Tips on Risks

Recommendations for Reducing Risks Associated with Breast Augmentation

Dr. Loftus recommends a number of things that can be done before, during, and after breast augmentation surgery to ensure the lowest complication rate and the best results. Explained below are a number of recommended steps.

Reducing Infection:

Reducing the risk of infection after surgery should be a primary concern. The following are steps that can be taken to reduce the risk.

• To reduce the risk of infection, your plastic surgeon should administer IV antibiotics at the time of your breast augmentation surgery.
• Your plastic surgeon may use Vancomycin during surgery to rinse the implant pocket before your implants are placed. Vancomycin is active against resistant strains of staph, such as MRSA. It covers both staph aureus (which is often linked with implant infections) and staph epidermidis (which is often linked with capsular contracture), so it also may reduce the rate of capsular contracture.
• If you are prone to chest acne, ask your plastic surgeon about the use of Bactrim, an antibiotic, to be taken a week before surgery to help your acne clear up before the day of surgery. As acne harbors bacteria, especially staph, clearing it prior to surgery may reduce the likelihood of chest acne contributing to a breast implant infection or capsular contracture.
• If you have your breast augmentation operation in a private accredited surgery center which does not handle infected cases, your risk of infection may be lower than in a hospital.
• To avoid the possibility of contamination of surgical instruments between the time they are sterilized and the time of your procedure, ask your doctor about sterilizing surgical instruments immediately prior to your procedure, rather than days or weeks ahead of time. The instruments may be transferred directly from the autoclave to the operating room table, as opposed to being stored between the time they are sterilized and used.
• During your breast augmentation operation, your plastic surgeon must handle your implants directly or indirectly. However, it is not necessary that other members of the team handle the implants. As such, it makes sense to limit the handling of your implants to the only person who must handle them: your plastic surgeon. In other words, it is not necessary for scrub techs to handle the implants directly….so why should they? Limiting the number of people who handle implants may reduce the risk of contamination. Also, before handling the implants, your plastic surgeon should change gloves before he or she handles them, thereby reducing the possibility of contamination in the event that the gloves had become contaminated during the procedure.

Reducing Capsular Contracture:

• No one knows exactly why capsular contractures form around saline implants, but most plastic surgeons think that they are related to bacterial contamination that occurs at the time of surgery. Therefore, every step taken to reduce the risk of infection (see above) may translate into reduced risk of capsular contracture.
• Breast implant displacement exercises may reduce the rate of capsular contracture and may help keep your breasts soft and natural. Your surgeon should provide instruction on these after your surgery and work with you until you are comfortable performing them.

Reducing Deflation (If you select Saline Implants):

You may reduce the risk of saline implant deflation by overfilling your implants according to the manufacturer’s recommendations for breast implant augmentation. This usually means 25-30 CCs, which is equivalent to an ounce of fluid. This can be accomplished by selecting an implant that is smaller than the size you chose and then overfilling it to the amount that you choose. Your surgeon should take care of this for you.

Reducing Rippling (Wrinkling):

You may reduce your risk of rippling by overfilling your implants if you select saline implants. Smooth implants have a lower risk of rippling than textured implants. These two simple measures markedly reduce the risk of rippling for saline implants. If it is determined that rippling may be a high risk for you, consider silicone gel implants which have a much lower risk of this problem when you undergo breast augmentation .

Additionally, if you have a very modest amount of breast tissue, you should strongly consider placing the implants under the muscle to avoid rippling in the upper half of the breast.

Reducing Sloshing:

Sloshing, quite simply, is reduced by overfilling your implants. There is no disadvantage to overfilling your implants. You should clarify this issue with your surgeon to ensure that your implants will be overfilled.

Reducing Nipple Numbness:

The national average of permanent nipple numbness occurs in 15% of all women who have breast augmentation. Numbness is due to damage to the nerve that provides sensation to the nipple (the 4th intercostal nerve). As this nerve is small, it is often not visible during the operation which makes damage more likely. To minimize the possibility of damage to this nerve, your plastic surgeon should avoid "cutting" or "cauterizing" anything in the area of the nerve, which is on the side of the breast nearest the armpit. Your plastic surgeon may instead gently stretch tissue apart to make room for the implant. By stretching rather than cutting, the nerve is stretched but not severed. Stretched nerves are less likely to result in permanent numbness. Regardless, no plastic surgeon can guarantee preservation of nipple sensation. So, if the possibility of permanently numb nipples would make you regret having had this procedure, then you should probably chose to not have breast augmentation.