Contracture after mammoplasty capsule
Contracture after breast surgery is one of the types of complications after surgery and not always even the most experienced plastic surgeons will ensure that such education may not arise.
This problem occurs in 10 percent of women who breast augmentation surgery.
What it is
It is the formation of a dense fibrous tissue capsule around the implant, which in consequence compresses and deforms it. The formation of the capsule is a normal reaction to a foreign body.
After implantation, this process can occur in any part of the body, which conducted the operation in the chest, buttocks, thighs and in itself may not be a complication if its thickness is normal and does not exceed a few tenths of a millimeter.
However, this education can thicken and compress the implant, which may contribute to rupture of the prosthesis and subsequently is a threat to the health and life of the patient.
The reasons for the formation of a capsule around the prosthesis can be associated with:
- with the surgery – bruising, brutal use of the techniques and methods of operation, improper formation of the incisions, infection of wounds as a result of infection, failure to install drains and does not identify the inflammatory processes in the body;
- implants (implants) — the inconsistency of its dimensions with the dimensions of the pockets formed in his chest, the material from which made the prosthesis and filler;
- the individual characteristics of each organism and the reaction to the prosthesis and its ability for deeper scarring;
- external causes – the impact of harmful habits on the body, as well as the frequent use of the same drugs. Injuries to the chest, which contribute to the formation of hematomas and grey around the implant.
The factors of occurrence of
The main factors of the appearance of contracture after mammoplasty and education of the capsule around the implant are:
- the formation of hematoma after breast augmentation surgery, which ostavljaet after resorption of dense fibrous tissue, which contains calcium;
- serous fluid that accumulates around the implant and is formed by detachment of large areas of subcutaneous tissue;
- too large size of the prosthesis, forming a bed for iplant;
- substandard work of the surgeon
- failure to comply with the recommendations in the rehabilitation period;
- inflammation postoperative time;
- rupture of the implant, and the contact with silicone fluid in the area between the prosthesis and the fibrous capsule.
Another factor influencing the formation of fibrous deposits is fibroblastic theory in which reduced myofibroblast (muscle tissue) and the appearance strukturirovannykh fibers.
According to this theory it is recommended to use implants with a textured surface.
Symptoms of capsular contracture after mammoplasty
The formation of contractures, can occur with both Breasts, but usually has a one-way sign.
The prosthesis may begin to shrink and deform after a few years, but mostly it happens in the year following the correction of the breast.
The breast becomes more dense, changes its shape: from triangular to ovoid passes, and then, already takes on the unnatural form of a sphere.
Often there are painful sensations and discomfort.
Depending on the timing there are two stages of formation of seals around the implant:
- early develops within twelve months after the mammoplasty. The early stage of emergence will harakterizuetsya getting infection that leads to inflammation and scarring of the tissue;
- of late, manifested through several years after breast surgery. This may be associated with rupture of the prosthesis, propotional silicone solution through the implant that leads to inflammation, aging and wear of the prosthesis.
Conventionally, the symptoms of capsular contracture can be divided into four stages:
- the first mammary gland has the same density as before the surgery. The area around the implant soft, fibrous capsule supple and does not exceed permissible levels;
- second – palpable edges of the implant and the breast becomes more dense than before the surgery;
- the third chest is much firmer, it is possible not only to test the prosthesis, but also to see its contours. You can see the deformation of the implant, dents and roundness;
- fourth – the fibrous shell becomes hard and is not smooth, pain especially at the time of probing.
The transition from the normal state of the fibrous sheath to pathological, it is possible to determine visually, by palpation and by MRI or ultrasound of the breast.
Video: breast augmentation
What is dangerous
In itself, the seal, does not threaten the patient’s life, but the formation of capsules, is the predictable result after breast surgery, which can be affected by various reasons.
The development of such seals leads to an unaesthetic result and dissatisfaction with your appearance and requires correction.
In this case, the surgeon removes the deformation. But the operation takes place in more difficult conditions than the primary, as the doctor will have to deal with the solution of several problems.
Also do not forget that the operation requires local anesthesia, and therefore it is dangerous for the cardiovascular system and the organism as a whole.
Therefore it is necessary to choose the right prosthesis for the future of the breast and the fawn to the advice of experts.
What to do
Specialist determining the degree of development of the capsule, you may assign a range of therapeutic and surgical measures. It all depends on the degree of development of the fibrous seal.
When the first and second degree must do the breast massage and physiotherapy. In the early stages, you can apply anti-inflammatory obkalyvanie, and the use of vitamin «E».
Everything is much more complicated with the development of contractures in the third and fourth degree of development. Here not to do without surgical intervention.
Such operations may be conducted under the following methods:
- Open capsulotomy is the incision of the capsule, whose main tasks are:
- oceneny fibrous capsule;
- korrekcija thickness of the implant position (if necessary the installation in another space);
- replacement of the prosthesis (if necessary);
- Endoscopic capsulotomy – an incision is performed with special instruments using the endoscope. With this method, there is little tissue damage and the body are only few visible traces of punctures. The recovery period lasts for a relatively short time. The only disadvantage when using this method is the impossibility of changing the position of the prosthesis and its replacement.
- Partial or complete capsulectomy. Using this technique removes the capsule, with the subsequent replacement or removal of the implant. This method traumatic enough, so the replacement endoprosthesis is not carried out, because of possible recurrence of fibrotic seals. But sometimes, after all, a replacement prosthesis may be produced, but only when you reinstall it to another area of the breast.
The best way that you can avoid complications is to be responsibly and seriously to the choice of the surgeon. No less affects the formation of capsular contractures and the behavior of the patient during the rehabilitation period.
Prevention, in which the appearance of a breast lump wakes to form less subject to such measures:
- the implant is used with a textured surface that does not rotate and does not move, in the end, the friction between the prosthesis and the capsule is very small, and therefore the capsule wall are thinner. There is a perception that using implants with textured surface reduces the risk of complications than a prosthesis with a smooth surface;
- for breast surgery using the most modern plenty that have certificates of quality and trusted manufacturers. It is recommended to use implants of the fourth and fifth generation. For example, implants with silicone filler can accumulate and come to the surface of the filler, this leads to the formation of a fibrous capsule and a cohesive gel is viscous, it is able to go beyond the chapels of the prosthesis, but not to the same extent as silicone filler;
- correct preoperative study of the health status of the patient, with the exception of injury to the chest, which left scars and seals;
- in the rehabilitation period, complied with all recommendations of the doctor. Correct observance of all rules will help You avoid many complications, including the development of a fibrous capsule;
- wearing compression underwear – for about two months. Wearing such clothes will not allow the denture to move and be displaced, in consequence, wakes sagging of the prosthesis;
- breast massage, but only with the permission of the doctor. And your doctor may prescribe a set of exercises and increase blood flow to the chest area;
- regular visits and consultation with a plastic surgeon who did the plastic surgery. The doctor can prevent the development of contractures, appointing the necessary research and use of physiotherapy.
Advice and opinion of specialists
According to Sergeev, Ilya Vyacheslavovich, if there are any doubts it is necessary to go on consultation to the doctor.
In the following the symptom such as compaction of the breast, but does not change its shape, can be such complications as seroma, and if left untreated can be formed and the fibrous capsule. It is not necessary to self-medicate a temporary contact to reduce the risk of complications after correction of the chest.
Saruhanov George M. – plastic surgeon advises patients to avoid such complications like capsular contracture to only refer to highly qualified and Board certified plastic surgeons.
Women who have very thin skin, it is recommended to use in this procedure, a prosthesis filled with silicone gel to prevent the formation of fibrotic seals.
Suherman V. – plastic surgeon, believes that capsular contracture appears later installation of low-quality dentures and advises women to establish only high-quality implants and follow the recommendations of the attending physician.
Plastic surgeon – Aleksanyan Tigran Albertovich, whose experience in plastic surgery for over 15 years, said that conservative treatment of the fibrous capsule there, but to get rid of such complications, surgery is needed to remove the hard capsule with the subsequent replacement of the breast implant.
A specialist in the field plasticheskoi surgery Yakimets Valery G. claims that around implant always formed capsule, as this is a normal reaction to the presence of foreign bodies AI to diagnose seal and increase the capsules can only be a surgeon when carrying out ultrasound or breast MRI.
According to some experts fibrous capsule is formed in the provoking factors affecting the condition of the capsule. It can be hormonal changes after pregnancy, childbirth and breastfeeding.
Studies show that a detailed study of the causes of fibrous capsules that allow bol to build constructive methods of treatment and in the process to get a good result in the study of complications following mammoplasty.
It is important to know all the patients who ever done the breast implants, that only the third and fourth degrees of occurrence of the fibrous capsule may be an option for the question about surgical intervention to resolve the complications.