If you’re unhappy with your breast size, breast augmentation could be the answer to achieving the shape you want. In the final segment of our Breast Augmentation interview, Dr. McKee talks in-depth about the potential complications associated with the surgery. Plus, what you’ll need to do after your surgery to help protect your investment.
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What else can you tell me about complications associated with the surgery?
David E. McKee: Yes. First of all, you have to have an anesthetic. There are people who do this operation under local anesthesia, but the truth is, there is no anesthetic that’s 100% safe. And the amount of sedation that’s required to do this operation under local anesthesia probably makes it more unsafe to do it that way than just to put somebody to sleep. General anesthetic is incredibly safe today, but there’s always some risk. No matter what kind of anesthesia it is, you can get a medicine that can cause you some reaction that you could even die from, but that is incredibly rare. So that’s the first complication I always tell people about.
You could have a pulmonary embolism from a blood clot that forms in your leg- again incredibly rare, especially in an operation, like breast augmentation, that is so short (I do it in about an hour and fifteen minutes) that the chances of you having any blood clot problems is almost zero, but nothing is zero in medicine.
Then you get to the operation itself: you could get a wound infection. Wound infections in breast implants are very, very rare because we’re careful in every operation to keep things sterile, but we’re incredibly careful about any time we’re putting foreign bodies in because it doesn’t take many bacteria to cause an infection in the face of a foreign body. So if you get an infected implant, it’s very possible and even probable that we’re going to need to remove the implant to get the infection clear. So we are very careful about infection, but infected implants occur in the United States with some frequency. Not as high in breast augmentation as in breast reconstruction, but still.
Malposition: we work very hard to make the pockets exactly the same, perfectly smooth, how big they are on the sides, how tall they are at the top, but sometimes after you’ve fixed the pockets and they’re perfect, implants can move.
Implant failure is not a complication: it’s guaranteed, if you live long enough, because all implants fail. All implant manufacturers guarantee their implants for life and will provide you with a replacement implant, no matter when it occurs, whether it’s 20, 30, or 40 years later, they will supply you with a free implant to replace the one. But, they only give you money to help pay for the replacement of your implant in the first 10 years. Beyond 10 years you can buy an extended warranty from the company and, if you do that, they will provide you with money to help replace the implant no matter when the implant has to be replaced.
The single biggest complication in terms of frequency is capsular contraction. Every implant gets a scar around it because your body recognizes the implant as a foreign body. That is not a complication, but in some patients, that scar thickens and tightens down around the implant and it can make look and feel different and it can be uncomfortable. Probably the frequency of capsular contraction, either in one or both breasts, is as high across the board in the U.S. currently as about 35%. Most of those patients do not require surgery because it’s not severe enough that it bothers them that much. It doesn’t change the way the breasts look or feel and it’s not painful, but if you check the breasts for symmetry by feel, you’ll find that one is encapsulated and the other is not. That patient doesn’t have to have anything done, but she has a complication called capsular contraction. They are graded from 1-4, many of the complications of capsular contraction are mild and do not require surgery, but about 5% of patients who have breast implants will require treatment, surgery, for capsular contractions.
After Your Operation
DEM: Let me talk about post-operative care a minute. There’s a thousand ways to take care of breast enlargement patients after surgery. Anything that’s been proven beneficial, everybody does, but the rest is magic, and every doctor has their own magic. Some doctors wrap patients up in Ace bandages, some use special surgical bras, some doctors make patients buy this or that special device. All of that is “magic”. My personal approach is, I use gauze dressings on the incisions only, let the patients take those off a day after surgery. I let patients shower after 24 hours, put a little vaseline on the incision and wear a t-shirt as a dressing. I do not wrap and I do not want patients in a bra at all, at least until they come back for their first visit. That’s my personal magic, and I’ve had good results with it.
Whether your implant is above or beneath the muscle, there are certainly activities you want to avoid: stooping, bending, straining, lots of things with vigorous arm motion, certainly lifting heavy weight, running, jumping, jogging. All of those things should be avoided for 3 weeks in my practice and with some doctors, even longer.