Month: July 2016

The development of capsular contracture is a nightmare for women who have had breast augmentation surgery. The breasts feel hard and shift position causing them to look lopsided. In extreme cases, it might also cause a lot of discomfort and pain.

WHAT IS CAPSULAR CONTRACTURE
Fibrous breast capsules are formed around the breast implants when they are inserted during breast augmentation, as the body tries to wall off the presence of the foreign implant. This is the body’s natural immunologic response whenever a foreign object is placed into the body, be it a pacemaker, an artificial joint, or a breast implant.

When the fibrous capsule tightens and squeezes the implant, capsular contracture occurs.

Anybody can develop capsular contracture, but according to many authors, the occurrence rates are usually about 5%-8% of women with breast augmentation.

 

SIGNS OF CAPSULAR CONTRACTURE

Although capsular contracture usually happens anytime after a breast augmentation, most instances occur in the first few months following the procedure.

The signs of capsular contracture commonly appear gradually and may first be experienced by it being firmer than usual. As the hardening intensifies, the breast may look misshapen and even painful. The breast can also appear round and shift higher up the chest while visible rippling appears. (Read more about the rippling of breast implants.)

There are various stages of capsular contracture, according to Dr Baker:

Baker Grade One — The breast appears natural in size, shape, and softness. The capsule has formed, but it is not tightened around the implant.

Baker Grade Two — The breast appears normal but feels slightly firm. There is a slight to moderate tightening of the capsule around the implant.

Baker Grade Three — The breast not only feels firm but is also beginning to deform. The breast appears round like a ball due to the tightening of the capsule on the implant. In some cases, the implant is displaced from its original position, usually upwards.

Baker Grade Four — The patient exhibits all the signs of Grade Three, with the addition of pain caused by the tightening of the capsule.

Grade Zero — The fibrous capsule is formed loosely around the breast implant, causing the implant to droop and sag within the envelope. A visible rippling of the breast implant may also be noticed.

 

REDUCING RISK OF CAPSULAR CONTRACTURE

There is no way a plastic surgeon can predict who will develop capsular contracture, but we have ways that help reduce the risk of it happening.

• Sub-muscular implant placement is correlated with lower rates of capsular contracture as compared to sub-glandular implant placement. (Read more about breast implant placements here.)
• Oversize implants might lead to capsular contracture as there might be more trauma to the breast pocket during physical activities. With more trauma, the scar capsule could be injured, and it can go on to heal with an additional scar, which might be thicker and less elastic than the original scar.
• Perform breast implant massage at least twice daily for about 10 minutes following breast surgery. Displacement of the implant inside the breast capsule may help scatter any excess tissue around the implant, reducing the chance of capsular contracture.
• Avoid smoking until full recovery has been achieved, as capsular contracture rates are about twice as high in smokers.
• Choose a licensed and experienced plastic surgeon to do your breast augmentation. A surgeon who practices in a safe facility with strict infection control policies ensures better results and decreases the risk of capsular contracture.

 

CAPSULAR CONTRACTURE CORRECTION

Non-Surgical Methods:

• Medications — Accolate® has anti-inflammatory properties that have helped to reduce the severity of capsular contracture. It works best for patients in the early stages of capsular contracture.
• Breast Implant Massage — Again, breast implant massage may help to loosen the capsule in the early stages of capsular contracture.

Surgical Methods:

• Open Capsulectomy — An open surgery where the entire capsule is surgically removed. During this surgery, the patient can choose whether to replace the implant or use a new one.
• Open Capsulotomy — An open surgery that involves releasing the scar tissue by scoring the capsule with small incisions. It might also involve partial removal of scar tissue.

To learn more about capsular contracture or to discuss any queries you have, consult with your plastic surgeon. If you suspect that you may have a case of capsular contracture, talk to your plastic surgeon immediately. Capsular contracture does not heal on its own. In fact, it can get worse over time.

To learn more about capsular contracture, do contact us at:
Dr Marco Faria-Correa Plastic Surgery
Tel: +65 64648075
E-mail: enquiry@drmarco.com
Web: www.drmarco.com

 

Disclaimer: The information contained in this post is neither intended nor implied to be a substitute for professional medical advice. It is provided for educational purposes only. Always seek the advice of your plastic surgeon or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Always speak to your healthcare provider about any questions you may have regarding a procedure.

Before we explore the possible revision surgeries for breast implant rippling, I want to explain what it is and the reasons behind it happening.

WHAT IS BREAST IMPLANT RIPPLING

Breast implant rippling usually refers to the folds and wrinkles on the implant that is visible on the skin. This happens for women who have had breast reconstruction with saline or silicone breast implants and it usually develops on the outer perimeter (side, bottom, near cleavage) of the reconstructed breasts. It is also especially likely to be visible in very thin women or when leaning forward.

WHAT CAUSES BREAST IMPLANT RIPPLING

It is not uncommon for the breast implants to ripple but it is also not always visible on the skin. Rippling is actually more common for saline-filled breast implants as compared to saline implants. And to be totally honest, silicone gel breast implants can also ripple, but it is much less likely.

Even though there are many reasons why breast implants ripple, these are the most common:

• Poor tissue coverage of the implants: This usually happens for sub-glandular placement of the breast implants. With such placement, sometimes, there is insufficient soft tissue to cover the breast implant, and when the implants ripple, it is more likely to be visible over the skin.
• Scar capsule too loose: Sometimes, the scar capsule that forms naturally around the inserted breast implant might be larger than the implant itself, causing the implant to be drooping inside the scar capsule. When this happens, waves will be formed on the implant, which might result in visible rippling.
• Underfilled/Overfilled saline breast implants: This only applies to saline-filled implants as all silicone implants are prefilled. When saline implants are underfilled or overfilled below or beyond the manufacturer’s recommended amount, it may cause the edge of the implants to wrinkle or pull to create ripples. These ripples may in turn be visible on the breast skin.
• Round implants: Rippling is more common in round implants than in anatomical (tear-shaped) implants.

REVISION SURGERY FOR BREAST IMPLANT RIPPLING

Unfortunately, no amount of massaging, exercising or skin products can get rid of rippling. And in most cases, revision surgery might be required.

These are a range of options that can be used to address breast implant rippling depending on its cause:

• Replace the undersized implant: Swapping the undersized implants for more suitable-sized ones to fill out the breast envelope/scar capsule.
• Tighten the scar capsule: Tightening the scar capsule so that it fits the small breast implant better.
• Replace the saline implants with silicone gel implants: Silicone gel implants tend to ripple less than saline implants, as they are more form-stable. In fact, silicone gel implants tend to be the most resilient to rippling as they fill out the shell more smoothly and consistently than other types of implants.
• Add/remove saline to underfilled/overfilled implants: In cases where rippling is caused by improper filling of saline implants, adding and removing of saline will help. However, doing this will also void the manufacturer’s warranty.
• Repositioning the implant: Repositioning the breast implant under the chest muscles might help by giving the implant more soft tissue padding, thereby reducing the visibility of rippling.
• Change the shape of the implant: Changing round implants to anatomical (tear-shaped) implants, which tend to ripple less.
• Fat graft: Additionally, the transfer of fat from the hips, thighs or stomach to the breast via fat grafting can make ripples less noticeable. (Read more about fat grafting here.)

To learn more about breast implant rippling revision, do contact us at:
Dr Marco Faria-Correa Plastic Surgery
Tel: +65 64648075
E-mail: enquiry@drmarco.com
Web: www.drmarco.com

 

Disclaimer: The information contained in this post is neither intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. Always seek the advice of your plastic surgeon or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Always speak to your healthcare provider about any questions you may have regarding a procedure.

Should breast implants be placed above the muscle or below the muscle? Which method is the best?
There is no best answer for any one person. Each individual’s physical characteristics and physique determine the best method for them. The solution is to look for an experienced and skilful plastic surgeon who can give the best recommendation for your needs.

Here is some useful information for you to make an informed choice.

BREAST IMPLANT PLACEMENT

The sub-glandular technique, or over-the-muscle placement, places the implants between the breast tissue and the chest muscle.

The sub-fascial technique involves elevating the layer covering the outer surface of the chest muscle and placing the breast implants in the space created.

The sub-muscular technique, under the muscle placement, means putting the implant below the pectoralis major or chest muscle.

The dual-plane technique involves both the sub-muscular and sub-glandular techniques. The upper part of the breast implant is sub-muscular, which means the placement of the implant in a pocket underneath the chest muscle, while the lower part of the implant is covered only by the breast tissue.

Note that all of these techniques place breast implants UNDER the mammary glands, which still allows for breastfeeding.

SUB-GLANDULAR BREAST IMPLANT PLACEMENT (OVER THE MUSCLE)

Advantages:

• Achieves a more rounded, augmented look, which some women prefer.
• Implants can be placed slightly closer together to achieve more cleavage.
• The breast implants do not become distorted when the pectoral muscles are flexed, which makes them a good choice for women who lift weights regularly.
• The surgical procedure is slightly easier and perceived as less invasive. This also means that there is less postoperative pain as compared to under-the-muscle placement.

Disadvantages:

• Only advisable for women who have a good amount of their own breast tissue (B-cup or larger). This is so that there will be adequate soft tissue covering the breast implants to reduce the risk of breast implant visibility (palpability) and rippling, especially over time.
• For patients with smaller amounts of breast tissue, bigger implants result in a less natural outcome. (Note: Different degrees of projections can be chosen to suit the chest width to get a more natural outcome.)
• With less tissue covering the breast implant (only skin as compared to under the muscle technique), the breast might be more susceptible to visible rippling in the future.
• Although technology allows for better breast imaging, with or without implants, the over-the-muscle technique is generally thought to require more mammogram views due to the shadow present.
• Based on clinical studies, the sub-glandular technique has a higher rate of capsular contracture formation due to constant muscle movement. Patients are advised to massage the implant to reduce the risk of capsular contracture formation.

SUB-FASCIAL BREAST IMPLANT PLACEMENT

Advantages: The advantages of the sub-fascial technique are similar to the sub-glandular technique. But it comes with an additional feature: a strong fibrous sheath and breast tissue that supports the implant.

Disadvantages: The disadvantages of the sub-fascial technique are similar to the sub-glandular technique.

SUB-MUSCULAR BREAST IMPLANT PLACEMENT (UNDER THE MUSCLE)

Advantages:

• Suitable for women with any amount of breast tissue.
• Achieves a more natural look with natural sloping upper poles.
• With more soft tissue padding on the breast implants, there is a reduced risk of breast implant visibility and rippling in the long run.
• Less chance of sagging as the weight of the breast implant is supported by both breast tissue and chest muscle.
• Less likely to interfere with mammography.
• Reduced risk of capsular contracture formation.

Disadvantages:

• The breast might appear to sit in a higher position until the muscle fully relaxes in about 4-6 weeks after surgery.
• This technique might not be advisable for women who regularly lift weights as it might cause implant distortion when the chest muscle is flexed.
• The surgical procedure is perceived as more invasive. This also means that there is slightly more post-operative pain and longer recovery time than the over-the-muscle placement.
• Not advisable for patients with too much flabby/hanging breast skin as there is a chance of the skin hanging over the implant in the long run.

DUAL-PLANE BREAST IMPLANT PLACEMENT

Advantages:

• Combines both advantages of sub-glandular and sub-muscular techniques.
• By releasing the attachments of the overlaying breast tissue to the pectoralis major muscle to varying degrees based on individual anatomy, the best-looking breast can be customized to suit each patient.
• A natural result is particular for patients with very small breasts, as both the breast muscle and tissue cover the upper pole of the implant.
• Lower risk of the formation of capsular contracture.
• The possibility of implant dropping is reduced as the muscle and fascia secure the implant and keep it in the right position.
• Possibility of reduced palpability of implant borders. 
• Lower risk of wrinkles forming on the upper part of the body.

Disadvantages – The disadvantages of the dual-plane technique are similar to the sub-muscular technique.

Given this, it is still up to your individual physical characteristics and preferences to determine which technique is best for you. Discuss all the advantages and disadvantages with an experienced plastic surgeon before deciding.

To learn more about the different breast implant placements, do contact us at:
Dr Marco Faria-Correa Plastic Surgery
Tel: +65 64648075
E-mail: enquiry@drmarco.com
Web: www.drmarco.com

 

Disclaimer: The information contained in this post is neither intended nor implied to be a substitute for professional medical advice. It is provided for educational purposes only. Always seek the advice of your plastic surgeon or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Always speak to your healthcare provider about any questions you may have regarding a procedure.