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Breast Augmentation Complications and Breast Implant Removal FAQ
This section covers frequently asked questions (FAQ) about breast augmentation complications and breast implant removal. Many patients worry about scarring, infection, and their consequences and about breast implant removal. If you have a suggestion for any additional question, please let us know.
- If one of my breast implants deflates, will I know it? Will I become flat immediately?
- If I choose to have a breast implant removal, will I need a breast lift afterward?
- What is symmastia (uniboob)?
- What is capsular contracture and how often does it occur? Is it painful, what can be done about it?
- What are keloids?
- What is bottoming out? How do I know if I have it?
- If I have breast augmentation complications, what is covered? Will I have to pay for breast implant surgery again?
- One of my breast implants is in my armpit! What happened?
- What is a hematoma or a seroma, and how do I know if I have one?
- My suture popped and the incision has opened slightly. What should I do?
- My sutures have been out for a few days and my wound has opened back up? What does this mean and what should I do?
- My temperature is elevated, how can I tell if I have an infection?
- It has been a few weeks and my breast has become tender, red, and swollen all over again. What is going on?
- My arm(s) has been numb ever since my surgery. Is this caused by my breast implants?
- I have red lines coming up from my breasts to my neck. What is this from?
- I am very asymmetrical and I am 6 months postoperative. Is it going to get better?
- I have clear or milky fluid coming out of my nipples! Is this an infection or am I lactating or something??
- Why do I look like I have 4 breasts? Does this go away?
- What is Mondor's cord and how do I know I have it?
- I have lumps and wrinkles all on the sides of my breasts. What causes this and does this go away?
- Is it true the replacement of implants is fairly minor?
- I have been feeling very fatigued and under the weather lately. Are my implants making me sick?
- I have heard of fungus growing in the saline of a saline-filled implant. Is this true and can it cause an infection?
- I have heard that the silicone shell of a saline implant can cause silicone toxicity or silicosis, is this true?
- Will I have stretch marks? How can I keep this from happening?
1. If one of my breast implants deflates, will I know it? Will I become flat immediately?
Most saline breast implants deflate within 4 hours of a tear or hole developing. However it is possible for an implant to take a few months to deflate if the hole is very small. Silicone implants deflate much slower and you may never know if one has ruptured. A silent rupture occurs where the implant is leaking but the silicone is contained within the pocket and no local breast implant complications arise. Many ruptures of silicone implants are not found until you have a mammogram or MRI.
2. If I choose to have a breast implant removal, will I need a breast lift afterward?
More than likely, you will. The increased weight and size of the implant can stretch the breast envelope and the breast tissue. After the breast implant removal, you may be left with a stretched out breast and the need for a mastopexy or breast lift procedure. This is especially true if you had larger breast implants.
3. What is symmastia (uniboob)?
Symmastia is sometimes spelled synmastia, and is a breast augmentation complication that basically means “joined breasts.” It is also occasionally called “uniboob.” It occurs when the breast implants are not separate and actually touch each other under your skin or other tissue. It can happen when the surgeon creates the pockets for the implants too close together in an effort to create more cleavage. The area over the breastbone (sternum) is usually a barrier between the two breasts. Your surgeon should not disturb this area unless there it is too wide and he is very skilled. If your surgeon suggests doing this, ask how many times he or she has performed this particular technique and ask to see photos of patients and to possibly speak with them as well.
Symmastia usually becomes apparent within a few days to weeks after your surgery. As the swelling and bandaging puts pressure on the outer sides of your breast implants, or when you try to lie on your side during your sleep, they move to the center of your chest and can end up touching.
Unfortunately, the only way to correct symmastia is with revision surgery, which can involve breast implant removal, correction and replacement (if applicable). This breast augmentation revision surgery entails suturing the tissue over the breast bone to recreate a pocket, and may need to use permanent sutures.
Capsular contracture is caused by scar tissue that forms around the breast implant that contracts and squeezes it. It is quite normal for scar tissue to form around a foreign body and is it is a natural response of the body. The problem is when the encapsulated implant is squeezed by the scar tissue. When the tissue squeezes the implant it becomes compacted and very round, resulting in the look and feel of "baseball breasts." Your breast can look deformed and it can be very painful.
Some surgeons still attempt to treat capsular contracture by squeezing and massaging your breast. This can result in a lot of pain, possible deflation of the implant, and bruising of the breast. Other surgeons prefer to make an incision and cut the contracted tissue surrounding the implant. Still others use injections of corticosteroids into the pocket to treat the problem. Before these techniques, the only remedy removing the implant and removing any residual scar tissue. However, it is quite possible to develop capsular contracture again.
Most patients who develop capsular contracture start having symptoms around 3 months postoperatively. You can develop capsular contracture if trauma to the breast or an infection occurs. For instance, if you get hit in the chest, you can possibly develop capsular contracture. You can also develop it for no reason at all. Capsular contracture also is more likely to occur with subglandular placement, so if you have this type of placement, make sure you follow your surgeon’s instructions about massaging your breasts and wearing support garments.
Read more about this at our page on capsular contracture.
Keloids are lumps of fibrous tissue that form at the site of an incision or injury, and can be a complication of breast augmentation surgery. It is essentially an overgrowth of scar tissue that has formed outside the barrier of the original wound or injury. Keloids can look thick and ropy or rounded and are usually darker than the surrounding skin. It can be difficult to revise keloids because removing them can trigger the growth of even more keloids. People of color are more likely to form keloids than lighter-skinned individuals.
6. What is bottoming out? How do I know if I have it?
Bottoming out is when the lower halves of your breasts have lost their tissue support and the natural crease is slowly lowering itself. This can sometimes be avoided with full submuscular coverage with the abdominus rectus fascia and serratus muscles supporting the lower half of the implant.
Correction for this complication usually requires revision surgery, although it can sometimes be remedied with sutures and a firm band supporting the lower poles of the breast for many weeks.
You should find this out before you schedule your surgery. Not all surgeons require that you pay for your breast augmentation revision (especially if it is their mistake). Some surgeons ask that you pay the medication costs and the lab work fees for your revision surgery, but will cover the operating room and anesthesia costs. Other surgeons will have you pay only the anesthesia fees and still others will make you pay full price. Find out what your surgeon’s policy is in advance and get it in writing so that you have documentation of the coverage for breast augmentation complications, should the need arise.
8. One of my breast implants is in my armpit! What happened?
This breast augmentation complication is called implant displacement. How it is repaired depends on whether the breast implant was put in subglandularly (overs) or subpectorally (unders).
Implant displacement with overs happens rarely. Your surgeon will suture your breast envelope to the underlying tissue at the outer side of your breast so that your pocket closes on that side and your implant will be in its intended pocket. You will need to take it easy and wear a good supportive bra with cups so that your implant doesn't get forced to the side and out of place again.
If your breast implant was placed subpectorally, the implant displacement was more than likely caused by the contractions of your pectoral muscle. The implant was forced out of the pocket because the muscle is trying to return to its former position. Your surgeon will redissect your pectoral muscle if needed and replace the implant back behind it. If the force of the displaced implant has separated the tissue under your armpit, you will need sutures there. Again, you will need to take it easy and wear a good supportive bra with cups so that your implant doesn't get forced back to the side.
Don't be alarmed if your breast implants fall into your armpit when you are lying down on your back. This is normal. All breasts usually fall towards the armpit when the body is in this position.
9. What is a hematoma or a seroma, and how do I know if I have one?
A hematoma is a pocket of solid clotted or liquid blood in the tissues. A seroma is a pocket of clear or slightly blood fluid (usually blood serum or blood plasma) in the tissues. Serious problems due to hematomas or seromas are rare, and may require further surgery to control bleeding or remove the fluid or clot.
If you have either a hematoma or a seroma, you will notice a very swollen and tender area that is possibly darkened, like a very dark bruise. It may feel like a pocket of liquid or hard like a lump underneath. If you have any concerns, call your surgeon immediately.
10. My suture popped and the incision has opened slightly. What should I do?
Usually one suture coming loose or "popping" won't make too much of a difference after a few days postoperatively, although it depends on where it is in the incision site, if there is much pressure on the wound, and if there is any liquid or blood seeping out of the wound.
However, if your wound is starting to open, you need to call your surgeon. He or she may ask you to come in to be resutured or may just have you keep the incision covered and see if it heals by itself, which it quite often does. Don’t touch your open incision unless you’ve washed your hands thoroughly with an antibacterial soap.
Call your surgeon immediately! An open incision can lead to infection and can also continue to open and widen. If the edges of the wound have healed in an open position, you may need to have the edges trimmed and resutured.
Smoking significantly increases your chances of a surgical wound reopening and seriously compromised healing. Try to avoid smoking for as long as possible after surgery. Even better: quit completely.
12. My temperature is elevated. How can I tell if I have an infection?
You should be concerned if you have a temperature higher than 101 degrees, if you see any sudden swelling or discoloration, if you experience more than a little bleeding, if there is any increased redness or tenderness (with or without weeping/seepage) at the wound edges, or if you think you are having an allergic reaction to any of your medications. Call your surgeon immediately if you have any of these problems.
Call your surgeon if you experience any sudden changes like that. You may be experiencing postsurgical bleeding or may be developing an infection. You may have overdone yourself and overstressed your treatment area.
14. My arm(s) has been numb ever since my surgery. Is this caused by my breast implants?
It could be. You may be experiencing loss of sensitivity due to pressure from swelling around the implants. Or, if you had a transaxillary incision, a nerve could have possibly been severed. Tell your surgeon about any arm numbness. If the numbness is caused from the swelling or something minor, it should resolve by itself as you heal. If a nerve has been cut, you may regain sensation, but this can take to months or even longer. Consult with your surgeon.
15. I have red lines coming up from my breasts to my neck. What is this from?
Call your surgeon and tell him or her. Red lines can be a sign of infection that can be serious, especially if hotness or swelling are also present.
16. I am very asymmetrical and I am 6 months post-op. Is it going to get better?
Although no one is ever completely symmetrical, if one of your breasts is significantly higher or lower than the other after your implants, you may need a breast augmentation revision. Usually, your breast implants will have dropped by this time, but it can take longer, especially if you have textured implants. Speak with your surgeon about this. He or she will know more about your case and may recommend nonsurgical treatments that can be tried before you resort to surgery.
You may be experiencing galactorrhea, which is a breast implant complication when you start producing breast milk when you aren’t pregnant or breastfeeding. It is considered a mild side effect of having breast implants and usually stops on its own. Some cases of galactorrhea may need to be treated with medication, and extreme cases with removal of the implants.
Tell your surgeon if you experience this, since as he or she may want to examine you. Any foul smelling, yellowish or greenish discharge from the nipples may be a sign of an infection.
18. Why do I look like I have 4 breasts? Does this go away?
The slang term for this is “double-bubble,” and it sometimes happens when an implant is placed under the muscle(s) of a patient with ptotic, sagging breasts. Now, over placement is fine with breasts with slight ptosis, and some surgeons choose this when a patient doesn't want a breast lift, and isn't saggy enough to really need it. But if the patient is given unders and has substantial sag, the breast tissue may fall further. The real breast tissue is low enough to look like one set of breasts and the implants up under the muscle and look like a second set of breasts. The moral of the story is, if you need a breast lift, get one.
This problem can also happen after a woman is pregnant. Her breast tissue now sags with the excess weight and stretch of the full mammaries, but the implant remains where it was originally placed, under the muscle.
Double bubble may go away depending upon how far postoperatively you are. If you are newly implanted, wait a bit before panicking, your breast implant may not have fallen yet. If you are several months postoperative, you more than likely need a breast lift or revision.
19. What is Mondor's cord and how do I know I have it?
Mondor's Disease (or cord) is thrombophlebitis (inflammation) of an epigastric vein of the chest. It is a bulging vein under your breast lobe on your abdomen and breast.
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Mondor’s cord appears spontaneously and is not a serious breast augmentation complication. You can treat it by putting warm compresses (a very warm, wet washcloth or a microwaveable pack wrapped in a warm, wet washcloth) over it and by taking an anti-inflammatory drug such as aspirin or ibuprofen. However, aspirin and ibuprofen are also blood thinners and you should consult with your surgeon before taking them. The cord is usually nothing to be alarmed about and will disappear on its own. If you are concerned, consult with your surgeon.
Rippling is the indentations at the edges of the breast implant that can resemble a scallop or the edges of a blow-up pool toy. There is a chance of rippling being apparent, especially when one has little breast tissue and chooses to go over the muscle. Even when there is significant tissue, it is possible that the implant can shift and indentations will show and can be felt through the skin.
Does rippling go away? Usually not. Silicone gel-filled breast implants tend to ripple and wrinkle less and some women with rippling problems choose to switch to silicone implants. This is an option that many women feel has corrected their rippling problems.
Silicone high-profile breast implants have less wrinkling and increased projection. They need less volume to reach the same size as a standard implant in patients with less breast tissue at the sides, so you may want to ask about this implant. They are narrower at the base and are ideal for smaller diameter ribcages.
To help cover the breast implants, some women choose to have their implants placed fully under, under the serratus muscles and rectus abdominus fascia as well as the pectoralis major.
Curiously, both underfilling a saline implant and overfilling it can cause it to ripple.
21. Is it true the replacement of breast implants is fairly minor?
For removal and replacement of smooth, saline breast implants and intact silicone implants, yes. The major part of the original operation is the creation of the pocket. When the replacement is needed, the pocket is already there, so the surgeon just opens the pocket, takes the old implant out and puts in a new one.
If it is a ruptured silicone implant, the removal of silicone can take quite a while. Most surgeons report that replacing or otherwise removing a ruptured silicone implant is quite a job.
It is unlikely. The Institute of Medicine investigated reports that silicone and other types of breast implants were linked to autoimmune problems and other conditions. It found no evidence that there was a link.
If you have recently had your breasts augmentation surgery, your body has been through a trauma and is trying to heal. This can make you tired and feel ill. You need time to heal, and sleep will help you best.
You may also be having a bout of postsurgical depression. Please see our section on Postoperative Depression and remember to just let yourself heal.
There are no verifiable reports of an implant removed that was sustaining a fungal infection. At one time, saline breast implants were filled from an open source of saline, which could have been contaminated and thus contaminated the implant. Now, implants are filled from sterile bags of saline fluid, of the same sterility as the fluid that is used in IVs.
It is possible for water molecules to move in and out of the implant through osmosis through the silicone shell, but salt molecules are too large to go through the shell. Fungus, mold spores, bacteria, and viruses are too large to permeate an intact implant.
Silicosis is a disease of the lungs caused by inhaling silica particles. Silica is a mineral that contains silicon, the element that is also in the elastomer polymer that is called silicone. You cannot get silicosis from silicone or from silicone breast implants. You get silicosis by working in factories or industries that create a lot of silica dust. Even lying on or living next to a sandy beach, which is almost all silica, will not cause silicosis, so having a silicone (not silica) implant will not cause it.
For several years, silicone breast implants were taken off the market after reports that they were connected to autoimmune and connective tissue diseases. They were approved for marketing again after the Institute of Medicine studied the matter and issued a report saying that there was no proof of a connection.
This does not mean I feel that patients who have breast implants are faking their illnesses. I believe that people who have a dormant or mild case of lupus erythematosus can have their disease exacerbated by an implant of any kind, or by other sources of physical stress, such as surgery, a car accident, stress, a high fever, or infection. This is true for many types of autoimmune diseases.
So, although it may be possible that having breast implants can cause physical problems, silicosis is not one of them.
25. Will I have stretch marks? How can I keep stretch from happening?
The elasticity of skin varies from person to person. Some individuals never develop stretch marks and still others are very prone to them. Some people develop stretch marks from growth spurts during puberty, muscle growth from weight lifting, and pregnancy.
There is still no successful treatment for the removal of stretch marks and many people say that moisturizing the skin can help prevent their formation. Some swear by shea nut butter, others, olive oil. Some swear by Retin A (tretinoin) as a treatment for the red lines that are the early stages of stretch marks.
Vitamin E used to be the treatment of choice, but according to new studies, topical vitamin E can cause contact dermatitis and exacerbate scar appearance in some patients. Some surgeons say not to take vitamin E orally for 3 weeks before any surgery or 3 weeks afterwards. Other surgeons advise it 1 to 2 weeks postoperatively, along with massage exercises to inhibit capsular contracture. As I’ve said, different surgeons will have different ideas.
Always ask your surgeon before using anything on your skin or taking any medication or supplement.
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