Breast enhancement is being increasingly used today. Once thought only to be something that celebrities or rich people had done, breast augmentation is now frequent among all strata's of the general population. Whilst the finished surgical results typically work really well, improving the patient's perceived outlook and lives, what must be remembered are the small but not irrelevant associated potential risks. This is after all surgery, a highly invasive procedure that requires the careful consultation and application of experts.

Breast enhancement surgery can lead to a whole host of complications, two of which are mentioned below:

Necrosis:

This is where injury and/ or disease kills off groups of cells around the implant in the weeks after surgery. Such an occurrence makes the healing of the wound surrounding the implant difficult. In the worst cases the implant may have to be removed to enable the affected area to be effectively cleaned and then healed.

Necrosis of breast tissue can be more likely if the patient:

smokes already has an infection uses steroids undergoes heat or cold therapy undergoes radiation/ chemotherapy.

What can be left from a case of necrosis is large permanent scarring. Surgeons can apply silver nitrate (or other similar anti-infection chemical) to a recent scar that appears to be re-opening soon after implants surgery. The cessation of smoking is highly recommended prior to breast surgery, in particular when having a breast lift. Breast lifts need a larger quantity of incisions which can increase the chances of less than adequate oxygen supply to regions of the breast, further promoting the chance of necrosis.

Capsular contracture:

Any object inserted in a living human will be surrounded by a protective tissue lining frequently termed a 'tissue capsule', 'scar capsule', or simply a 'capsule'. This lining is not identical to the regular scar tissue.

Capsular contracture is the most widely seen of the breast enhancement complications, although possible at any time it is most frequent in the first few months after surgery.

Breast enhancement surgery involves the cutting of tissue to create the hole for the implant to fit into. Once the implants are in this so called 'pocket' a very fibrous tissue develops, i.e. the capsule. Scar tissue is genetically programmed to shrink to a certain degree. In some people the scar tissue will not shrink noticeably, in others shrinking places pressure on the implants making them seem quite tough and rigid.

Under pressure the breasts can become physically distorted, later becoming firm and ball-like. What can increase the risk of capsular contracture are:

Patients that smoke Past cases of seroma Past incidences of haematomas can aggravate the capsule, i.e. inflammation, leading to the capsule contracting Implants placed on top of the musculature generally have more of a chance than implants inserted below the muscles of capsular contracture Pathogens present on unclean implants can lead to rapid contracture.

A grading system is used to mark the degree of capsular contraction:

• Baker Grade 1: The breast looks natural and feels soft.
• Baker Grade 2: The breast looks natural but is a little bit firm.
• Baker Grade 3: The breast looks slightly distorted and is firm.
• Baker Grade 4: The breast looks distorted and feels hard. A certain level of pain may be present.

When thinking about having surgical breast enhancement do really think about whether you need the operation. Consult your local qualified surgery and know the potential risks!