Capsular contracture is a hardening of the tissue surrounding the breast. Mild cases cause some firmness of the breast while severe cases lead to pain and visible distortion of the breast. Treatment can include removal of the implant and capsule with the replacement of an implant in a different location. With most implants now placed under the pectoralis muscle, the rate of capsular contracture has been markedly reduced with some studies showing 1% or fewer incidences. Causes of capsular contracture are thought to be varied and can include genetic predisposition, bacterial contamination, or a history of bleeding or seroma.
One of the most common complaints from patients is “my breasts are not exactly the same”. This is entirely normal as no two breasts share perfect symmetry. Asymmetries of the breast should be noted and discussed prior to surgery. Most asymmetries remain even after the placement of breast implants. Some abnormalities can be made better by moving the nipple-areola complex, adjusting the pocket, or placing a larger or smaller implant.
Migration of implant
Following placement of a breast implant, scar tissue is deposited around the implant forming a “pocket”. This pocket normally keeps the implant in place. If the pocket becomes too large or is improperly dissected, the implants can migrate to an incorrect position. Frequent areas of malposition include migration to the inferior or lateral part of the breast. Migration to the medial part of the breast can lead to a deformity known as “bread loafing” where the breasts actually touch each other in the midline. The majority of these cases are caused by over dissection during placement of the implant. Correction involves repositioning the implant by tacking up the capsule and closing off space. A supportive bra must be worn for 4-6 weeks.
Bleeding into the breast following an augmentation is very rare. Management is usually nonoperative but may require surgical removal of the hematoma.
A seroma is a collection of serous fluid inside the breast pocket. Most resolve spontaneously but some require drainage via a needle.
Loss of nipple sensation
Loss of nipple sensation – During dissection of the pocket, the main nerve to the nipple (4th intercostal) may be stretched or damaged, resulting in loss of sensation to the nipple. Most nerve injuries are temporary and recover fully. Return of sensation may take up to 2 years.
Rupture of implant
Immediate rupture of the implant is almost always a result of damage to the shell by the surgeon. Long-term rupture is inevitable and will occur in 10-20 years as the implant wears out. Mentor and McGhan implants are warranted for life and will be provided free of charge by the companies. Implant exchange in the event of a rupture is a minor procedure and can be performed under local anesthesia in the office.
Infection of breast implants is very unusual and occurs in less than 1% of cases. Many infections can be treated with antibiotics only. More serious infections involving drainage or exposure of the implant require removal of the implant and drainage of the breast. After 6-12 months of healing, a new implant can be placed into the breast. Prophylactic antibiotics for procedures such as teeth cleaning are usually not needed.
Long-term pain in the breast is very rare and usually occurs in patients with very large implants. Treatment involves placing a smaller implant or surgical removal of scar tissue.
Some procedures may cause temporary production of milk from the breast. This is usually self-limited but can cause concern because of its similarity to signs of infection.
The decision to have breast implants requires careful research and planning to ensure excellent results. Dr. Kurtis Martin specializes in cosmetic breast surgery in the Cincinnati area and has the artistry and skills necessary to achieve beautiful results in breast augmentation surgery. Check out a patient review on RealSelf! For more information on breast implants go to www.BreastImplantSafety.org.