Infection

If an infection cannot be improved with oral antibiotics, IV antibiotics administered by a catheter directly into your vein must begin immediately. If the infection does not improve with the antibiotics, the plastic surgeon may recommend removal of the breast implants as a temporary measure, to be replaced three months later. Patients who are poor candidates for breast implants and more likely to develop infection are those with diabetes, those who have problems with wound healing, or those with compromised immune systems, such as patients with kidney transplants or asthma, those taking the medication Prednisone, or those who have the AIDS virus.

Postoperative Bleeding

Bleeding is very rare, but it can occur with this operation. It's important that patients discontinue the ingestion of aspirin, Motrin, Advil, Alka-Seltzer, or any aspirin-containing products prior to surgery. Aspirin affects the clotting factors and platelets in the blood which control bleeding.

Bleeding will present as increased swelling on one side or the other. A patient should call her plastic surgeon immediately if she notices fullness on either side of the breast wall. If this happens, the patient must return to the surgeon, who will then remove any fluid or blood that has collected (hematoma) internally. The implant is left in place, and the incision is closed. There should be no problem with the final result unless the hematoma is not caught early enough or treated appropriately.

Scarring

Excess or obvious scarring depends on genetics and the patient's wound-healing ability (see Fig. 12-7). Different techniques can improve the scarring. For instance, for hypopigmented or very pale white scars, the plastic surgeon may recommend tattooing around the nipple areolar complex or around the suture line. We can inject raised scars with steroids, vitamin E, or Silastic sheeting. Chronic pain is rare, but it can occur. Feeling in the nipple and breast can increase or decrease after implant surgery. These changes in feeling can be temporary or permanent and may affect sexual response. Ninety-nine percent of patients who have breast implants are extremely happy with them.

As far as the expense of breast augmentation, the fees depend on your geographic area. It's a more expensive procedure in New York than it is in Colorado or Nebraska. The implants themselves are usually the same price nationwide and range from $1,000 a pair for saline to $1,800 a pair for silicone. Occasionally, revisions need to be done. Implants may need to be changed for larger or smaller ones. Most surgeons will do this at a reduced fee, but this needs to be discussed ahead of time

BREAST IMPLANT REMOVAL AND AUTOIMMUNE DISEASE

Frequently, people come to see me for silicone breast implant removal. They are often self-referred because of the implant scare, or are sent to me by rheumatologists who feel that the implants should be removed.