BIO LIFT ™ Surgery Sydney

General Potential Complications

More information on general potential complications can be found on our site. LEARN MORE 

Whenever someone is having an anaesthetic, no matter what it’s for, then things can potentially go wrong. That is why no surgery should be considered “minor”. Of course, whilst the chances of the following potential problems occurring are extremely small, you still need to know about then:

• Anaesthetic issues – which can affect heart, lungs or cause strokes.
• Allergic reactions – This can be very mild to life threatening.
• Clots
  • Superficial vein clots, which is a complication of the cannula or drip that’s placed in your vein.
  • Deep vein clots – these can potentially spread to the lung and be life threatening. We do several things during surgery and after surgery whilst you’re in hospital to minimise the risk of you developing these.
• Wound problems – such as infection and breakdown
• Bleeding – early or late
• Death – whilst the chances of this is exceeding rare, any of the previous issues can result in this devastating complication.

All these potential problems are standard for any operation, although some operations and some patients have an increased risk of developing them.

Ruptured Implants – can this occur and what happens if they do?

Breast implants can potentially rupture, with a quoted lifetime incidence of between 1-2%. The cause of this is typically unknown and it’s not as though your physical actions would contribute to this happening. It can happen within 6 months after surgery or many years later. If a rupture does occur it’s typically not something which actually causes problem – you don’t develop any pain or issues like that. Indeed, often the women doesn’t even know if they have a ruptured implant. Of course, a couple of subtle signs do exist, and a skilled Plastic Surgeon can often tell if they are ruptured. Basically, a ruptured implant is not a medical problem and is not going to cause you any health problems. It is not a problem that warrants “urgent” treatment. On the rare occasion, a ruptured implant can cause pain and discomfort with the silicone something spreading to the lymph nodes in the armpits.

The key signs that you may have a ruptured implant are if your breast has lost a bit of shape, especially with a loss in upper pole fullness. When lying on your back the breast with the ruptured implant often has a loss of projection and appears quite flat. Also, when you feel a breast with a ruptured implant, it has a very soft doughy feel to it.

If a ruptured implant is suspected, then an ultrasound and/or MRI should be done for completeness.

What is Capsular Contracture and Does it Matter?

A well-known potential complication associated with implants is capsular contracture. In this video Dr Dona discusses this in an easy-to-understand manner.

A real case of capsular contracture

Capsular contracture is a condition that can affect women with implants. Essentially, it refers to hardening of the breasts, with sometimes distortion and even pain associated with it. Capsular contracture affects up to 5% of women. Historically it was far more common and affected up to 20% of women.

So why does it occur?

Implants are a foreign material, and the bodies natural and normal response to foreign material is to form scar tissue around it, like a capsule around it. Normally it’s a loose fit and the implant is soft and mobile.

However, in capsular contracture, for reasons unknown the scar tissue slowly starts to contract around the implant. Eventually, it gets to the point where the implant is being held under tension by the surrounding abnormally thickened scar tissue, and that’s why they feel hard. That’s also why the breasts can become distorted.

So why is it less common? Below are some of the reasons why, and steps required to help reduce the risk of CC.

• Silicone gel implants
• Textured implants
• Under the muscle
• Breast massage
• Meticulous technique with minimal bleeding
• Using antiseptic in the breast pocket and soaking the implant in antiseptic before inserting.
• Antibiotics during surgery
• Minimal handling of the implants – the packet is only opened up prior to insertion.

Rippling – what is it and why does it occur?

Rippling is where you can see the folds of the breast implants.

To some degree, all implants develop some form if rippling that can be felt. However, it is only when it’s seen that it’s considered an issue.

Also, certain positions are more likely to cause visible rippling – such as leaning forward commonly results in rippling in the side boob area.

Certain factors contribute to the development of rippling. These include:

• How thin the person is. Very thin people have little natural tissue separating the implants from the skin…so you can see the implant.
• How much natural breast tissue the person has. Just like being very thin, having very little breast tissue has a similar issue.
• Being on top of the muscle increase the risk of rippling near the cleavage
• Development of capsular contracture can contribute to ripping as it essentially results in buckling of the implant
• The type of implant. Saline implants are very collapsible and typically cause rippling.
• Also, not all silicone implants are the same. Some are a firm gel which is far less likely to buckle/ripple. However, very soft silicone gel implants are more likely to buckle and cause visible rippling.
• Sizes of implant – very large implants are more likely to buckle and cause some form of rippling.

Double Bubble – what is this and why does it occur?

Double bubble is complex problem and has many different causes. The end result is basically where you have a double curve in the bottom half of your breast, from your nipple to your lower breast fold. This is caused when there has been a loss of harmony or balance between the implant and breast tissue – so we don’t have a uniform spread of the natural breast tissue over the implant. Effectively you see the breast tissue mound sitting on, or hanging from, an implant mound.

The causes of this include:

• Constricted breast base with short distance from nipple to breast fold – or very conical or pointy shaped breast tissue which typically also have a constricted breast base are more prone to double bubble
• An implant base that is too big relative to natural breast tissue base. The end result is a small natural breast tissue base sitting on top of a larger implant base
• Implant bottoming out/dropping down so that the lower part of the implant is lower than the natural lower base of the breast tissue.
• Breast tissue changing over time and becoming softer and droopier. So, what was once a great breast shape with a uniform spread of breast tissue over an implant, changes with breast tissue essentially hanging from an implant mound.
• A combination of any of the above-mentioned issues

A skilled and experienced Plastic Surgeon can do a few things internally and with implant selection to minimize the risk of this happening. However, many times a double bubble is secondary to the persons natural anatomy and is therefore largely unavoidable.

If you do have double bubble, correcting it is a very difficult problem and the underlying cause will ultimately determine what needs to be done to fix the problem.

Double Bubble – a customised video animation explaining what double bubble means and four different causes?

Double bubble is a problem that can develop after breast augmentation.  There are a number of possible causes of the double bubble, but the key sign of it is a groove along the lower breast curve creating the appearance of a bubble sitting on top of another bubble, hence the term double bubble.

One example of double bubble is that which can occur in a woman that has a very short distance from the nipple to the lower breast fold, or a tight breast base.  In this example, an excision is typically placed below the breast fold.  The lower end of the muscle is identified and detached from the chest all, and a space is made under the muscle to accommodate the implant.  The implant is then inserted and positioned and the wound closed.  In this situation, the implant position is below the original breast fold which is now sitting along the lower breast curve.  Initially this region remains tight and causes a flatness or indentation.  This indentation is what creates the double bubble.  Over time as the breast tissue softens and the implant settles, this double bubble typically resolves, resulting in a smooth lower breast curve.  However, sometimes due to a natural persistent tightness at the site of the original breast fold, this double bubble persists.  To compound the problem, at the level of the original breast fold where the muscle sits close to the skin, as this muscle contracts it pulls in the skin causing a dynamic double bubble.

A double bubble can also occur in those who have a loose and well-formed lower breast curve with a long distance from the nipple to the lower breast fold.  Here it can occur if the incision is placed too low, below the breast fold, and the implant is therefore effectively placed too low.  In this situation, the lower end of the muscle is detached from the chest wall and the implant pocket is made deep to the muscle.  The implant is then inserted and positioned and the wound closed.  However, here we have the breast implant sitting too low, below the natural breast tissue mound, and the original breast fold remains tight.  The end result is an implant sitting below the original breast mound with the breast tissue sitting on top of the implant mound, and with the persistent tightness of the original breast fold, this creates an appearance of a breast tissue hanging from an implant mound, creating a significant double bubble.

Another cause of double bubble is caused when a correctly placed implant drops down below where it was originally placed, otherwise known as bottoming out.  In this type, if the lower breast fold remains tight, then as the implant bottoms out it ends up with a situation with the implant sitting too low and the breast tissue mound hanging from it.

The final cause of a double bubble occurs due to changes that can develop to the natural breast tissue over time.  In this example we have a normal ample-breasted woman with implants sitting in the correct position and a nice lower breast curve.  Over time, normal changes in natural breast tissue volume associated with natural body weight fluctuations can change the appearance of the breasts.  However, if the natural breast tissue softens up and drops down, a common occurrence with weight loss or after pregnancy and breastfeeding, then the breast tissue drops down and effectively starts to hang from the breast implant mound.  This can result in a significant double bubble formation.

Monoboob – what is it, why does it occur, and how is it treated?

Monoboob, or symmastia being the official term, is a condition where the two breasts are sitting too close together. In practical terms what that means is that the cleavage is not as deep as it should be with the skin along the midline lifted up. This problem can look worse with a bra or dress that pushes the breasts together.

This problem can occur after breast augmentation and is quite a difficult problem to fix. In fact, it’s not uncommon to require more than one surgery to try and fix it.

A number of things can contribute to the development of monoboob.

These include:

• Implants that are too large
• Creating an implant pocket that is too big with too much release of the pectoralis muscle from the chest wall.
• The persons natural anatomy can predispose to the development of monoboob, with some women more prone to it than others. This is especially the case in those who have very loose and mobile skin along the midline and typically these women have their pec muscles inserted close to or at the midline.

So, what happens if it looks like we’re getting monoboob?

• Early treatment is massaging along the midline and massaging the breasts outwards.
• Wearing a special symmastia compression type bra is required.
• Avoid wearing push up bras.

If it’s still a problem after 6 months, then surgery may be required. This includes tightening the pocket along the midline, and possibly changing to smaller implants.

Bottomed Out Implants – what is this and why does it occur?

BOTTOMING OUT is a condition where the implants have dropped lower than where they should be.

So how does a “bottomed out” breast look?

• The bottom of the breast is much fuller than ideal, with a long distance from nipple to lower breast fold.
• The upper half of the breast is empty
• With the implant dropping down, and because the nipple doesn’t physically move, the nipple is no longer central over the breast mound. Instead it ends up sitting too high on the breast mound and pointing upwards, and other than just looking odd this can cause practical problems with areolars visible above the upper end of a bra.

So before we look at what can potentially cause bottoming out a basic surgical concept needs to be explained.

Surgically, when the implant is positioned the deep aspect of the wound is stitched to form a secure rigid internal support to hold the implant in position, like an internal bra. Dr Dona closes the wound using three internal layers of stitching and this deepest layer is perhaps the most important.

So with this in mind, it follows that bottoming out can occur if this deep stitch layer is poorly performed, or not performed at all.

Or, if this deep stitch layer is not allowed to heal properly. For example, too much inappropriate physical activity too soon can potentially cause this layer to break down.

Other things that can contribute to bottoming out include:

• How heavy the implants are – heavier implants are more prone to dropping
• Smooth implants are more prone to dropping than textured
• Implants placed in front of the muscle are more prone to dropping compared to those under the muscle
• The quality of the person’s breast tissue and skin – breast tissue that’s soft and thin is less capable of supporting an implant
• Not wearing appropriate supportive bras to support the weight of your breast implants
• Or any combination of these issues

So, if you develop bottoming out, this can be an extremely difficult problem to fix, and the underlying cause will need to be determined. Of course, a skilled and experienced Plastic Surgeon should be able to address this problem.

Bottoming Out – a customised video animation demonstrating what happens with a bottomed out implant

Bottoming out is a condition which occurs when the implant drops below the position that it was originally placed.  An ideal breast shape should have a nice upper breast fullness and a gentle taper leading down to the nipple, then a gentle curve from the nipple to the lower breast fold.  The nipple should be pointing forward and centred at or just above the centre of the breast mound.  This is the same regardless of whether there is an implant or not.  If an implant drops down below the point where it was originally placed, then this balanced breast appearance changes.  The reasons why this can occur are several, but whatever the cause is, the end result is the same.  The distance from the nipple to the lower breast fold becomes much greater as the upper half of the breast empties and becomes smaller.  To compound the problem, the nipple points upwards and can be very difficult to hide in a regular bra.

BIA – ALCL

This is a rare cancer associated with some types of breast implants. The video (created in September 2019) explains the details.

Breast Implant Illness (BII)

BII is a controversial condition. The video (created in 2019) explains BII.