year. Smoking and radiotherapy and any deep infections are known to increase the risks greatly. If it becomes severe, salvage with a tissue flap based reconstruction or removal of the reconstruction altogether might be required.
Need for further surgery
It is not possible to predict how your breasts will change; over time the shape and volume of your natural breast may be affected by weight loss and gain and the natural ageing process.
There is a significant chance that you will need some further aesthetic surgery at some stage- this may be adjustment to the reconstruction or implant replacement as time progresses. Surgery may be required to the contralateral breast to improve symmetry. It is not always possible to obtain good symmetry due to the limitations of this type of surgery.
Implant rupture
Modern generation silicone breast implants have a well established safety record. However they are not devices that will last for the rest of your life. The rupture rate is thought to be between 5 and 10% within the first 10 years after surgery. It is generally advisable to consider implant exchange after 10 years in any event.
Other Rare Implant Systemic Symptoms
It is possible in a small number of individuals that there can be unexpected systemic symptoms. The research in this area has usually discounted any association with systemic symptoms such as tiredness, dry eyes, muscle or joint aches, or automimmune disorders. Some of these problems may happen in association but purely by chance (as they would occur in women with out implants) and therefore not be related to the implants. But there have not been large enough volume, or high enough quality research studies to prove or disprove any link conclusively, and although previous studies have stated there are no links, it is fair to say there is still the possibility of a link that can affect a small percentage of susceptible people, but it has not yet been proven.
Implant related cancer (Anaplastic large cell lymphoma – BIA-ALCL)
There is a rare implant-associated cancer of the tissue-based white blood cells found in the capsule or fluid around the implant that is very occasionally seen years after reconstruction. A sudden effusion around the implant like a bag of fluid would always need to be assessed just in case it was caused by this rare condition. However, there are many totally innocent causes of fluid to form around an implant such as trauma, or infection, or implant rupture. However, to check for BIA-ALCL you should been seen and assessed by your specialist if it did occur. The occurrence of ALCL is difficult to quantify and some estimates put it as rare as 1 in 100,000, but in some countries such as Australia it has been estimated to affect around 1 in 3800 with some implant types. If it occurs it can usually be successfully treated by removing the implant and the capsule fully.