When you are preparing for a breast augmentation you need to be aware of the complications that could occur. You may be able to avoid some by proper planning or at least be better equipped to deal with problems if they do come up. You may even be identify a complication early and address it before it becomes too serious.

In this article we will give you the details of four serious breast augmentation complications, why they occur, how you can identify them, and what you can do to prevent them.

Double Bubble

When implants are placed behind the pectoral muscle, rather than in front of it, women whose breasts have begun sagging naturally can experience a unique complication commonly referred to as double bubble. While the implant remains in place, breast tissue sags bellow it, creating the appearance of two separate breast creases.

How the double bubble effect can be avoided:

• Implant placement in front of the muscle fills out sagging skin and helps avoid this complication (although it can increase the occurrence of other aesthetic problems like the appearance of rippling)
• A breast lift in conjunction with sub-muscular implant placement can help prevent inconsistent sagging

If the double bubble effect does occur the only treatment option is surgical intervention with two options:

• Re-operation with breast lift and sub-muscular placement
• Surgery with implant removal and replacement in front of muscle

Note: double bubble can occur within a few days or weeks after surgery or may develop over time as breast tissue undergoes continues sagging (especially after pregnancy)

Understanding Capsular Contracture: Its Risks and Treatments

When any implant is inserted the body reacts by forming a lining of tissue around it called the capsule. In some cases the capsule begins to shrink, squeezing the implant that it surrounds.

Contributing Factors

Though the exact causes of capsular contracture are largely unknown, there are factors that can contribute to this complication, including:

• Germ contamination during implantation
• Seroma (the development of extra fluid around implant)
• Hematoma (internal bleeding)
• Infection
• Smoking
• Placement of implant above muscle (when placed bellow the muscle capsular contracture occurs with less frequency)

Depending upon the severity the breast can feel firm or hard, become distorted, and begin to cause pain. To cure or treat capsular contracture there are both surgical and non-surgical options.

Non-surgical Treatment

• Prescribed antibiotics and Vitamin E. While this is not always effective as a cure, many surgeons will suggest that patients take a regular dose of Vitamin E for the first year after augmentation as it helps to keep tissue soft.
• Closed capsulotomy. The breast is forcefully squeezed in the hopes that the capsule pops or tears. This is not often done because it could cause the implant to rupture and may void the manufacturer's warranty.
• External Ultrasound. May help reduce swelling and inflammation and does not involve any major risks.
• Accolate. This anti-inflammatory used in the treatment of asthma has shown, in minor studies, to help regress capsular contracture. This is a relatively new and experimental treatment with no long-term statistical data.

Surgical Treatment

• Open capsulotomy. The capsule surrounding the implant is surgically cut open in order to release the implant. After this is done, however, there is a chance of contracture occurring again.
• Open capsulectomy. This is generally the most successful, as well as the most intensive, form of treatment. The entire capsule is removed, allowing new tissue to form around the implant. In some cases, surgeons will change the implant placement: for example if the implant is placed above the muscle the surgeon may place it underneath the muscle during capsulectomy in the hopes of better results.

With capsular contracture of both breasts	After revision surgery Performed by Dr. Michael Ciaravino

When Implants Bottom Out: How it Happens and How it's Fixed

In some cases tissue support at the bottom of the breast can weaken, allowing the breast implant to move downward forcing the bottom crease lower on the chest.

Factors that can contribute to bottoming out include:

• Over dissection of implant pocket (when this is the cause, bottoming out usually occurs within weeks or months)
• The implant is too heavy for the amount of skin and underlying breast tissue (under this circumstance bottoming out occurs gradually over time)
• Placement of implant (complete sub-muscular placement has a dramatically lower occurrence of bottoming out than placement above muscle or partially below muscle, although this may result in a less natural look)

Correction of Bottoming Out

To correct this complication additional surgery is necessary:

• An incision is made (usually along the breast crease)
• The tissue surrounding the implant is cut and rolled upward to the desired position of the new crease and held in place with internal sutures
• The incision site is closed

Note: If the implant is too heavy for the amount of tissue it may need to be replaced with a smaller implant or temporarily removed while the tissue heals.

Understanding Symmastia: How it Forms and How it's Treated

Commonly referred to as breadloafing or uniboob, symmastia occurs when two implants touch one another in the center of the chest just above the breastbone. This complication only occurs when implants are placed underneath the pectoral muscle. If the horizontal muscle that is connected to the sternum and goes across the implant is cut then the implant, when it begins to settle a few days after surgery, can move towards the middle of the chest, pushing up the skin and tissue above it.

Repairing Symmastia

The repair of symmastia requires additional surgery to move the implant back into the pocket of original placement.

• An incision is made (usually along the breast crease) to expose the underlying tissue, muscle, and implant.
• The tissue that encapsulates the implant is cut and rolled back to fit into the pocket.
• Tissue is sutured together to hold implant in place.
• The muscle is then sutured internally back in place, connecting the sternum.
• The incision is then sutured close.

When external sutures are used to correct symmastia, the complication has a high rate of recurrence.

In the picture above the two implants have migrated to the middle, giving the appearance that the two breasts are connected underneath the skin.	The picture above shows corrective surgery performed by Dr. Michael Ciaravino.