Breast augmentation is the leading surgical procedure performed globally. The latest statistics from the International Society of Aesthetic Plastic Surgery (ISAPS) show that 1,348,197 women have undergone this procedure, and it even could be more as intervention numbers are only gathered from those ISAPS members who responded to the survey.
Short term complications from this surgery, such as capsular contraction, are infrequent but they may occur. Other causes for a follow-up breast surgery are dissatisfaction with the volume (the most common cause in all the series), implants’ bad quality, or changes in the form or volume due to factors such as aging, pregnancy and menopause.
As surgeons we must be increasingly prepared to perform what is known as breast augmentation secondary surgery. The more experienced the surgeon, the easier it will be for the patient if they require a reintervention after a breast augmentation and now have problems. In addition, secondary surgical procedures are more complex and are therefore not dealt with in low cost clinics (as they are not economically profitable).
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What does the surgery for complications of breast augmentation consist of?
At Antiaging Group Barcelona, we perform interventions in around 25 cases a year with implant problems, these include patients who were operated on in other clinics. The risk of capsular contraction or rupture is not related to the surgeon performing the implant or the technique used. They are known complications of implants.
When faced with implant rupture the first step will be to determine whether this is intracapsular (i.e. limited to the implant shell which has been isolated by a layer of collagen fibres called a capsule) or extracapsular (if the silicone has leaked from the shell and is visualised in the mammary gland). Ultrasound or MRI (magnetic resonance imaging) investigations will be required for this. An axillary exam will also be required as it is not uncommon for the silicone to migrate and for the axillary lymph nodes to be found full of silicone. When dealing with an intracapsular implant we would usually change the implant after having carefully cleansing the cavity. The capsule will be removed (capsulectomy) when dealing with a non-cohesive gel prosthesis (up to and including 3rd generation prostheses) and extracapsular rupture. There is no consensus over the procedure required if there is silicone in the axillary lymph nodes, but we will remove the affected lymph nodes for histology investigations. For capsular contraction the operation will include a total capsulectomy and change of implant. In these cases we prefer to substitute these with micro polyurethane implants which have a 10 year contraction index of only 3%.
For cases of rupture or capsular contraction, if the patient does not want implants again and has enough fat available, a fat-graft injection can be performed. Fat does not give the effect of an implant as it does not push or ‘project’, but if there is sufficient volume we can remain somewhere between having nothing (simple implant removal) and a new implant. It is a very good alternative for women who do not want to be waiting for an implant and a potential repeat intervention.