Breast Surgery: Key Considerations and Potential Complications

Breast Surgery: Key Considerations and Potential Complications

Insights and Recommendations for Making Informed Decisions About Breast Surgery


20 Apr 2023

Are you Contemplating Breast Surgery?

It's essential to be well-informed about the factors that ought to be considered as well as any potential complications that may arise.

Breast surgery is a big decision that can impact both your physical and emotional well-being, being aware of the critical aspects and possible risks is crucial for making educated choices. Whether you're planning for breast augmentation, reduction, reconstruction, or other breast surgeries, this article aims to be your informative guide, equipping you with the knowledge needed to make those important decisions for your breast surgery journey. So, let's dive in…

Breast Augmentation

Enhancing Shape, Volume, and More…

Breast augmentation is a popular cosmetic procedure that aims to enhance breast shape and volume. In addition to the obvious physical changes, such as improved body image and symmetry, breast augmentation can also have other advantages. It can help clothes fit better, enhance cleavage, and boost your self-esteem.

Modern breast implants are made of cohesive gel, which is a stable substance formed by increasing cross-linking between silicone molecules. This results in improved shape retention, reduced folding, and lower chances of implant visibility. The use of cohesive gel implants has significantly advanced the field of breast augmentation, providing patients with more natural-looking and long-lasting results.

To read more about breast augmentation and the different types, be sure to check out our blog on ‘The Science and Art of Breast Surgery’.


Key Factors to Consider During Patient Evaluation - Navigating the Process

Breast Ptosis or Drop

Mild ptosis will be improved by augmentation, but moderate or severe droopiness can only be corrected with either a breast lift or combination of lift and enlargement.

Skin Quality

Skin tone, elasticity and presence of striae can affect the result. Ladies should be made aware that augmentation will make the stretch marks more visible and poor skin quality increases the chances of the implants showing, especially with larger sizes. The three important discussions during consultations are implant choice, incision choice and the implant placement pocket.

Implant Choice

Factors that need to be considered are as follows: Volume: 
Patients can try sizers in the clinic to establish the desired volume and understand the weight of the implants. Other ways that can help individuals are digital imaging and photos of other ladies. Breast analysis and objective measurements can help the surgeon and patient to choose the optimal size and volume. Choosing an implant too large for the frame will cause irreversible damage to the tissue as well as increase palpability and rippling over time. Surface
: The two main implant surfaces are textured and smooth
Textured implants have lower capsular contracture rate and move less but they can cause more rippling and become more palpable. Smooth implants have a thinner capsule, so they are less palpable but have a higher capsular contracture rate. Motiva implants have a nano textured surface which has the advantages of both textured and smooth implants. Shape
: Implants are either round or anatomical which are coming in different projections. Anatomical or gummy bear implants designed to create a more natural look, but they can rotate and maintain a modest upper pole projection. Motiva round implants will give a more natural breast shape and become anatomical when the individual is standing.

Incision Choice

The most common incision placement is on inframammary fold which will be well hidden after a mild breast drop. Peri areolar, trans axillary and insertion via belly button are other options, but are generally unpopular due to disadvantages such as blind dissection and difficult implant placement.

Pocket Placement

Implants can either be placed behind the glands or pectoralis muscle. Most of the submuscular ones are Biplanar or Dual plane, which allows the nipple to lie at the most projecting part of the implant. Sub glandular insertion prevents muscle distortion and is preferable in active patients. Placing the implants behind the muscle creates better tissue coverage and reduces the rippling and visibility on the upper pole of the breast but in the long term can cause lateral displacement of implants, animation deformity (Dancing breasts) and Double bubble deformity.

Motiva Ergonomix Implants

Why we use them and their advantages

Motiva Ergonomix implants are a type of breast implant that is designed to mimic the natural shape, feel, and movement of natural breasts. The implant is filled with a highly cohesive silicone gel that is biocompatible and intended to maintain its shape and prevent wrinkling or rippling over time. The elasticity and cross linking of the gel makes it look and feel more like a natural breast tissue.

These implants are specifically designed to provide a more natural-looking sloped silhouette when a person is standing up, rather than the more traditional round shape of other breast implants. They imitate how real breasts look, feel and move. This is achieved through the use of a unique shell and gel combination that allows the implant to respond more naturally to movement and gravity.

The Motiva implants are also designed with a number of safety features, including a specialised shell that is designed to reduce the risk of rupture or leakage, as well as a special barrier layer that is intended to reduce the risk of capsular contracture (a complication that can occur after breast augmentation surgery). The specific surface layer which is called ‘True Monobloc’ also reduces the risk of implant displacement.


The Keller Funnel Technique

What is it and Why Use it?

The Keller Funnel is an FDA-approved device that is often used by plastic surgeons during breast augmentation surgery. Shaped like a cake decorating bag with a narrow tip, the cone-shaped device allows for a "no touch technique" insertion of the breast implant. The funnel is made of nylon with a hydrophilic coating on the inside that becomes smooth and slippery when it comes into contact with normal saline.

There are several advantages to using the Keller Funnel in breast augmentation surgery. One of the main benefits is that it can reduce stress to the implant surface, lowering the risk of damage or rupture during insertion. The use of the funnel can also result in a smaller incision size, which can help to minimise scarring and improve the cosmetic outcome of the procedure.

Reduced Infection Risk, Shorter Scar

Another important advantage of the Keller Funnel is that it can help to reduce the risk of infection during the surgery. By minimising the contact between the implant and the surgeon's hands, the risk of contamination and infection is greatly reduced. Additionally, the no-touch technique can help to reduce the likelihood of capsular contracture, a complication that can occur when the body's immune system reacts to the presence of a foreign object (such as a breast implant) by forming a thick layer of scar tissue around it.

Other benefits include shorter surgery times and faster recovery for patients. Overall, the Keller Funnel is an advanced tool that can help plastic surgeons to achieve safer, more effective breast augmentation results for their patients.


Understanding Potential Complications After Surgery - Navigating Postoperative Risks

Change in Nipple Sensation

It’s common after breast augmentation, however only 5% lasts more than one year, so the majority goes back to normal. Larger implants due to stretching the nerves and skin can cause longer lasting sensory discomfort, also peri areola placement diminishes nipple sensation.


Haematoma Is rare, less than 0.5%, and the risk can be reduced by meticulous haemostasis.


Infection is rare (less than 1%) and more common in smokers. Superficial skin infection can be managed with antibiotics, but deeper infection needs implant removal, washout of the pocket and re insertion of the implants 6 months after.


It’s common for breasts to be slightly asymmetric, patient expectation levels need to be properly managed and discussed preoperatively.

Capsular Contracture

The body naturally forms a soft capsule around all implants, tightening and hardening of the capsule can become painful and distort the breast. The grading of the contracture has been described by BAKER from 1-4, as Normal, Palpable, Visible and Painful. Smoking cessation, choosing an appropriate implant, using Keller funnel, meticulous haemostasis and preventing infection can contribute to the reduction of chance of capsular contracture. Management of the contracture must be discussed and includes removal of the implant and capsule, change of pocket, type of the implant and considering implant holiday (period without implant to reduce inflammation).

Leakage or Rupture

The chance of leakage of silicone implants increases with time, some studies suggest that up to 50% of implants have microscopic leak 10 years after insertion. Management includes exchange of the implant and cleaning the pocket.

Waterfall deformity

Waterfall or Double bubble deformity is when breast tissue drops lower to the position of the implants, it happens in breasts with sub-muscular implant placement. Managing this condition is by performing a breast lift and repositioning the tissue.

How Mr. Alamouti Reduces the Risk of Infection and Capsular Contracture

The Important Steps and Advanced Techniques

Mr. Alamouti takes several important steps to lower the risk of infection and capsular contracture during breast surgery. To begin with, he administers peri-operative antibiotics and takes meticulous care to ensure haemostasis during the procedure. Additionally, he washes the pocket with an antibiotic solution and cleans the skin with betadine. He also changes his gloves frequently throughout the procedure and uses advanced techniques like the Keller funnel and No touch technique to insert the breast implants. This can help reduce the risk of capsular contracture by minimising tissue trauma and avoiding direct contact between the implant and the surgeon's hands.


Key Take-aways…

In conclusion, breast surgery can be a transformative experience for many patients, helping to enhance their physical appearance and boost their self-confidence. However, it is important to approach this decision with a clear understanding of the potential risks and benefits associated with each procedure. Hopefully this article has provided you with lots of useful information and insight. However, if you have any further questions or would like more information, please do not hesitate to get in touch. We’d love to hear from you!

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Breast Augmentation

Implants are used to create fullness, and improve symmetry and shape. Performed using the Keller funnel method.

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Also known as 'Mastopexy', a breast lift can rejuvenate the droopy appearance of breasts, and improve the shape and position of nipples.

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