The actual “full” recovery period from breast enhancement surgery is at least a year and this involves a gradual softening of the tissues around the breast implant and time for the implant to settle into its natural position. A significant amount of the recovery occurs within 2-3 months; but it will take the external scar a year to soften/mature and the internal tissues undergo similar softening. Immediately following breast implant placement, most implants will appear high up on the chest wall with a very rounded upper pole. Over the course of a year, this “implant look” will soften and the upper pole of the breast will develop a more natural slope with the breast mound assuming a more natural appearance as well.
Occasionally, the capsule around the breast doesn’t soften or becomes more firm and this is called capsular contracture. There may be some early treatment options for this and this will be discussed with your plastic surgeon during your early postoperative visits. Some of the long term adverse complications from breast augmentation surgery include capsular contracture (previously mentioned) or breast implant rupture. Rupture of a saline filled device is easy to determine as the breast loses volume. The larger the leak, the quicker the volume loss; but could be as quickly as a day or slowly decrease over several weeks. The usual treatment of a ruptured saline breast implant is to replace the device. This should be done relatively soon after diagnosed to minimize the shrinking of the capsule which may require more work to expand if allowed to shrink too much. Rupture of silicone gel devices are much more difficult to diagnose. Quite often patients will have a ruptured device for years and not note any difference in appearance or feel.
Diagnostic imaging is notoriously inadequate as there is no gold standard test which has a high sensitivity or specificity (low rate of false negative or false positive results). MRI scans are the most accurate but are only about 85 % specific for ruptured silicone gel and they are quite expensive. Mammography is excellent for detecting early breast CA; but not very helpful in detecting ruptured silicone gel breast implants. Most clinicians would recommend replacing a known ruptured silicone gel implant, but there is no proof or agreement of untoward sequelae from long term ruptured silicone gel causing physical symptoms or problems despite many anecdotal reports and junk science on the subject. Other long term potential breast augmentation complications are related to each patient’s own tissues and the loss of elasticity in those tissues. The amount of sagging which can occur in these tissues is also dependent upon whether the implants were placed above or below the muscle. Most plastic surgeons would agree that breast implants don’t last forever and the most recent studies suggest that most patients who have breast implants placed will have another breast implant operation during their lifetime. Breast augmentation surgery is a lifelong commitment and appropriate follow up should be anticipated.