Systemic diseases

Though a moratorium was placed on silicone implants from 1992 to 2006 because of suspicions of increased risk of systemic illness, a number of studies have failed to show any correlation between the use of silicone implants and rheumatologic diseases18. Furthermore, a 2001 study by Fryzek et al64 examining 1369 women who underwent breast augmentation found no consistency in either the types of symptoms reported or their time of onset after surgery. However, recent immunologic research has identified pro-inflammatory proteins that adhere to the surface of silicone implants causing significant capsular fibrosis, possibly triggering autoimmune conditions in predisposed individuals18,65. Further research is needed to determine if, or whether, a correlation exists between these proteins and systemic disease. Nevertheless, a full personal and family history of autoimmune disease should be accounted for from each patient during evaluation for breast augmentation.

Nipple desensitisation

Reduced sensation or pain of the nipple and areola are common complaints after breast augmentation, with 26.7% of 121 women surveyed in a recent study reporting dissatisfaction with sensory changes after augmentation37,66,67. In a retrospective study of 1222 patients, Araco et al identified that the incision selected during augmentation represents the sole risk factor for development of paresthesias of the nipple-areolar complex, with a threefold increase in desensitisation and pain associated with a periareolar approach37,66. The risk of desensitisation can be reduced with good surgical technique, and a periareolar incision remains a popular choice for many breast augmentations. Patients who wish to have a periareolar incision should be thoroughly counseled on the risks to nipple sensation postoperatively.


Many women who undergo breast augmentation during their reproductive years raise concerns that breast implants may affect their future ability to lactate. Desensitisation of the nipple areolar complex can result in a poor suckling reflex culminating in decreased milk letdown. Additionally, complications such as infection or capsular contracture can potentially lead to further operations with additional risks of damaging the mammary gland. Although trauma to the breast and desensitisation of the nipple areolar complex can be minimised with good surgical technique, 10% of patients who undergo breast augmentation are still likely to have lactation insufficiency compared to those without implants68. Regarding the safety of breast milk, studies examining women with and without implants have found no difference in silicone levels. Furthermore, women those who have undergone breast augmentation have statistically less silicone in their breast milk compared to over-the-counter formulas69.

Patient satisfaction

When surveying patients, multiple studies found that 99% of women were extremely satisfied 1 month after augmentation and that 95% maintained this high satisfaction after 6 years. Satisfaction rates were based on self-assessment of attractiveness, psychosocial wellbeing, and sexual function70–73.

Though breast augmentation successfully achieves the goal of improving patient satisfaction, multiple studies have found an almost three-fold increase in suicide rates among women who have undergone breast augmentation compared to non-augmented women. Risk increases in women over the age of 40 years at the time of surgery or who have had implants for a longer period of time74,75. Though no precise cause-and-effect relationship has been established, the increased prevalence of pre-existing psychological disturbances among women who pursue breast augmentation, inappropriate expectations for quality of life after augmentation, and failure of psychosocial coping mechanisms in the event of postoperative complications have all been considered as possible causes74,75. More recently however, Kalaaji et al67 found a 6% rate of depression in a study of 121 augmented women compared to a 7–17% reported for the general population in Norway. Although depression and suicide risk are relatively rare outcomes after breast augmentation, a patient’s psychosocial status and psychiatric history must be seriously evaluated during their initial consultation with the surgeon.


Breast augmentation does not increase the risk of developing breast cancer but does obscure portions of the breast from view on mammographic screening. This is especially true in the case of silicone implants, which are relatively radiopaque, and in cases of capsular contracture owing to the increased fibrous tissue21,76,77. Greater sub-muscular or subfascial as opposed to sub-glandular coverage of an implant helps reduce obstruction of the breast parenchyma on mammography21.

Magnetic resonance imaging (MRI) of the breast is able to accurately and reliably detect a breast mass in the presence of an implant. For women who have undergone breast augmentation, current guidelines recommend an initial MRI at 3 years, followed by a screening every 2 years thereafter78,79. In addition to cancer surveillance, this regimen has the added benefit of assessing for subclinical implant rupture78,79. The expense of MRI however, raises questions for whether other imaging techniques such as ultrasound or standard mammography should be used, particularly for patients younger than the appropriate age for breast cancer screening79,80. While other screening mechanisms are being investigated, MRI currently remains the gold standard for breast cancer screening after breast augmentation.


Multiple evidence-based studies have found implants to be a safe and effective approach to breast augmentation. Although the most commonly performed aesthetic procedure, breast augmentation still presents with its limitations and complications. Novel techniques in planning for augmentation and updates to implant structure have helped to minimise adverse outcomes. For patients who desire augmentation but wish to avoid implant-based procedures, recent developments in autologous fat injection after external tissue expansion appear promising81. Nevertheless, with newfound research and understanding of the challenges associated with breast implantation, clinicians are better equipped to appropriately counsel patients, thereby increasing the likelihood of improved patient satisfaction.