Complications

Breast Augmentation Complications and Warning Signs

UNE Plastic Surgery · Dr. Kim Uigeon, board-certified plastic surgeon · Published 2026-09-21 · Updated 2026-09-21

1. First week: signs to call about immediately

The pain, swelling, and bruising right after surgery are mostly normal recovery. But a few things should not wait for a scheduled visit — the key is the speed and intensity of change. Slow improvement is normal; sudden worsening or pain that a painkiller cannot control is an emergency.

Hematoma, the most common early emergency

A hematoma is blood pooling in the dissected space. It usually forms within days of surgery and appears as a combination: one breast suddenly enlarging and hardening, severe pain, and tight skin. In the 783-patient 10-year subfascial data, hematoma was 1.8% (Brown, Plastic and Reconstructive Surgery, 2020).^[7] Treated quickly, the implant can be kept and only the blood drained; treated late, the revision grows larger and it seeds capsular contracture. If the three signs above appear, call — night or weekend. After calling, rest lying down, do not press the breast hard, and come in as directed.

Infection shows on days 3–7

Infection signals later than the immediate post-op period, between days 3 and 7: fever over 38°C, a red, hot, swollen incision, pus or foul discharge, severe tenderness, and chills. Incidence is low, around 1%. But when it occurs, antibiotics must start promptly, and in some cases the implant may need to be removed temporarily. That is why the prescribed antibiotics in the first week are not to be skipped.

2. Commonly reported complications

Capsular contracture — the most common

The capsule thickens and the breast hardens. Incidence ranges 1–15% across studies, and recent reviews put it at 5–19% for cosmetic augmentation. In one 6-year study of Mentor MemoryGel implants, capsular contracture in primary augmentation was 9.8% (Cunningham & McCue, Aesthetic Plastic Surgery, 2009).^[5] The sign is a breast growing progressively firmer and changing shape, sometimes with pain. It is graded Baker I–IV; grades III and IV generally point to revision (capsulectomy and implant exchange).

Implant rupture

This deserves particular attention at follow-up, because people can live without knowing. The shell tears and cohesive gel leaks within or around the capsule. Incidence is reported at about 1.5% at 5 years and 5–10% at 10 years; in the MemoryGel 6-year data, primary augmentation rupture was 1.1%.^[5] A cohesive-gel implant keeps the gel as one mass even when ruptured, so there is often no immediate symptom — called silent rupture. Living with a rupture raises capsular-contracture risk 4.5×, so early detection by periodic ultrasound matters.

Malposition — lateral displacement, bottoming out, double bubble

The implant moves from its intended position. Lateral displacement pushes the breast sideways so the intermammary gap widens. Bottoming out is the implant descending below the inframammary fold (IMF). Double bubble is a new fold forming above the old one so two lines show. Symmastia, the breasts merging so the cleavage disappears, is also a malposition. In a 2,277-patient study, 4.3% had a reoperation for a complication, and the most common reason was implant position change (38%) (Henriksen et al., Annals of Plastic Surgery, 2005).^[6] That works out to about 1–2% overall. Implants over 350 mL carried 2.3× the reoperation risk. Malposition is the complication most directly tied to reaching for size.

Chronic pain

This is rarely raised, yet it affects quality of life most. It is pain lasting more than 6 months after surgery; the exact incidence varies widely between studies. Causes range from nerve injury (especially intercostal nerve branches), differences by plane, and a mismatch between implant size and body type. Nerve blocks, physiotherapy, and medication are tried first; without improvement, revision is considered.

Animation deformity

People who exercise often ask about this: with submuscular or dual plane placement, the implant deforms temporarily as the pectoralis contracts, so the breast shape briefly changes with exercise or arm-raising. In the 783-patient subfascial data it was 0%, while the meta-analysis figure for submuscular placement was 3.8%.^[7] Most feel little effect on daily life, but if it is bothersome or exposure matters professionally, a revision moving to subfascial can be considered.

3. BII and BIA-ALCL, two often confused

BII (Breast Implant Illness)

BII is an informal umbrella term for chronic fatigue, joint pain, cognitive decline, and autoimmune-type symptoms reported by some implant users. No objective diagnostic criteria are established yet, and while case reports describe symptom improvement after implant removal, the level of evidence is limited. The FDA maintains guidance that patients be informed of the possibility of BII.^[1]

BIA-ALCL, breast implant-associated anaplastic large-cell lymphoma

This is a different disease from ordinary breast cancer. It is not a cancer of breast tissue but an immune-system lymphoma arising in the capsule around the implant — different in type and in treatment. How rare it is, in numbers: a study of the Dutch national pathology registry, 1990–2016 (de Boer et al., JAMA Oncology, 2018),^[2] found the cumulative risk in women with implants was 29 per million by age 50 and 82 per million by age 70 — put another way, about 6,920 implant patients for one case to arise before age 75. The association itself, though, was clear: of 43 BIA-ALCL patients, 32 had an implant on the same side, versus only 1 of 146 patients with other breast lymphomas. Surface is the fork in the road: in that study 82% of the implants used by BIA-ALCL patients were macrotextured, while macrotextured implants were 45% of those sold in the same period. The smooth and nanotextured surfaces mainly used in Korea today have very few reported cases. In 42,035 implants placed with a 14-step process to reduce bacterial contamination, there were zero cases of BIA-ALCL (Adams et al., Plastic and Reconstructive Surgery, 2017).^[4]

The sign is typically one breast suddenly enlarging at a mean of 8–10 years post-op (reported range 1–30 years), from fluid collecting around the capsule; pain, a lump, or skin redness may accompany it. If suspected, the diagnosis has a set order: ultrasound or MRI to confirm fluid, then aspiration of that fluid for cytology — CD30-positive and ALK-negative is diagnostic — and a capsule biopsy if needed. Found early, complete removal of the implant and capsule alone has a very high chance of cure, so the whole point is not to delay when there are symptoms. Conversely, removing implants preemptively out of fear when there are no symptoms is not advised: as the numbers show, the risk of the removal surgery itself is greater.

4. Implants and breast cancer risk

This question comes up so often it deserves its own note. On the data so far, the answer is no. If anything, pooling observational studies, women with implants show a lower subsequent breast-cancer incidence than the general population (relative risk 0.63, 95% CI 0.56–0.71). But this must not be read as “implants prevent breast cancer.” People who have implant surgery tend to be leaner, younger, and more health-conscious — conditions that themselves lower breast-cancer risk. It is association, not causation.

One study went a step further, testing the hypothesis that the local inflammation an implant creates might actually stimulate immune surveillance (Fracol et al., Plastic and Reconstructive Surgery, 2021).^[3] Comparing 36 women with implants for more than 6 months against 68 without, antibody responses to two breast-cancer antigens (mammaglobin-A, mucin-1) were higher; there was no difference for tetanus or other tumor antigens, so the response was interestingly confined to breast tissue, and in 9 women compared before and after their own surgery, antibodies rose a month after. Interesting, but it is a small observational study of 104 people that rated its own evidence at the lowest level. It poses a hypothesis, not a conclusion — a rise in antibodies is a different thing from a fall in cancer, and implants are never recommended for prevention. What actually matters is separate: an implant can obscure part of a mammogram, so at screening you must state that you have an implant and request the implant-displacement (Eklund) view. That is a far more practical issue than the cancer risk itself.

5. Fat-grafting complications are different

Many ask about moving one’s own fat instead of an implant. The type of complication differs, so it is looked at separately. A systematic review gathered 22 studies and 2,073 patients of cosmetic fat-grafting augmentation (Ørholt et al., Plastic and Reconstructive Surgery, 2020).^[8]

• Hematoma 0.5%, infection 0.6%, seroma 0.1% — major complications were low, and none of these led to reoperation.
• The most common problem was a palpable cyst, 2.0%, of which 67% resolved with needle aspiration.
• On imaging, oil cysts 6.5%, calcification 4.5%, fat necrosis 1.2%.
• As a result, 16.4% were advised to have further imaging and 3.2% a biopsy.

In short, complications you feel are rare, but it is a method that can complicate breast screening — and these imaging changes did not lead to treatment. Still, at every screening you should say you had fat grafting and be reviewed with a breast radiologist. Implants carry contracture and rupture; fat grafting carries a screening burden and reabsorption — the nature of the complication differs.

6. Self-check by timing

If any one of these appears, seek care rather than self-judging. Comparing both sides in the mirror once a month and feeling for a change in firmness is habit enough.

7. The frequency actually seen in practice

The list above is the textbook list; the frequency actually seen in practice differs from that order. Across more than 3,500 breast procedures performed at UNE (as of January 2026), the capsular-contracture rate was about 0.165% — an internal audit of the clinic’s own cases. This figure holds because the Motiva SmoothSilk surface, no-touch insertion with the Keller Funnel, and triple-antibiotic irrigation are followed every time. Even so, it is not zero: with a coinciding hematoma or infection, it can occur under the same technique. Conversely, the well-known names BII and BIA-ALCL are far rarer in practice. They are not left out of the explanation for being rare, but the point that the size of the worry differs from the actual frequency is always made in consultation. If a place claims “0% complications,” that is advertising, not data — and under medical-advertising law it is not a usable expression.

8. Summary

• The first week is about hematoma and infection. If one side suddenly enlarges and is severely painful, or there is fever and pus, call immediately rather than waiting for a check-up.
• Seven complications are covered here: capsular contracture, implant rupture, malposition, chronic pain, animation deformity, BII, and BIA-ALCL. Reported incidence ranges widely, 1–15% by item.
• Most appear between 6 months and 2 years after surgery, but some arise 5–10 years later, so continued periodic screening is the key to early response.
• Fat grafting differs in the type of complication: those you feel are rare, but breast screening can become more complex.
• When a sign appears, care comes before self-judgment. After the stage is assessed, observation, medication, or revision is decided.

References

1. U.S. Food and Drug Administration. Breast Implants: Update on Postapproval Studies. (Guidance to inform patients of BII possibility.)
2. de Boer M, van Leeuwen FE, Hauptmann M, et al. Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol. 2018;4(3):335–341. doi:10.1001/jamaoncol.2017.4510. (Dutch national registry; 29 per million cumulative by age 50; 82% of cases macrotextured.)
3. Fracol M, Shah N, Dolivo D, et al. Can breast implants induce breast cancer immunosurveillance? An analysis of antibody response to breast cancer antigen following implant placement. Plast Reconstr Surg. 2021;148(2):287–298. doi:10.1097/PRS.0000000000008165. (104 patients; level V evidence.)
4. Adams WP, Culbertson EJ, Deva AK, et al. Macrotextured breast implants with defined steps to minimize bacterial contamination around the device: experience in 42,000 implants. Plast Reconstr Surg. 2017;140(3):427–431. doi:10.1097/PRS.0000000000003575. (42,035 implants; zero BIA-ALCL.)
5. Cunningham B, McCue J. Safety and effectiveness of Mentor’s MemoryGel implants at 6 years. Aesthetic Plast Surg. 2009;33(3):440–444. doi:10.1007/s00266-009-9364-6. (1,008 patients, 6 years; primary augmentation rupture 1.1%, capsular contracture 9.8%.)
6. Henriksen TF, Fryzek JP, Hölmich LR, et al. Surgical intervention and capsular contracture after breast augmentation: a prospective study of risk factors. Ann Plast Surg. 2005;54(4):343–351. doi:10.1097/01.sap.0000151459.07978.fa. (2,277 patients; malposition 38% of reoperation reasons.)
7. Brown T. A comprehensive outcome review of subfascial breast augmentation over a 10-year period. Plast Reconstr Surg. 2020;146(6):1249–1257. doi:10.1097/PRS.0000000000007333. (783 patients; hematoma 1.8%; animation deformity 0%.)
8. Ørholt M, Larsen A, Hemmingsen MN, et al. Complications after breast augmentation with fat grafting: a systematic review. Plast Reconstr Surg. 2020;145(3):530e–537e. doi:10.1097/PRS.0000000000006569. (22 studies, 2,073 patients; oil cysts 6.5%; further imaging 16.4%.)