Understanding the Risks of Surgical Procedures: Every surgical procedure involves inherent risks, and it’s crucial for patients to be well-informed about these before deciding to proceed. Here, we outline not only the general risks associated with surgeries but also emphasize that specific procedures have their own unique risks.

General Surgical Risks: All surgical procedures can potentially lead to complications such as:

• Bleeding or hematoma formation
• Infection
• Healing issues, including slow/delayed healing or separation of the incision (wound dehiscence)
• Excessive or abnormal scarring, such as keloid formation
• Seroma (accumulation of tissue fluid)
• Deep suture extrusion that could lead to infection
• Fat necrosis (death of fat tissue)
• Pain- acute post-surgical pain; sometimes chronic pain
• Change in sensation (usually temporary but may be permanent)
• Allergic reactions to drugs or local anesthesia
• Deep vein thrombosis (blood clots in deep veins) that could lead to pulmonary embolism (clots travelling to the lungs)
• Pressure effect- excessive, unrelieved, or prolonged pressure on tissues can cause temporary or permanent damage. The risk of these complications is increased in lengthy operations and in the obese (BMI 30 or more), smokers, diabetics, and medically compromised patients. Great care is taken to minimize these risks during operations.
• Unsatisfactory result and need for revisional surgery

Informed Consent: Before any surgical operation, it is mandatory for all patients to read and sign informed consent forms. These documents are essential as they ensure that you have been provided with comprehensive information about the risks associated with your procedure. Dr. Tan and her team are committed to ensuring that you feel informed and confident in your healthcare decisions.

Procedure-Specific Risks: Each type of surgery carries additional risks that are specific to the procedure itself. During your consultation, Dr. Tan will provide a detailed explanation of these risks tailored to the specific surgery being considered. This information will also be included in the informed consent forms, which are discussed and thoroughly reviewed during your consultation. You are encouraged to ask any questions you may have during this time to ensure you fully understand all aspects of the procedure and its risks.

What you need to know…

There are many types of breast implants that come in various shapes, sizes, and textures. Choosing the right implant for you depends on many factors. You will want to talk with your doctor about picking the right implant. Your surgeon can also recommend the best way to insert the implants based on your preference and body structure. The shape and size of your breasts before surgery will affect your doctor’s recommendations and the results of your surgery. If your breasts are not the same size or shape before surgery, they probably won’t be completely same afterward.

If your breasts sag or if you have issues with skin tone like stretch marks, you may need additional help to get the results you want. For example, you might choose a breast lift surgery to move your nipple and areola upward or remove loose skin.

Before you decide to have breast implant surgery, you must think about the following:

• No breast implants last a lifetime. You may require surgery in future to replace or remove your implants.
• The chance of developing implant-related complications increases over time.
• Some complications will require more surgery.
• Breast Implants may be associated with systemic symptoms.
• Changes that occur to the breasts after an implant surgery cannot be reversed. If you decide to remove the breast implants later, you may not like how your breasts look.
• Choosing very large implants may cause some problems and may need more surgeries to fix the problems. For example, the implants may bulge out or your skin may look wrinkled. It is also likely that you will see or feel folds in the implant. Other serious issues with very large implants may include infection or significant bruising.

What are the inherent risks of using silicone gel implants?

Implants rupture

Like our body, implants go through ‘wear and tear’ over time and weakness of the shell may occur. This could lead to rupture if excess pressure is applied. The risk increases the older the implant, especially after 10 years.

Calcification:

Calcium deposits can form in the scar tissue around the implant over time.

Implant Extrusion/Tissue Death:

Several things may cause serious problems with your breast implants. If you don’t have enough tissue over the implant, have problems healing, or get an infection, the implant may be visible through your skin (“exposure”). It is also possible for some or all the implant to come out of your body (“extrusion”). It’s possible for your breast tissue to break down (“necrosis”). Smoking, microwave diathermy, and excessive use of heat or cold therapy can also cause problems. In some cases, the cuts your surgeon made may not heal normally. The breast tissue may weaken (“atrophy”). If the implant pushes through layers of skin, it might become visible at the surface of your breast. If your skin breaks down and the implant is exposed, you may need to have the implant removed. There’s a chance that you’ll have permanent scars or other visible changes. It’s impossible to predict how your body will react to surgery or how you will heal.

Skin Wrinkling and Rippling:

It’s possible for both implants and breast skin to wrinkle. These wrinkles may be visible, or you may feel them, or both. Some amount of wrinkling is normal and expected with silicone gel-filled breast implants. You may have more wrinkling if you choose a textured implant or if you have thin breast tissue. It’s important to know your body and what it feels like. If you feel wrinkles or folds in your breast after surgery, tell your doctor. These changes in your breast should be checked to find out what’s causing them, because they can feel like a tumour.

Chest Wall Irregularities:

You may experience changes to your chest wall after the breast implant surgery. This can cause problems to your ribs.

Implant Displacement and Tissue Stretching:

It’s possible for a breast implant to move, rotate, or shift after surgery. This may be uncomfortable. It can also cause your breast to look different, change shape, or have wrinkles or ripples in the skin. Some ways of placing your implant can increase the risk of it moving. You may need more surgery to correct this problem. It may not be possible to resolve this problem if it happens.

Surface Contamination of Implants:

It’s possible for skin oil, lint from surgical drapes, or talc to get on the surface of the implant when it’s inserted. The consequences of this are unknown.

Unusual Activities and Occupations:

Activities and occupations that may involve things hitting or injuring your chest (“potential for trauma”) could potentially break or damage your breast implants. They may also cause bleeding or fluid leakage (“seroma”).

Silicone Gel Bleed:

It’s possible for the silicone gel in your implant to leak from the implant itself (“silicone gel bleed”). At present, there’s mixed evidence about how this could affect you. Over time, extremely small amounts of silicone gel can pass through the implant’s outer layer and coat the outside of it. Studies show that silicone gel contains small amounts of platinum. This platinum can interact with your body (“zero oxidation state”). This may contribute to scar tightening (“capsular contracture”) and may make your lymph nodes swell. However, most studies suggest that the extremely low levels of gel bleed do not pose a serious risk to your health.

Change in Nipple and Skin Sensation:

Your nipples and the skin of your breast may be less sensitive after getting breast implants. After many months, most people get normal feeling back. In some cases, it’s possible you might partially or permanently lose feeling in your nipples and skin. Such changes may affect your sex life or your ability to breastfeed a baby.

Future Pregnancy and Breastfeeding:

Getting breast implants should not interfere with getting pregnant in the future. If you’re planning to get pregnant, remember that your breast skin may stretch as your body changes. This can change the look of your breasts and may make you less satisfied with the results of your surgery. You may have difficulty breastfeeding after this operation.

Removal of implants with capsulectomy-

What you need to know..

• Full attempts will be made by Dr Tan to remove all the capsules but this cannot be guaranteed, especially if it is deem unsafe or in doing so may cause too much tissue destruction. If any capsule is left behind, especially on the ribs, it will be cauterized (burned).
• Calcium deposits in the capsule. This usually develop gradually over a long period after having the implant inserted. Existing ‘old’ capsule covered with calcium deposits is often very difficult to remove without causing significant destruction to the adjacent tissue. Extreme precautions will be undertaken to minimise that. Some calcified capsule may be left behind if it is too risky to remove it.
• Fluid accumulation in the space where the implant has been removed (either serum/serous fluid or blood). Small amount of tissue fluid collection is not uncommon and you usually cannot feel it. The drain is left until there is minimal fluid draining. If you develop swelling at any time after surgery, please let Dr Tan know.
• Altered nipple sensation, usually decreased sensation, but may be increased sensation.

Uncommonly, this may be permanent.

• Thrombosis of veins within the breast
• Granuloma, if a gel implant has ruptured, which then leaks gel into the tissues, resulting in a lump. It may not be possible to remove all the gel.
• Pneumothorax. Particularly in very thin patients, it is possible to let air into the chest cavity through a small hole between the ribs. This rarely needs to be treated with a large drain tube (chest tube) to reinflate the lung post-operatively.
• Infection- Infection is unusual after this type of surgery but may occur. This would require antibiotics.
• Breast deformity or asymmetry related to removal of the implants. To reduce the ‘deformity’ of the breasts after removal of breast implants, you may have to consider breast lift/mastopexy, fat grafting, or replacement with new implants.
• Dissatisfaction with the appearance of the breast following removal of the implant.
• Residual silicone may be left behind in the breast or in the axilla