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Breast implantation probably produces the highest satisfaction rate of any of the cosmetic surgeries. Sometimes, the feeling is that the implant could have been a bit bigger, and very rarely, smaller. Lots of minor complications can happen, however, and the patient must remember that she may need more surgery or other kinds of follow-up. (Further in this chapter, you will see an example of a letter we give to our patients, which will provide more details.)

Infection, for example, is very rare, but if it happens, both implants must be removed for four months or longer. The deflation rate for new saline implants is probably a few percent each year. Numbness of the breasts occurs in fewer than five percent of patients. This happens because in the process of cutting away tissue, small nerves may be cut or stretched. However, these nerves heal themselves over time, and the numbness usually goes away. In very rare cases, even with the most competent and careful surgery, numbness can last indefinitely. A decrease in nipple sensation occurs in about seven percent of patients when this area is used for the incision. This is quite uncommon with the other approaches. Other rare complications include poor healing of the edges of an incision and the possibility of internal bleeding, which must be corrected within the first few days after the original surgery.

Occasionally, the breast may gradually harden after surgery as scar tissue forms. In some cases even 10 or 20 years later, scar tissue has to be removed. For silicone-gel implants, hardening occurs in perhaps 20 percent of patients. With the new saline implants, the chance of this may be only two or three percent.

In some cases, there can be problems with shape or symmetry. This can often be corrected by changing the implants or modifying the implant pocket surgically. Keep in mind that absolute symmetry can never occur because breasts (and faces and bodies) are naturally not perfectly even.

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