Breast augmentation is one of the most popular cosmetic surgeries performed each year. It involves using implants or fat transfer to enhance the size and shape of the breasts. When considering breast augmentation, one of the most important factors to take into account is safety. Patients want to ensure they choose the method that carries the lowest risk of complications both during and after surgery.
What are the options for breast augmentation?
There are two main options when it comes to breast augmentation surgery:
- Silicone or saline breast implants – This involves surgically placing pre-filled silicone or saline (sterile saltwater) implants to augment breast size. Implants come in different shapes and profiles to achieve the desired look.
- Fat transfer breast augmentation – This uses liposuction to remove fat from other parts of the body like the thighs or abdomen, processes it, and injects it into the breasts to enhance size and shape.
Both options have been shown to effectively increase breast size and fullness when performed by a skilled plastic surgeon. However, there are differences in safety profiles that patients should consider.
What are the risks and complications of breast implants?
Breast implants do carry risks, both from the surgery itself and over the long-term of having implants in the body. Some potential complications include:
- Anesthesia risks – As with any surgery requiring general anesthesia, there are risks of breathing or heart complications.
- Bleeding – During the operation or post-operatively, usually resolves without further treatment.
- Infection – Can occur after any surgery. Infections may be treated with antibiotics but could lead to removal of the implant if severe.
- Scarring – All surgeries leave scars but they can sometimes be pronounced or uneven with breast implants.
- Implant rupture and leakage – Theshell around the implant can rupture, most often from injury or intense pressure on the chest. Silicone implant ruptures may go undetected while saline implants deflate quickly.
- Capsular contracture – Scarring around the implant tightens and squeezes the implant, potentially causing pain, distortion and need for additional surgery.
- Breast pain – Can occur and linger after implants are placed.
- Implant visibility – Sometimes implants can be seen through skin due to thin tissue coverage, wrinkling or movement.
- Asymmetry – Breasts may end up uneven in shape or size after surgery.
- Changes in nipple/breast sensation – Nipples may become painfully sensitive or numb after breast augmentation.
- Implant displacement or malposition – Shifting of the implant can distort breast shape.
- Seroma – Fluid can accumulate around the implant, requiring drainage.
- Hematoma – Post-operative bleeding into surrounding space causes painful bruising.
- Delayed wound healing – Incisions are sometimes slow to heal normally after implant surgery.
These potential complications increase the risks of re-operation, implant removal, and other corrective procedures. Some women end up needing one or more revision surgeries over a lifetime with implants.
What are the specific risks of silicone vs. saline implants?
Silicone and saline implants have some different inherent risks:
Silicone implant risks:
- Silent rupture – Since silicone gel is thick and cohesive, leaks may go undetected by sight or feel if the shell ruptures.
- Leakage – Small amounts of silicone gel may diffuse (“bleed”) through an intact implant shell.
- Granulomas – Leaked silicone outside the scar capsule can cause inflammatory lumps called granulomas.
- Migration – Ruptured silicone can migrate away from the breast area to other regions of the body such as the lymph nodes.
Saline implant risks:
- Visible rupture – Saline implant leaks are obvious as the breast deflates rapidly.
- Rippling – The watery saline filler can develop visible wrinkles or ripples on the implant surface.
- Deflation – Any tear or hole in the implant shell will cause a saline implant to deflate quickly.
- Bottoming out – Saline implants are slightly heavier and may gradually descend and cause sagging.
What are the risks and complications of fat transfer breast augmentation?
The alternative technique of fat transfer breast augmentation has become increasingly popular for its more natural results and lack of implants. However, it still carries risks such as:
- Anesthesia risks – General anesthesia is typically used, at least for the liposuction part of fat extraction.
- Bleeding – Minor bleeding or bruising can occur during liposuction.
- Infection – Low infection risk, but still possible especially with liposuction.
- Fat necrosis – Parts of the transferred fat don’t survive and die, creating firm lumps.
- Cysts – Fluid-filled cysts can form from fat necrosis.
- Irregular contours – Transferred fat may not take evenly, causing breast asymmetry.
- Fat absorption issues – Some of the transferred fat may get reabsorbed by the body over several months.
- Need for additional procedures – After fat absorption stabilizes, many women opt for another round of fat grafting for added fullness.
The complications of fat transfer procedures are less severe than for implants. But shaping irregularities, volume loss over time, and frequently needed additional sessions make consistency and precision more difficult compared to implant augmentation.
How do complication and reoperation rates compare between methods?
Various studies have looked at the different rates of complications and reoperations between breast implant and fat grafting augmentation methods:
Complication | Breast Implants | Fat Grafting |
---|---|---|
Capsular contracture | 16.2%* | 4.6%** |
Added surgery rate | 29.2%*** | 12.3%*** |
*10-year rates for silicone gel breast augmentation
**6-year rates for fat graft breast augmentation
***10-year rates
These rates demonstrate significantly higher complications and need for additional surgeries with breast implants compared to fat transfer augmentation. While techniques continue improving, implants pose some inherent long-term risks from having a foreign object permanently placed in the body.
Is there a difference in mammography screening after augmentation?
Women considering breast augmentation may also want to understand any impacts on future mammography screening for breast cancer detection. Research shows some key differences between augmentation methods:
- Breast implants – Can obscure breast tissue during mammograms and make cancer detection more difficult.
- Fat transfer – Shows up similarly to normal breast tissue on mammograms and does not interfere with imaging.
While mammogram screening is still possible after implants, it often requires extra views and specialized techniques. The radiolucent fat grafted tissue does not obstruct breast imaging like implants potentially can.
What about satisfaction and quality of life after augmentation?
Augmentation aims to improve a woman’s satisfaction with her breasts and quality of life. But results vary between methods:
- Breast implants – Show high satisfaction initially but this declines more rapidly over time compared to fat transfer.
- Fat grafting – Demonstrates stable, high rates of satisfaction lasting over the long-term follow up period.
This suggests the more natural results of fat grafting may provide greater quality of life benefits over time compared to breast implants.
What surgical technique has the lowest risk profile?
Based on complication statistics, imaging considerations, and patient satisfaction measures, autologous fat transfer breast augmentation carries the lowest overall risk profile compared to breast implants.
Though individual skill levels can vary, fat grafting’s less invasive nature and use of the body’s own tissues reduces risks inherent to implant surgery. The rates of capsular contracture, reoperation, and major complications are significantly lower with fat transfer procedures.
Fat grafting provides better quality of life over the long run compared to implants. And it preserves the accuracy of future mammograms since it doesn’t obstruct imaging of breast tissue.
Conclusion
While no surgery is completely without risk, fat grafting breast augmentation provides the safest option based on:
- Lower incidence of complications like capsular contracture
- Lower rates of additional revision surgeries
- Reduced risks of the foreign body effects of implants
- Minimal interference with breast cancer screening
- High and lasting patient satisfaction
Careful patient selection, an experienced surgeon, and realistic outcome goals are still key to achieving optimal, safe results from breast enhancement. But overall, fat transfer allows enlarging the breasts utilizing the body’s own natural tissues with the lowest chance of problems.