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Breast implants have been used to improve the size, shape, and symmetry of breasts for more than 40 years. As with any surgery, complications can arise. Each of the following complications has been well recognized. The described problems encompass both saline and silicone gel implants.
As of 2007, the FDA has approved silicone gel implants across-the-board for any woman interested in breast enhancement surgery.
Breast augmentation for the experienced cosmetic surgeon is treated as a routine surgery. Treatment of breast implant complication is however usually more difficult and requires an experienced breast surgeon.
“The surgeon is a left with altered anatomy, distorted tissue to cover the implant, and a situation where we start with an anatomic problem that is not just small breasts trying to be made larger” explained world renowned Cosmetic Surgeon, Dr. Richard A. Joseph MD.
Here is a list of the common complications that can occur with breast augmentation surgery and how they are usually addressed.
Whenever the body receives a foreign object, it will naturally form scar tissue around it, called a capsule. Whenever this normal scar tissue becomes thick and hard it is referred to as a “capsular contraction“. This frequently causes distortion, hardening, and discomfort in the breast.
In recent years, due to the introduction of new breast implants and with different techniques of breast implant surgery, the rate of capsular contraction has dropped dramatically. Historically, this was one of the most common complications of breast implant surgery. However, this complication occurs in less than 3% of women with breast implants compared to rates as high as 40% only 10 years ago.
Treatment usually consists of the implant and capsule been removed together and the patient receiving a new implant. The surgeon and patient may decide to change both the type of the new implant and the position of a new implant. Implants are typically of a smooth or textured surface and are placed either above or below the muscle. So, treatment for a capsular contraction may result in the patient receiving a different type of implant, but also having the implant placed in a different location.
The majority of capsular contractions involve smooth saline implants or older, silicone implants placed above the muscle.
“If this is the case, then I would exchange the implant for a different type and then typically place the implant underneath the muscle, says Dr. Joseph. There’s also evidence that the sub-muscular position for the implant has a lower capsular contraction rate and may make mammography easier.”
Rippling of the implant is generally found in women with saline implants who have very thin skin and therefore don’t have much breast tissue overlying the implant. Rippling is noticeable when the woman is not wearing a bra and when she bends over and the implant shifts. Rippling can be either visible or palpable.
This particular complication is very difficult to fix, especially if the woman wants to keep her saline implants. We have three options in this case. One option would be to remove her current saline implants and replace them with silicone implants. In most cases, this totally eliminates the rippling. If the woman desires to keep her saline implants, then I would recommend to relocate them to a sub-muscular position. In some patients, with only a small amount of rippling, who are also thin in stature, it may be possible to do fat transfers to have some additional volume to the patient’s breast.
According to Dr. Joseph, silicone gel implants are far easier than the saline implants to correct this problem, because the outer shell of the silicone implant is thinner, and therefore causes less potential rippling.
Synmastia is a term that refers to the migration or movement of the implants inward so there is little or no cleavage. Usually, the pockets holding the breast implants have been made too large and too close together by the surgeon. Treatment usually involves removing the implants and changing their locations.
“If for instance, the implants were placed on top of a muscle, they would be removed and now placed under the muscle. If the implants were initially placed underneath the muscle, then a more extensive surgery would be required to correct this complication. Synmastia can be one of the most difficult breast implant complications to correct.”
With aging, all breast tissue, with or without implants, will sag. When excessive sagging occurs over an implant, it causes a double breast shape called a “double bubble deformity“. This complication can be corrected by either replacing the implant with a larger implant or a high-profile implant, or if needed performing a breast uplift surgery, where the excessive skin is removed.
Rupture or deflation, of the breast implant is relatively uncommon occurring in about 3% of all patients yearly. This is one of the easier complications to correct. Basically, the implant is removed and replaced with another implant. At this time, the patient has the option of either increasing or decreasing the size of her present implants.
While not being a complication, many patients after breast implant surgery will, for a variety of reasons, request a change in the size of their present implants. “I have rarely been asked by a patient for smaller implants. It is much more common for the woman to seek larger ones,” said Dr. Joseph. This is a very simple procedure and only requires the removal of the old implant and the replacement of the new ones. Typically, this surgery can be performed through the old incisions and patients return to work or other duties the next day.
“In summary, while complications are rare, they do occur. Patients should be fully informed all of any and all risks associated within elective cosmetic surgery. I can advise patients to choose their Cosmetic Surgeon carefully. This in turn will assure not only a better result with your initial surgery, but an experienced surgeon capable of dealing with any and all postoperative complications,” says Dr. Joseph.
Richard A. Joseph, MD
Midwest Surgical Arts
1250 North Mill St. Ste 103
Naperville, IL 60563
(630) 717-8200 | MyCosmeticSurgeon.com
Dr. Richard A. Joseph selected this article for publication based on its comprehensive overview of breast implant complications and corrective strategies. The discussion highlights common issues such as capsular contraction, wrinkling, synmastia, sagging, and implant rupture, while also addressing patient-driven size changes. By detailing both the causes and surgical solutions—including implant repositioning, replacement, and adjunctive procedures—the article underscores the importance of experienced surgical judgment in achieving safe, natural outcomes. It further emphasizes the value of informed consultations, where patients understand potential risks, corrective options, and the role of surgeon expertise in minimizing complications. This information provides practical guidance for individuals considering breast augmentation and reflects the evolving standards of modern aesthetic medicine.