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Breast augmentation is a surgical procedure where the breast size is enhanced. Augmentation can be from the placement of an implant, or less commonly, thru fat transfer. Breast augmentation is one of the most commonly performed plastic surgery procedures in the United States. The FDA put a restriction on silicone filled implants for cosmetic enhancement starting in 1992. However, most reconstructive patients continued to receive silicone implants after mastectomy. This ban was due to concern over the risks of silicone implants which has now been resolved. This activity describes the indications, contraindications, and complications of breast augmentation and highlights the role of the interprofessional team in the pre and postoperative management of these patients. Objectives: Identify the different techniques of breast augmentation. Describe the indications for breast augmentation. Review the complications of breast augmentation. Outline the importance of improving care coordination among interprofessional team members to improve outcomes for patients undergoing breast augmentation. Access free multiple choice questions on this topic.

Breast augmentation is a surgical procedure where the breast size is enhanced. Augmentation can be from the placement of an implant, or less commonly, through fat transfer. Breast augmentation is one of the most commonly performed plastic surgery procedures in the United States.  The FDA put a restriction on silicone-filled implants for cosmetic enhancement starting in 1992. However, most reconstructive patients continued to receive silicone implants post-mastectomy. This ban was put in place following concern over the risks of silicone implants. Extensive research and clinical trials did not confirm those fears of silicone. After many studies had failed to show silicone linked to diseases, the FDA, in 2006, again allowed silicone-filled implants to be used by any patient without requiring them to be enrolled in a clinical study. In 2017, the majority of patients undergoing breast augmentation received cohesive gel silicone implants. The FDA also recommends MRI screening every 2 years in patients with silicone implants to detect subclinical implant leaks. However, patients and their physicians do not always adhere to this recommendation, and MRI scans can also have false-positive readings. The gel in current implants is more cohesive than previous implants and even shaped, or form-stable implants have been increasing in use. These may have lower complication rates, but further evaluation is ongoing. Recently, implant makers have been introducing different levels of cohesive gel in their products. The higher or more cohesive the gel, the more firm or "gummy" the implant will be. This may lead to lower rupture rates of implants. But eventually, all implants will likely eventually rupture or break.[1][2][3]

The risk of complications is low; however, there are known potential problems, and no implant is considered a lifetime device.[7][8][9] Implants can rupture at any time or last a lifetime after placement. However, many surgeons will estimate a 15 to 20-year lifespan for the implants. Presently there is no established uniform recommendation to replace implants at a set time interval. Some surgeons will recommend routine replacement at 10 to 15 years after initial placement and others will recommend waiting until the implants break or deflate before replacing. Early postoperative complications include: Infection Scarring Asymmetry Hematoma Seroma Breast pain Poor cosmetic outcome Nipple/breast sensation changes Later complications include: Implant malposition or displacement Implant deflation or leak Capsular contracture which is tightening of the tissue capsule around the implant Surgeons do not know the specific cause of contracture, but many suspect a sub-clinical or low-grade infection that can lead to inflammation and a capsule biofilm that may initiate the contracture. The most commonly isolated microorganisms from studies on breast implant capsular contracture are Staphylococcus epidermidis and Propionibacterium acnes [10]. Capsular contracture is graded on a scale of 1 to 4, and if severe, it may require surgical correction or even implant removal. It is important for patients undergoing this procedure to understand that many women receiving breast implants may need more breast surgery at some point in their life. Recently, there have been reports that there is a slim possibility of women with breast implants being more likely to be diagnosed with anaplastic large cell lymphoma (ALCL). The exact relationship between implants and ALCL has not been determined yet, but it may be more common with a certain type of texturing on the implant.

Although breast augmentation surgery has a low risk of acute complications, it is imperative to make all attempts to minimize any risks. Over the years, many litigations have resulted primarily due to the lack of informed consent. The pre-operative visit conducted by a nurse can help ensure that all post-operative care instructions are understood and followed. Patients should be instructed to discontinue smoking and make a positive change in lifestyle so that the results of the surgery will last a long time. Patients who follow their given post-operative instructions will likely have a lower rate of complications.  Also, pharmacists can play a role in the care of a breast augmentation patient by ensuring that patients have no allergies to their prescribed medicines and by instructing patients on their proper use.  This may help decrease the rate of infections or assist patients in their postoperative pain control.  Interprofessional care provided to the patient may also help to identify any potential problems earlier. Patients should not be offered unrealistic expectations but also told about the potential for an iatrogenic complication. Earlier awareness of a complication can lead to quicker treatment and a better eventual outcome.[11] (level III) Outcomes Of all the cosmetic procedures, breast augmentation results in outstanding results. The majority of patients not only are pleased with the outcome but develop more self-esteem and confidence. The rate of complications after breast augmentation is low and varies depending on surgeon experience. Surveys intact that about 70-80% of patients are satisfied and feel that the outcome was perfect. [2][12](Level V)