Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Every surgical procedure carries risk, and breast augmentation is no exception. Most patients recover without major problems, but informed decision-making requires understanding what can go wrong, how common each complication is, what management looks like, and what symptoms should prompt urgent review. The TGA and FDA also remind patients that breast implants are not lifetime devices, and that the longer someone has implants, the greater the chance they may develop complications that require further surgery.
I’m Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS), consulting at Bondi Junction in the Eastern Suburbs and Manly on the Northern Beaches. Over a decade in private practice and more than 1,000 breast procedures performed have informed how I approach the risk conversation: not to frighten patients away from surgery, but to give them the information they need to consent properly. For an overview of the operation, implant choices and consultation pathway, see the BA Sydney procedure page. Every breast augmentation I perform is carried out at an accredited Sydney private hospital with a specialist anaesthetist.
The Main Risks of Breast Augmentation: Quick Overview
A breast augmentation risk conversation should cover both common and uncommon complications. The recognised risks include capsular contracture (tightening of scar tissue around the implant), implant malposition or displacement, breast asymmetry, implant rupture, infection, bleeding and haematoma, seroma (fluid collection), changes in nipple or breast sensation, visible rippling or palpability, scarring, dissatisfaction with size or shape, the need for revision surgery, BIA-ALCL (a rare implant-associated lymphoma), and symptoms some patients describe as breast implant illness.
The FDA lists breast pain, sensation changes, capsular contracture, rupture, additional surgery, BIA-ALCL, systemic symptoms and other local complications among the recognised risks of breast implants. Australian patients should also know that every implant placed in Australia is registered with the Australian Breast Device Registry (ABDR), which tracks long-term safety and performance.
Each risk below has its own characteristics, likelihood, symptoms, and management pathway. The risk profile that matters for your decision is yours specifically, not the population average.
Capsular Contracture
The body naturally forms a thin capsule of scar tissue around any breast implant. In some patients, this capsule tightens or hardens around the implant over time. The breast may feel firmer, look distorted, or become painful. It can affect one or both breasts. The Baker grading system describes severity:
- Grade I: breast is soft and appears normal
- Grade II: breast is slightly firm but looks normal
- Grade III: breast is firm and looks abnormal
- Grade IV: breast is hard, painful, and looks abnormal
Severe Grade III and IV cases may require revision surgery to remove the capsule (capsulectomy) and replace or remove the implant. Lower-grade cases may be monitored. Risk factors include bacterial contamination during surgery, bleeding within the pocket, implant surface, and individual healing response. For more detail, see the capsular contracture guide.
Implant Malposition or Displacement
Malposition means the implant is not sitting in its intended position. It may appear too high, too low, too far to the side, too close to the midline, or uneven compared with the other side. Causes include pocket stretch over time, tissue weakness, trauma, capsular contracture pulling the implant out of position, implant size mismatch with tissue support, and healing differences between sides. Significant malposition may be improved with revision surgery involving pocket adjustment, internal support, or implant change. For more on placement decisions, see the breast implant placement options guide.
Breast Asymmetry
No two breasts are perfectly identical before surgery. Augmentation can improve proportion and balance but may not eliminate natural asymmetry, and in some cases volume highlights underlying differences that were less visible before. Asymmetry can involve breast size, nipple position, chest wall shape, inframammary fold height, rib prominence, or tissue thickness. Correcting significant asymmetry may require different implant sizes between sides, fat grafting, lift surgery, fold adjustment, or staged procedures. The pre-operative assessment should include detailed measurement and documentation of any existing asymmetry so expectations are realistic.
Implant Rupture
Implant rupture means the implant shell has developed a tear or breach. Behaviour differs between silicone and saline implants.
Silicone implants: Rupture is often silent, meaning the breast may look and feel normal. The cohesive silicone gel used in modern implants tends to stay within the capsule rather than spreading. Symptoms when present can include shape change, lumps, pain, swelling, tenderness, or sensation changes. The FDA recommends MRI as the most effective imaging method for detecting silent rupture in silicone implants, with ultrasound as an acceptable alternative for asymptomatic screening.
Saline implants: Deflation is usually obvious because the saline leaks and the implant loses volume over a short period. The saline itself is absorbed safely by the body, but the implant shell still requires removal or replacement assessment.
Management depends on patient symptoms, imaging findings, and patient goals. For more on implant longevity, see the implant lifespan guide.
Infection
Infection is uncommon but important. It can develop in the days or weeks after surgery, or much later. Symptoms include increasing pain, redness, warmth, swelling, fever, wound discharge, or feeling generally unwell. Mild early infections may respond to antibiotics. More serious infections may require hospital admission, drainage, or implant removal. Patients should not self-manage suspected infection; contact your surgeon promptly if you have concerns.
Bleeding, Haematoma, and Seroma
Haematoma is a collection of blood near the surgical site. Seroma is a collection of fluid around the implant. Both can cause swelling, tightness, bruising, pain, or asymmetry. Small collections may settle without intervention. Larger collections may require drainage, and significant post-operative bleeding may require return to theatre. Sudden one-sided swelling after surgery should be treated as urgent and reported to your surgeon immediately, not left until the next routine appointment.
Changes in Nipple or Breast Sensation
Sensation can change after breast augmentation. Most commonly, sensation reduces or feels different in the nipple, lower breast skin, or near the incision. Changes are often temporary as nerves recover from surgical disturbance, but in some patients changes persist or become permanent. Altered sensation may affect comfort, sexual response, and breastfeeding capacity. Larger implants, revision surgery, and certain incision and placement combinations may carry higher risk of persistent sensation change. This should be specifically discussed at consultation if breastfeeding or nipple sensation matters to your decision.
Scarring and Delayed Wound Healing
All breast augmentation involves an incision and therefore a permanent scar. Scar quality varies based on genetics, skin type, incision location, tension at the wound, infection, smoking or nicotine use, and aftercare adherence. Delayed wound healing may increase scar visibility or infection risk. Following the post-operative wound care protocol and avoiding nicotine completely throughout the recovery period both reduce these risks. For more detail, see the 12 ways to minimise scars guide.
Rippling, Palpability, and Visibility
Rippling means folds or wrinkles of the implant can be felt or seen on the breast surface. Palpability means the implant edge can be felt through the skin. Visibility means the implant outline shows through the skin under certain lighting or positioning. Risk factors include thin tissue coverage, low body fat, larger implants relative to tissue support, subglandular placement (over the muscle), and certain implant types. Management options include implant exchange to a smaller or different profile, pocket change, fat grafting to soften the upper pole, or accepting mild rippling if it is not bothersome.
Unsatisfactory Size, Shape, or Cosmetic Outcome
Some patients feel the final result is too small, too large, too round, too wide, too projected, or not lifted enough. This is not always a technical complication; it can reflect a mismatch between expectations and what was anatomically achievable. Prevention starts with consultation: detailed measurement, photo discussion, sizers, honest assessment of whether a lift is needed, and realistic conversations about what implant choice can and cannot achieve. Revision surgery may be possible, but it adds cost, risk, and recovery, so getting the planning right the first time matters. For more on how implant selection affects outcomes, see the breast implant size guide.
Revision Surgery and Implant Removal
Breast implants are not lifetime devices. Some patients will need revision surgery at some point, whether for capsular contracture, rupture, malposition, size change, the breast changing through pregnancy or weight changes, infection, asymmetry, or personal preference. Revision procedures include implant exchange, removal (with or without replacement), capsulectomy, pocket adjustment, lift, fat grafting, or scar revision. Revision surgery is generally more complex than the original augmentation because tissue has been altered and capsule anatomy must be navigated. Capsulectomy technique depends on the indication and on capsule quality; not every removal requires an “en bloc” approach, and the right approach is determined by the clinical situation. For more on what removal involves, see the recovery after breast implant removal guide.
BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma)
BIA-ALCL is a rare cancer of the immune system associated with breast implants, particularly textured-surface implants. It is not breast cancer; it develops in the fluid and scar capsule around the implant. Risk has been highest with macro-textured implants, which have since been withdrawn from the Australian market under TGA regulatory action. Risk with smooth implants is much lower, and with microtextured (Siltex) implants the risk profile sits between the two but remains low.
Symptoms typically appear years after implant surgery and include persistent breast swelling (usually one-sided), a new fluid collection, breast size change, pain, lump, or firmness. Patients with these symptoms should seek surgical review for evaluation, which usually includes imaging and aspiration of any fluid collection for testing. Asymptomatic patients do not generally need preventive implant removal solely because they have implants, but the TGA recommends regular self-monitoring and review if changes develop. For more, see the BIA-ALCL guide.
Breast Implant Illness (BII)
Breast implant illness is the term some patients use to describe a constellation of systemic symptoms they associate with their breast implants. Reported symptoms include fatigue, brain fog, joint pain, memory issues, rash, and other systemic concerns. The cause is not fully understood, and the FDA states that researchers are still investigating these symptoms because their origins are poorly understood. Some patients report symptom improvement after implant removal, but outcomes vary, and removal does not consistently resolve symptoms for every patient.
Patients with systemic symptoms should have a proper medical assessment to exclude other treatable causes (thyroid disorders, autoimmune conditions, vitamin deficiencies, sleep disorders, mood disorders, and others). Symptoms should be taken seriously without being assumed to be implant-related until other causes are ruled out. For more, see the breast implant illness guide.
How Surgeons Reduce Risk During Planning and Surgery
Risk reduction starts well before the operating theatre. Careful patient selection, comprehensive medical history review, the GP referral that’s required under the 1 July 2023 Medical Board cosmetic surgery framework, psychological assessment where indicated, smoking and nicotine cessation, and tissue-based implant planning all reduce the chance of complications.
At surgery, the factors that influence risk include implant handling discipline (minimal touching, no-touch insertion technique, antibiotic-soaked devices), bacterial contamination reduction (the 14-point plan principles), bleeding control within the pocket, appropriate placement selection for the patient’s anatomy, accredited hospital setting with sterile theatre processes, and specialist anaesthetist involvement.
After surgery, structured follow-up matters: an early wound review, activity progression guidance, six-week return-to-exercise clearance, longer-term reviews at 3, 6, and 12 months, and ongoing surveillance beyond the first year. Following the post-operative protocol and attending all follow-up appointments contributes meaningfully to risk reduction. For more on what to expect, see the recovery after breast augmentation guide.
When to Contact Your Surgeon Urgently
Some post-operative symptoms warrant immediate contact with your surgeon or emergency care rather than waiting for a scheduled appointment:
- Sudden one-sided swelling
- Increasing pain not controlled by prescribed medication
- Fever or chills
- Spreading redness, warmth, or rash
- Wound discharge
- Shortness of breath or chest pain
- Calf pain or swelling
- Sudden change in breast shape
- New breast swelling that develops years after implant surgery
- New lump, persistent fluid collection, or unexplained firmness
If you’re concerned, contact your surgeon or seek urgent medical care. Don’t wait for a routine follow-up if symptoms are worsening. The conservative path is always to be checked early.
Frequently Asked Questions
What is the most common complication after breast augmentation?
Capsular contracture, implant malposition, asymmetry, rippling, sensation changes, and dissatisfaction with size or shape are among the complications patients commonly ask about and that surgeons most frequently address at follow-up. The FDA notes that severe Grade III and IV capsular contracture may require reoperation. The most common complication varies between practices and depends on factors including surgical technique, implant type and surface, placement choice, and follow-up duration.
Can breast implants rupture?
Yes. Silicone implant rupture can be silent, meaning the breast may look and feel normal even though the shell has breached. The FDA recommends MRI as the most effective imaging method for detecting silent rupture, with ultrasound as an acceptable alternative for asymptomatic screening. Saline implant rupture usually shows as visible loss of implant size or shape over a short period because the saline leaks out and is absorbed by the body.
What are the signs of breast implant infection?
Increasing pain not controlled by prescribed medication, spreading redness or warmth around the breast, swelling, fever or chills, wound discharge, or feeling generally unwell should all prompt urgent medical review. Most infections appear in the days to weeks after surgery, but infection can develop later as well. Mild early infections may respond to antibiotics; more serious infections may require hospital admission, drainage, or implant removal.
Will I need another operation in the future?
Possibly. Breast implants are not lifetime devices, and the FDA states that the longer someone has implants, the greater the chance they may develop complications requiring further surgery. Common reasons for revision include capsular contracture, rupture, malposition, size change, breast changes through pregnancy or weight fluctuation, and personal preference. Not every patient needs revision, and many patients keep their implants for 15 to 20 years or longer without revision.
How can I reduce my risk before surgery?
Choose an appropriately qualified surgeon (Specialist Plastic Surgeon, FRACS, verified through the AHPRA register), follow all pre-operative instructions, stop smoking and nicotine well before surgery, disclose your complete medical history honestly, choose implants based on anatomy and clinical assessment rather than size alone, attend the required two consultations and observe the seven-day cooling-off period, and commit to attending all follow-up appointments. Risk reduction is a partnership between the surgical practice and the patient.
Consult with Dr Scott J Turner in Sydney
Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) consulting at his Bondi Junction (Eastern Suburbs) and Manly (Northern Beaches) clinics in Sydney. Surgery is performed at accredited private hospitals in Sydney, including Bondi Junction Private Hospital, Delmar Private Hospital in Dee Why, and East Sydney Private Hospital.
Every consultation is conducted personally by Dr Turner. There are no patient representatives or coordinators standing in for the surgeon. Under the Medical Board of Australia’s cosmetic surgery framework introduced on 1 July 2023, the consultation pathway includes a GP referral before the first surgical consultation, two consultations with the surgeon minimum, a seven-day cooling-off period after informed consent before surgery can be booked, and a $1,000 surgical deposit payable only after the second consultation, not before. The risk conversation gets real time at consultation, including discussion of how each potential complication relates to your specific anatomy, implant choice, and lifestyle.
If you’re considering breast augmentation surgery in Sydney, the next step is to obtain a GP referral and book an initial consultation. Contact the practice on 1300 437 758 or email [email protected] to begin the process.
General information only, not medical advice. Risk profiles vary between patients based on individual anatomy, medical history, implant choice, and surgical technique, so any decision about breast augmentation requires individual clinical assessment by a qualified health practitioner.
About the Author
Dr Scott J Turner is an AHPRA-registered Specialist Plastic Surgeon (FRACS) consulting in Sydney (Manly and Bondi Junction), Brisbane and Canberra. He performs breast, facial, nasal, body and male surgery at accredited private hospitals. His practice focuses on individual patient assessment and clear information on risks, recovery and costs. Dr Turner holds Fellowship of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery.
