Any individual who desires breast implants should be familiar with the surgery, its side effects and potential complications. Proper understanding of the type of surgery can help reduce the potential complications or at least make you aware of when to go back to your surgeon before it becomes too late or too serious.
The classic complications after breast implant surgery usually become obvious soon after surgery and it is important to recognize these features.
Over the years, the most concerning complication of breast implants has been capsular contracture. Capsular contracture is essentially hardening of the surrounding shell of the breast implant. In some cases, only a tiny part of the shell is hard and in others the entire shell is hard.
One may have pain and tenderness at the site. The condition does not occur immediately after a breast implant but occurs more gradually over time. It may be discovered coincidentally or due to pain. The hardening of the implant is easily felt.
Once the outer surface hardens, this capsule can squeeze the inner capsule causing the implant to shrink and harden.
Why capsular contraction occurs is not really understood but many factors can trigger it.
The trigger factors for capsular contraction include:
- infection. Some surgeons believe that an infection may have been acquired during surgery which later leads to development of capsular contraction. However, in many cases, when the implant is removed, there is no evidence of infection and all the bacterial cultures have proven to be negative
- some surgeons believe that collection of fluid (such as blood ) or fluid released from the breast tissues (seromas) may be the cause of this condition. However, this is not always the case as many women show no evidence of fluid collection
- bleeding. It is felt that if the surgery is complicated with bleeding, the blood may invoke a reaction with the breast tissues and the implant which later leads to capsular contraction.
- Women who smoke have a slightly higher incidence of capsular contraction. One should note that there are many women who smoke but do not develop this condition
- Capsular contraction is by far more common when the implant is placed above the breast muscles compared to when the implant is placed below the breast muscles
Capsular contraction may be mild or severe and the treatment depends on the presence of symptoms, the degree of breast distortion and how one feels about it. Over the years, there have been both medical and surgical methods devised to treat capsular contarction. The medical means of treatment include:
- Antibiotics: some surgeons believe that infection may be a cause for capsular contaction and start patients on antibiotics. This generally does not help and the antibiotics have to be taken for a long time
- Vitamins: Some recommend taking long term vitamin E. it is claimed that the vitamins keep the capsule soft and loosen up all the adhesions. Most women think this treatment is junk science because it never works
- Some surgeons manually squeeze the implant to break up all the adhesions and bands around the breast. While this may feel good for the surgeon, there is a real possibility of rupturing the implant. Intentional manual rupture of an implant is usually not covered by warranty.
- Recently ultrasound induced massage has been found to be effective in releasing adhesions around the implant in a few women. The therapy sessions are undertaken for a few months and the implant does become soft.
- Drugs. There are some drugs like Accolate (anti asthmatic agent) which have bene postulated to decrease capsular contraction. The reports are all anecdotal and there is no scientific basis for the drug's effects. Long term studies are required before the drug can be prescribed to treat capsular contraction.
When medical therapy fails, surgery is the next step.
Some surgeons cut away the adhesions around the implant and free it up from the surrounding. While this technique does work for sometime, most women re-develop the condition in future.
Sometimes, the surgeons remove the entire capsule or just replace the implant or place the implant behind the chest wall muscles, where the risk of capsular contraction is low.
In any case, most women are unhappy about having had to undergo repeat surgery with no that guarantee the condition will not occur again.