Breast plastic surgery - mammoplasty - is a serious surgical procedure that can lead to a number of postoperative complications. In addition to general surgical problems (infectious processes, hematomas, scars), it is possible to develop specific complications that occur only after this procedure.

Specific complications of mammoplasty

The most common complications are:

1. Capsular fibrous contracture.
2. Calcification.
3. Violation of the integrity of the endoprosthesis.
4. Specific breast deformation (double fold).
5. Displacement of the endoprosthesis.
6. Symmastia.
7. Allergic reaction.
8. Reduced information content of mammography.

According to various estimates, the risk of developing specific complications is 30-50%.

Capsular fibrous contracture

Individual reactivity of the body in response to the implantation of a breast implant can manifest itself in the form of capsular fibrous contracture. As a result of inflammation, a dense connective tissue capsule gradually forms around the endoprosthesis.

According to Baker's classification (1976), capsular fibrous contracture has 4 degrees of severity:

1. In appearance, the breast does not differ from healthy breasts and is soft to the touch.
2. The implant can be palpated. There is no visible deformation, the appearance of the breast does not differ from healthy breasts.
3. The breast becomes hard. There is noticeable deformation.
4. The chest is cold, hard, and significant deformation is noticeable.

In practice, treatment is required only for grades 3 and 4 of severity.

The causes of capsular fibrous contracture are not fully understood. Breast implants with a smooth surface are known to be more likely to cause this specific complication. The location of the prosthesis under the skin is often accompanied by fibrous contracture.

Treatment of capsular fibrous contracture is surgical. During surgery, the breast implant is replaced and the fibrous tissue is excised.

Calcification

Calcification is also a manifestation of individual increased reactivity of the body. With this specific complication, around the implant there is aseptic inflammation , as a result of which calcium salts are deposited in limited areas.

Foci of compaction may be visible upon examination or detected by palpation. Severe calcification deforms the mammary gland and sharply reduces the aesthetic effect of the operation.

There is no specific prevention for this complication.

In severe cases of calcification, it is necessary to perform endoprosthesis replacement and excision of compaction foci.

Violation of the integrity of the endoprosthesis

Violation of the integrity of the implant may be a consequence poor-quality shell or strong mechanical impact .

Shell material that is too thin is found in cheap or defective implants.

Excessive mechanical stress on the implant can be caused by injury (impact, fall, accident) during some sports training.

Violation of the integrity of the endoprosthesis wall manifests itself in different ways, depending on whether a saline or silicone implant was chosen.

Saline implants after damage to the membrane, within a short time after injury (up to 24 hours), they completely shrink and the breasts are restored to their preoperative size. This is due to the fact that such a prosthesis is filled with liquid, which quickly drains even through a small wall defect.

Silicone implants After damage, the walls can retain their previous shape for a long time. Such dentures are filled with gel, which slowly leaks through a small hole in the wall. Sometimes a violation of the integrity of the endorotesis is discovered only several months after the injury. To clarify the condition of the implant wall, magnetic resonance imaging (MRI) may be required.

Prevention of violation of the integrity of the implant is careful selection of the manufacturer, paying attention to those that meet all modern safety requirements.

In addition, a woman must comply all the rules of the regime after surgery , including avoiding situations that traumatize the mammary gland.

Treatment of this specific complication - surgical only. The damaged endoprosthesis is replaced. Inflammation and fibrosis resulting from the leakage of a solution or gel are treated with medications (anti-inflammatory therapy, antibacterial drugs) and surgically (excision of foci of fibrosis).

Specific breast deformation (double fold)

A change in the correct shape of the breast after endoprosthetics may be associated with the development of severe calcification, capsular fibrous contracture, and implant displacement. A specific breast deformity is considered double fold formation .

During examination, the mammary gland lying on the surface of the prosthesis is contoured.

The cause of the double fold may be incorrectly installed prosthesis or inaccurately selected size . Round, low-profile implants are more likely to cause this complication.

Prevention consists of precise selection of the implant and its installation location.

Treatment for specific breast deformities– surgical (repeat mammoplasty).

Displacement of the endoprosthesis

Displacement of the breast endoprosthesis reduces the aesthetic appearance after surgery.

Incorrect implant position may be fixed in the immediate postoperative period, or arise later.

Displacement can result from the surgeon’s mistakes: neglect of anatomical features, selection of a prosthesis that is too voluminous. The technique of installing an implant through the armpit increases the risk of this complication.

Besides, trauma, capsular contracture can also lead to displacement of the breast endoprosthesis.

Treatment of endoprosthesis displacement– surgical. The asymmetry is eliminated during reoperation.

Symmastia

Symmastia represents placement of endoprostheses too close. Visually, the mammary glands “fuse together.” This complication arises due to the choice of overly large implants.

The anatomical features of the woman (close proximity of the mammary glands to each other before surgery) can also be considered the cause of the complication.

Prevention of symmastia - careful selection of the volume of the endoprosthesis before surgery.

Treatment of complications- surgical only. Breast implants are replaced with smaller ones.

Allergic reaction

Allergies to implant materials are quite rare. Manifestations of such a reaction can be in the form dermatitis, swelling, rashes etc.

To prevent complications, it is necessary to use high-quality implants made of hypoallergenic materials. Women with a history of polyvalent allergies are at higher risk of developing a reaction to the implant, so the advisability of surgery should be assessed especially carefully.

Treatment of an allergic reaction carried out therapeutically (antihistamines, hormonal drugs).

In severe persistent cases of allergies, removal of endoprostheses or their replacement with hypoallergenic analogues is indicated.

Complications after mammoplasty can be divided into two groups: general surgical and specific, associated with the presence of an implant. General surgical ones include hematoma, seroma, wound infection, pathological scarring (hypertrophic or keloid scars). Specific ones include prosthesis rupture, prosthesis displacement, implant wrinkling, capsular fibrous contracture, implant contouring.

You should immediately contact your doctor if one of the mammary glands suddenly enlarges, you have a fever, vomiting, diarrhea, you faint, feel dizzy and/or notice a rash on your body in the early postoperative period.

Capsular contracture

Capsular contracture is the formation of dense fibrous tissue around the installed implant, which compresses and deforms the endoprosthesis, and in the later stages can cause noticeable pain and discomfort.

The formation of the capsule is a normal physiological process that begins immediately after completion of the operation and takes several months; its thickness normally does not exceed tenths of a millimeter. Capsular contracture leads to deformation of the prosthesis and, accordingly, to distortion of the shape of the breast. This can only be corrected by repeated surgery.

Typically, capsular contracture occurs during the first year after mammoplasty, less often in the interval from one to several years after surgery. Capsular contracture can also occur with low-quality implants, but the problem can be easily avoided if you use high-quality and reliable breast implants, such as Mentor (by far one of the best brands in the world).

There are four degrees of capsular contracture. First: enlarged breasts are no different in softness from normal ones; second: the breast is denser than usual, but its shape is preserved, the implant is palpated, but its contours are not visible; third: the breast is clearly denser, the implant is clearly palpable and visible, the shape can be maintained, but more often it is distorted, asymmetry, bulges or indentations may appear; fourth: the fibrous membrane becomes very hard and inelastic, the skin is cold to the touch, tissue deformation is even more noticeable, and painful sensations intensify, especially during palpation.

Two types of operations can correct the situation: capsulotomy - dissection of the fibrous sheath, which allows you to reduce the pressure on the implant and return it to its normal shape, and capsuloectomy - partial or complete removal of the fibrous sheath, which may be accompanied by replacing the implant with a different size, moving it to the intermuscular zone, or complete removal.

Implant rejection

Any surgery carries a risk of infection. In most cases, it develops within a few days or weeks after surgery. If the infection cannot be controlled with antibiotics and the presence of the implant makes treatment difficult, the prosthesis may need to be removed. Installation of a new implant is possible only after recovery.

In rare cases, after implantation of a prosthesis, toxic shock syndrome develops, which is life-threatening. Symptoms include sudden fever, vomiting, diarrhea, fainting, dizziness and/or rash. If they appear, you should immediately consult a doctor and begin treatment.

Main causes of complications

Complications can arise due to the patient’s irresponsible attitude to the plastic surgeon’s recommendations, non-compliance with the rules of preparation for surgery and the rules during the recovery period, if the girl does not undergo all preoperative examinations (this will prevent the identification of contraindications), or does not consult a doctor in a timely manner after discovering suspicious symptoms , changes in the glands, other ailments, or will not provide the doctor with all the information about her health, that she has contraindications. And finally, the last item on this list is self-medication, which you did not agree with the surgeon.

How to avoid the consequences of mammoplasty

Strictly follow the rules that the doctor will tell you about; Regularly visit and consult with the surgeon who performed the operation. He can prevent the development of contracture by prescribing the necessary tests and physiotherapeutic procedures.

I talk a lot about the benefits of breast surgery all the time. There really are a lot of them. This type of aesthetic correction of appearance is considered safe and effective today. Over many years of world practice, thousands of patients have undergone breast augmentation with implants.

However, it is worth discussing the negative aspects of this correction. Yes, unfortunately, they exist, but looking ahead, I will say that these little troubles do not pose a serious danger. So, today we will talk about breast implants, or more precisely, about their revolution inside the mammary glands.

If round implants flip, there is no need to re-correct

How does this happen?

Unfortunately, this happens, which is a fly in the ointment. First, let's remember that breast implants come in round and teardrop shapes.

If the round ones turn over, nothing special happens. More precisely, the patient herself simply does not feel any discomfort. Sometimes a round implant may turn over not along its axis, but along a plane, like a coin. Then there will be a slight asymmetry of the mammary glands. But, as a rule, this option also does not bring much inconvenience. Such asymmetry is perceived as natural, because there are no girls with perfectly symmetrical mammary glands. So if round implants flip, there is no need for correction.

The situation is different with teardrop-shaped breast implants. They have a pronounced accent in the lower part, so any displacement of such prostheses will be noticeable. Asymmetry in this case will no longer look harmless; the breasts will take on a strange shape. Therefore, girls faced with such a problem turn to plastic surgeons for additional correction.

Why does implant displacement occur?

The issue of safety, of course, is primarily of concern to patients and doctors. Many girls get scared if the prosthesis flips. However, I want to calm everyone down right away. There are no health consequences to this. An inverted breast implant is purely an aesthetic problem. Therefore, there is no need to panic. It is important for the patient to simply decide for herself whether her breasts are getting comfortable, or whether she still wants to correct the shape during re-correction.

An inverted breast implant is a purely aesthetic problem

Many people wonder how often implants flip. In my opinion, yes. This happens for various reasons. Firstly, as a result of mechanical damage - falls, blows, injuries. Secondly, the work of the pectoral muscle forces the prostheses to slowly shift. This is quite normal if it does not go beyond the natural asymmetry that we discussed above.

It is worth noting that this process has a time frame. I’m talking about the fact that in the first months after surgery, the tone of the pectoral muscle is increased, therefore it is during this period that the probability of the implant shifting is high. The tone gradually decreases, and after a year such mild complications become rare. Here I would like to note that some time after mammoplasty there is no visual difference between round and teardrop-shaped implants.

Therefore, in order to avoid troubles with turning the latter and not face repeated surgery, you should carefully weigh all the pros and cons when choosing the shape of the prosthesis. Drop-shaped ones are installed according to strict indications. You should not take on unnecessary problems and opt for such implants if the doctor, after studying your initial data, suggests installing round dentures.

Re-correction

If, after all, the patient is faced with the described problem, then there is no need to despair. As we have already found out, the flip of implants does not threaten health. Aesthetic correction in this case is not difficult. The surgeon will simply have to adjust the already installed prosthesis. Of course, the operation will be performed under general anesthesia, the patient will have to go through the recovery period again, but all this will not take the form of a disaster. Rehabilitation will take a little less time and be smoother.

However, surgical measures are resorted to only in isolated cases when the shape of the breast has noticeably changed. Otherwise, the girls don’t bother and leave everything as it is, because a slight asymmetry, as we have already noted, is quite natural and appropriate. In the end, I would like to remind you that in any case, even if the new breast is in perfect order, you need to regularly visit your plastic surgeon as part of a routine examination. The doctor will notice any changes, if any, at an early stage and take steps to correct the problem.

No woman is immune from the risk of implant displacement after breast augmentation surgery. The implant can move in any direction.

Implant displacement is affected by its weight, size and position. The larger the volume of the implant, the more susceptible it is to displacement. This can happen with both saline and silicone implants.

In addition, implants located above the muscle are more likely to dislodge than those installed under the muscle.

Reasons for implant displacement:

• Gravity forces;
• Capsular contracture;
• Muscle cravings;
• Features of the soft tissues of the breast, i.e. "resistance" to stretching;
• Incorrectly formed implantation pocket.

Let's look at all the above reasons in turn:

Gravity force

Gravity affects both small and large breasts equally. The larger the breast mass, the greater the effect gravity has on the soft tissue. The silicone gel that fills the implants is close to unity in density, which means its mass is approximately equal to the mass of water. Relatively speaking, all implants over 350g can be called heavy. Such implants greatly stretch the soft tissue of the breast, which can lead to displacement of the implants downwards, which is accompanied by visual overfilling of the lower pole of the breast and tilting of the areola upward, and sometimes the formation of a double fold. When installing large implants, the surgeon must keep this in mind and take preventive measures.

Capsular contacture

In the case of capsular contracture development, the nature of the implant displacement has nothing to do with gravity. The main reason is the formation of a rough connective tissue capsule around the implant, which compresses the implant and displaces it upward. This issue is discussed in more detail in the corresponding article.

Muscle traction

A very common reason for an implant to move upward. In order for this reason to become the main one, three components are necessary:

• small implant volume
• Full axillary implant pocket
• strong pectoralis major muscles

A small implant is less affected by gravity. The implant, located completely under the muscle, experiences the compressive effect of the pectoralis major muscle and tends to move after the contracting muscle. A strong muscle that is in good tone enhances all of the above reasons.

Features of the soft tissues of the breast

These are extremely important characteristics that the surgeon must consider. There are about 50 characteristics of soft tissues. Let's list the most important ones.

• extensibility
• elasticity
• turgor
• elasticity
• condition of the ligamentous apparatus of the mammary gland

All together, these characteristics can be combined under the name “resistance” of soft tissue to the mass of the mammary glands. Moreover, regardless of whether the bulk of the mammary glands is represented by a gland or an implant.

The surgeon must determine as accurately as possible the limit that the soft tissue of the breast can withstand without overstretching and, accordingly, disturbing the shape of the breast. Surgeons have a lot of surgical techniques in their arsenal that will allow them to fix any implant in the correct position. You just need to use them correctly.

Incorrectly formed implantation pocket

• symmetrical
• slightly larger than the implant size
• the implant bed should be formed taking into account the characteristics of soft tissues
• the inframammary fold should not be lowered unnecessarily
• the formed bed must provide fixation points for the implants, which must be symmetrical on both sides

How does dystopia of implants manifest after surgery?

The displacement of implants can be either bilateral or only on one side. More often, implant displacement occurs only on one side. Signs of implant dystopia are as follows:

• overcrowding of the upper (lower) pole of the mammary gland, depending on whether the implant is displaced up or down
• the location of the areola is above or below the center of the breast, depending on where the implant is displaced
• displacement of the implant towards the sternum or outwards is manifested by a corresponding deformation of the mammary gland

Implant displacement can occur either immediately after surgery or several months after it. Significant displacement of the breast implant leads to a loss of the natural appearance of the breast, and requires surgery to restore the previous appearance.

What to do if the implant in the breast has moved?

If the implants are higher than the desired position and this becomes noticeable within 7 days, you can try to return the implants to their normal position using a pressure bandage. The bandage applies pressure to the upper part of the breast, which forces the implants to return to the correct position.

If a lot of time has passed since breast augmentation, i.e. more than three or four weeks, then, most likely, surgical correction cannot be avoided. The degree of complexity of such an operation depends on where the implant has moved. If the implant is higher than necessary, then returning it to the correct position is the easiest way. Most often you don't even need to remove it. The surgeon simply expands the implant pocket downwards and checks the symmetry of the implant placement.

If the breast implant has moved downwards or to the side, then the operation will be more complicated. In such a situation, the surgeon must restore the normal size of the implantation pocket. First, the implant is removed, then the surgeon sutures the required area of ​​the implant pocket and reinstalls the implant. It is more difficult to fix the implant in a higher position, since the implant tries to return to its place under the influence of gravity. Careful suturing of the implantation pocket to normal size is the most important stage of the operation.

• Implant displacement

After breast augmentation, there is a risk of implant displacement, i.e. changes in its position up, down, relative to the chest bone or armpit. This may be due to the following reasons:

• the force of gravity;
• muscle traction.

Provoking factors that contribute to the displacement of the elastomer are the weight of the endoprosthesis and its position in the mammary gland. The risk group includes patients whose breast volume exceeds 400 cc, as well as those who have endoprostheses implanted subgladularly. When the elastomer is placed submuscularly or biplanarly, it is fixed by muscle and fascial tissue, which reduces the likelihood of unexpected changes in its position. It should also be taken into account that the weight of saline implants is greater than gel ones, therefore, during implantation, the likelihood of subsequent downward displacement of the former is much higher.

Such a defect can occur either immediately after plastic surgery or months later. Externally, this is manifested by a change in the direction of the nipple: it will be turned in the direction opposite to the displaced implant, which will certainly create a negative aesthetic effect and require repeat mammoplasty.

Implant displacement options

Until recently, to correct such a defect, a technique was used, the essence of which was to open the chest capsule, after which they tried to fix the implant in a better position by suturing the tissue. However, the effectiveness of this method left much to be desired, since the result did not last long (the design turned out to be unreliable, the endoprosthesis migrated to the old place or occupied a new position).

A more modern technique that allows you to correct implant displacement is the technique of forming a new submuscular pocket. The sequence of actions is as follows:

• open the existing pocket and remove the elastomer;
• separate the natural capsule from the breast tissue;
• a spherical flattened plate is formed from it;
• the resulting substance is placed in such a place as to move the implant to the desired position.

After healing, a new capsule is formed around the endoprosthesis. The tissues located underneath support the correction results, providing a lasting and long-lasting effect.

Regardless of the technology, old elastomers are replaced with new ones. This is a good opportunity to review the size of the endoprosthesis and change it to a more suitable one.

As preventive measures to reduce the risk of implant displacement, you must strictly follow all doctor’s instructions:

• during the first 6 weeks, wear compression garments around the clock;
• do not expose the mammary glands to thermal and mechanical stress;
• avoid physical activity associated with stress on the breast muscles for 2 months after mammoplasty.