Mo Salhab MD, MS, PG Dip, FRCS 

Oncoplastic & Aesthetic Breast Surgeon

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Breast Augmentation

Risks & Complications of Breast Augmentation

Breast augmentation has for many years been the most common cosmetic procedure in the UK which is a testimony to its safety and ability to achieve a satisfying outcome in most patients. However, no surgical procedure is without risk.  During your consultation, I will discuss with you all the potential complications that could occur after breast augmentation surgery. Also, specific complications in relation to the type of the implant and shape and special considerations will be discussed.

Recognised implant risks are:

  • Bleeding and haematoma formation ( blood collection) rarely occurs (less than 1%). The patient will feel tightness and enlargement of the breast. This complication requires the patient to be returned to the theatre in order to stop the bleeding and evacuate the haematoma.

  • Infection is rare (less than 1%) typically occurs during the first week after surgery. Implant infection can be a serious complication and requires removal of the implant for the condition to settle down.

  • Loss of feeling in the nipples or breast tissue occurs in about 15% of the patients. This complication is due to nerve damage. Often this is temporary, but it may be permanent in some women

  • Changes in the nipple appearance or position, this usually occurs due to scarring and adherence of the nipple to the implant. Submuscular placement of implants reduces this risk.

  • Implant wrinkling or rippling

  • Implant rotation 


  • Capsular contracture. This condition is one of the most common problems caused by breast implants. It occurs when scar tissue around the implant hardens and begins to squeeze the implant. Capsular contracture can cause rippling of the skin and hardening and change of the breast tissue, some patients also report ache or even pain in severe capsular contracture. Smoking, infection, bleeding, previous capsulation and smooth service implants are recognised risk factors of capsular contracture. Revision surgery is sometimes needed to remove the scar tissue and exchange the implants. The newer designs of implants have features to reduce the likelihood of this complication happening.

  • Implant rupture or leak, surgery may be needed to remove the implant and replace it

  • Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) i

What is BIA-ALCL?

 Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare subtype of T-cell non-Hodgkin lymphoma (NHL). It is one of four subtypes of ALCL which has been found in association with breast implants in a small number of cases worldwide. This sub-type is always both CD30 positive and ALK-negative.

The aetiology is unknown but one of the most plausible current theories on the causation of BIA-ALCL is that it is related to the biofilm. A biofilm is where bacteria are attached to an implant surface and surrounded by a protective layer of glycoprotein. They are difficult to treat and can lay dormant for years. It is theorised that BIA-ALCL tumour cells might be derived from a sustained T-cell immune response to the bacterial antigens in biofilm, but as yet there is no substantive evidence this is the case.

If BIA-ALCL is caught early treatment is usually surgical and curative, by complete removal of the capsule and implant.

How common is BIA-ALCL?

The first case of BIA-ALCL was reported as recently as 1997 and was discovered in association with a saline-filled breast implant. Data regarding the frequency of occurrence of BIA-ALCL has changed. Previous estimates derived from epidemiological studies estimated the risk at 1 in 300,000 breast implants or an annual incidence of 0.1 to 0.3 per 100,000 women with implants. Recently published data from the Australia and New Zealand cohort of cases of BIA-ALCL combined with anonymized sales date from implant manufacturers has provided a different perspective with a higher risk estimate (Deva AK et al, Plast Reconstr Surg. 2017 Oct;140(4):645-654). The highest estimated risk as expressed as cases of ALCL per number of implantations was found for the Allergan Biocell texture at 1 in 3817 (95%CI 2718 to 5545) as compared with Silimed Polyurethane at 1 in 7788 (95%CI 3042 to 28581) and Mentor Siltex texture at 1 in 60631 (95%CI 10882 to 2397471). Higher surface area textured implants are therefore shown to significantly increase the risk of BIA-ALCL in Australia and New Zealand.

Although the first case of BIA-ALCL was in association with a saline implant, it has been shown to occur independently of the filler material. No cases to date are reported with the sole use of smooth implants..

In whatever circumstance a breast implant is being used, either for breast reconstruction or augmentation, there is now a need to provide patients with adequate information, and a discussion of BIA-ALCL must be included as part of the consent process and documented in the patient’s medical record. Implants are still regarded as safe for use in augmentation and reconstruction operations and the MHRA does not suggest a change in practice with the current data available.

Further information on Breast implant risks: Click here 

Breast Implants

A breast implant consists of an outer shell and a filling material which is most often silicone gel or sometimes saline (salt water). Some implants are round and others are shaped more like a natural breast referred to as tear drop or anatomical implants. Either can give excellent results. I will discuss with you the one that best suits your desired breast size and your expectations.  Round implants give a fuller appearance of the upper part on the breast while tear drop implants give a more natural-looking breasts and can help to reduce a small degree of breast sagging.

Breast augmentation is performed by placing an implant either under the breast tissue or behind the muscle on which the breast lies. Implants are usually inserted through incisions in the fold under the breast. This approach is commonly used and considered the one to place the silicone gel implant.  The operation is performed under general anesthesia and lasts about 1.5 hours.

During the operation, you will be given a dose of antibiotics to prevent infections. The wounds will be sutured with dissolvable stitches and dressed with waterproof dressing so you can shower normally after you go home. You would be expected to stay at the hospital for one night.

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