Breast Implant Through Armpit
If you’re interested in breast reconstruction after mastectomy, then this is a good option for you. However, this procedure does not work for everyone and should only be done under the supervision of a qualified plastic surgeon. If you’re looking for more information on body image or plastic surgery procedures, we recommend checking out our other articles!
In this guide, we review the aspects of Breast Implant Through Armpit, transaxillary incision complications, problems with breast implants under the muscle, and armpit incision healing.
Breast implant through armpit is a plastic surgery procedure that can help women who are interested in reconstructing or restoring their breasts after mastectomy.
What is breast implant through armpit and how does it work?
Breast implant through armpit is a plastic surgery procedure that can help women who are interested in reconstructing or restoring their breasts after mastectomy. It also known as an armpit breast augmentation.
It is a safe procedure, with low complication rate, and excellent results when done properly by a qualified plastic surgeon.
What are the advantages and disadvantages of breast implant through armpit?
The breast implant through armpit procedure is a great option for women who want to get larger breasts and are not interested in getting breast implants that are placed under the chest muscle. The advantage of this method is that it’s minimally invasive, so it results in less scarring than traditional implant surgeries. Additionally, there’s little risk of infection or rejection since the tissue around your armpit is healthy.
However, the disadvantage of this method is that it requires more time than other procedures because you need to wait until your arm has healed before moving on to other parts of your body (e.g., the chest).
Why do some people choose breast implant through armpit instead of the breast?
Why do some people choose breast implant through armpit instead of the breast?
There are a few reasons why someone might choose an armpit procedure. One is that it’s a less invasive procedure and less risky than a traditional breast augmentation, which makes it a better option for women who have had previous surgeries or would like to avoid surgery altogether. Another reason is that for some women with larger breasts, their natural tissue may not be sufficient enough to support the weight of implants placed in the chest; using your existing tissue means you can avoid getting additional scarring from another incision site. Finally, if you have had a mastectomy (a surgery where your entire arm was removed), this type of implant placement offers an alternative method of breast reconstruction after cancer treatment.
Are there any other articles I should read about body image?
You can find a therapist here.
If you’re looking for a support group, there are many options in your area.
If you want to explore body positivity and other resources, check out [list of sites].
Breast implant through armpit is a plastic surgery procedure that can help women who are interested in reconstructing or restoring their breasts after mastectomy.
The breast implant through armpit is a plastic surgery procedure that can help women who are interested in reconstructing or restoring their breasts after mastectomy. The procedure involves using an implant to replace the breast tissue removed by mastectomy. This option is available for women who have had breast cancer, and it is often combined with fat grafting to improve the appearance of the chest area.
In order to get started with this treatment plan, patients will need to meet with a doctor who performs this type of surgery regularly so that they can determine whether it’s right for them. If you think this might be something worth looking into further, talk to your doctor about your options today!
transaxillary incision complications
Background: Capsular contracture (CC) is the most common complication following primary breast augmentation and one of the most common causes of reoperation. Various studies have suggested certain risk factors, including incision choice.
Objectives: The authors investigate a possible association between the three most common breast augmentation incisions (inframammary, periareolar, and transaxillary) and CC.
Methods: The authors conducted a retrospective chart review of 197 primary breast augmentation patients treated between 2003 and 2009. Significant CC was determined to have occurred if the patient required reoperation for her CC. Patients were excluded if they underwent an augmentation/mastopexy, had previously undergone breast surgery, or received shaped silicone gel implants. CC rates were analyzed on a per-patient basis with Fisher’s exact test and on a per-breast basis with the Rao-Scott chi-squared test.
Results: One hundred eighty-three patients (336 augmented breasts) were included. Average patient age was 36.5 years. Mean follow-up was 392.6 days. Surgical complications included six breasts with CC (1.8%), three with hematoma (0.9%), and one with an infection (0.3%). Transaxillary incisions produced the highest incidence of contracture (6.4%), followed by periareolar (2.4%) and inframammary (0.5%). There was a statistically-significant difference in the incidence of CC among the three incision sites (P = .03). The increased rate seen with transaxillary incisions versus inframammary incisions was also statistically-significant. No significant association between implant fill material and contracture was found (P = .27).
Conclusions: The risk of CC is significantly higher with transaxillary incisions than with periareolar or inframammary incisions.
Capsular contracture (CC) is the most common complication following primary breast augmentation, with a reported incidence from 4% to 5% during the first two years of follow-up.1,2 While some studies have suggested a direct correlation between CC and the time elapsed since implant placement,2,3 others have found that over 90% of contractures still do occur within the first 12 months after surgery.1,4 CC is one of the most common causes of reoperation following an augmentation.3,5-7 Not all cases of CC require surgical correction, but the discomfort or distortion associated with CC may be significant enough to justify further surgery.
The etiology of CC is not completely understood and is most likely multifactorial.5 While most patients experience contractures within the first year after surgery, some risk for CC persists as long as the patient has the implant, which further supports the multifactorial nature of CC, since the effects of short-term risk factors (eg, bacterial contamination, surgical technique, drains, and antibiotics) most likely dissipate with time.2 Studies have also identified certain patient-specific risk factors for CC, including exposure to radiation therapy,3,8 implant placement as part of reconstructive surgery,2,3,8 or a prior history of CC.1,2
The association between implant-specific properties and the development of CC has also been closely examined. Studies of the implant fill material (saline vs silicone gel), surface (smooth vs textured), and profile have all produced inconsistent results.3 Placement of the implant into the subglandular plane has generally been associated with an increased risk of contracture when compared with placement into either the submuscular plane or dual plane.3
The location of the augmentation incision that provides access to the mammary pocket has been postulated as another potential risk factor for CC. Each of the most common augmentation incisions (inframammary, periareolar, and transaxillary) has its own advantages and disadvantages.11 No single choice is necessarily appropriate for all patients. Two studies have found an increased risk of contracture with periareolar incisions when compared with inframammary incisions.12,13 One hypothesis is that the greater degree of ductal system disruption that occurs with a periareolar incision when compared with an inframammary incision enables the normal breast bacterial flora to leak from the ductal system and colonize the device pocket.12 Few studies have extended beyond periareolar incisions and inframammary incisions to include transaxillary incisions in their analysis. The objective of this study was to investigate the relative risk of CC between the three most common incisions for primary breast augmentation.
Methods
A retrospective chart review was conducted of all women who had undergone a primary breast augmentation between 2003 and 2009 in the senior author’s (SLS) practice. Data collected included various demographic variables, specifics of breast augmentation procedures, and follow-up information. Patients were excluded from the study if they had undergone a simultaneous augmentation/mastopexy, had a previous mastopexy, had previously undergone breast surgery (eg, prior augmentation or reduction), or had anatomic silicone gel implants placed, since these are currently investigational devices in the United States. Patients requiring reconstructive surgery, mastopexy, or reduction on one breast who underwent a primary breast augmentation on the contralateral breast for symmetry were included in the study as a unilateral augmentation, so long as they had not received radiation therapy to the augmented breast. The Georgetown University Institutional Review Board approved this study.
All analyses were performed with and without the breast reconstruction patients. Only procedural data from the augmented breast were analyzed. The primary end point of the study was the development of clinically-significant CC, defined as reoperation or recommended reoperation. CC was also graded with the Baker Classification (Table 1), a common scale in both practice and studies due to its easy application.
Demographic variables were analyzed via Fisher’s exact test and paired t-tests where appropriate. Per-patient data were analyzed with a Fisher’s exact test due to the low incidence of CC in our study population. Due to the uncommon occurrence of bilateral CC and the relatively more common occurrence of unilateral CC, we analyzed each breast as a single case in addition to analyzing the data on a per-patient basis. The interrelatedness of our observations (ie, a patient’s right and left breasts during a bilateral augmentation are not completely unrelated, as they belong to the same person and are exposed to the same procedural environment) was accounted for with the Rao-Scott chi-squared test.14 This statistical test is more appropriate than a basic chi-square or Fisher’s exact test when multiple observations may be interrelated. An a priori alpha level of 0.05 was applied for all statistical tests. Analyses were performed with SAS for Windows, Version 9.2 (SAS Institute, Cary, North Carolina).
Of note, irrigation of the breast pocket with Betadine (Purdue Products LP, Stamford, Connecticut) solution diluted one-to-one with sterile saline followed by triple antibiotic irrigation is standard procedure at the authors’ institution and was implemented for all patients in the study.9,10 In addition, all patients, regardless of incision choice, received perioperative antibiotic prophylaxis, which in virtually all cases was cefazolin except when there was a contraindication (eg, allergy).
Results
Of the 197 charts identified for screening, 14 were excluded; 183 patients met inclusion criteria (Figure 1), of whom 153 patients (83.1%) had a bilateral breast augmentation. Of the remaining 30 patients, 18 had a primary breast augmentation and a contralateral breast reconstruction. Twelve remaining patients underwent a unilateral breast augmentation with a contralateral mastopexy or other procedure.
Retrospective chart analysis of the patients included in this study.
The average patient age was 36.5 years (range, 17.5-72.6 years). Twenty-one patients were active smokers and two patients had diabetes mellitus (Table 2). Patients in the study were followed for a mean of 392.6 days (median, 245.0 days), with a range of zero days (patient deferred follow-up visits due to her occupation as a plastic surgeon) to 2320 days. Of the 183 patients in the study, five patients (2.7%) developed a clinically-significant CC, defined as having or needing surgical intervention. One patient had a bilateral contracture. Three patients had hematomas (1.6%), and one developed an infection (0.5%). The three hematomas in our series all occurred in patients with inframammary incisions, and they all required exploration in the operating room. In all three cases of hematoma, the same implant was replaced. There was one documented infection, which was diagnosed three weeks postoperatively when the patient presented with drainage from her inframammary incision. This was treated with two weeks of antibiotics and never required implant exchange. No patient with a hematoma or infection developed a CC.
In total, 336 primary augmentations were performed on 183 patients. Less than 2% of the 336 augmented breasts developed a significant CC (Table 3). Patients who developed CC were older (average, 42.4 years) but not significantly older than patients who did not develop them (average, 36.3 years; P = .17). None of the patients who developed CC were active smokers or had diabetes mellitus. As expected, patients with CC were followed longer (mean, 749.8 days) than those without contracture (mean, 382.9 days); however, this was not statistically-significant (P = .09; Table 4).
Analysis of contractures on a per-patient basis (Table 4) and per-breast basis (Table 3) produced similar results. On a per-breast basis, transaxillary incisions produced the highest number of CC cases (n = three/47) followed by periareolar (n = two/84) and inframammary (n = one/205). The Rao-Scott chi-square test was statistically-significant with a P value of .03 (Table 3). While there was statistical significance, there were few cases of CC, so this significance must therefore be interpreted with caution. This association remained when breast cancer patients were removed from the sample. No significant association between implant contents (eg, saline or silicone gel) and contracture was found (P = .27). Due to the small number of CC cases, no P values could be calculated for the association of CC implant placement, implant surface, or implant shape. All patients who developed contracture had dual-plane placement and implants that were round and smooth. Only one patient who developed CC had a saline implant (Table 5).
Description of Contractures
Overall incidence of significant CC was 1.8 contractures per 100 breasts augmented (Table 6). Transaxillary incisions produced the highest incidence of contracture, with 6.4 per 100 breasts augmented, followed by periareolar incisions (2.4 contractures per 100 breasts) and inframammary incisions (0.5 contractures per 100 breasts). One patient experienced an immediate (less than six months postoperative) CC following a transaxillary augmentation and later experienced a delayed contracture (more than one year postoperative) on the contralateral breast. Of the six CC cases in our study, five were Baker II and one was Baker III. No Baker IV capsular contractures were present in this study population.
Incidence of Capsular Contracture per 100 Breasts Augmented
Five patients experienced significant CC, but six CC were reported (Table 7). Five of the contractures were corrected through surgical revision. One patient who developed a unilateral Baker II contracture following a transaxillary incision did not undergo surgical correction due to patient refusal, although the case was included because surgical correction was recommended. Surgical correction of the contracture occurred or was noted on average 249.2 days after the initial surgery, with a range of 73 to 559 days. The two patients with contractures following periareolar incisions had their CC surgically corrected sooner (73 and 104 days) than patients with inframammary (559 days) or transaxillary incisions (130 and 380 days).
Descriptions of Capsular Contractures
Discussion
Since breast augmentation is currently the most commonly performed cosmetic surgical procedure in the United States—with 318,123 augmentations estimated to have been performed in 2010 alone15—and CC is the most frequently encountered complication of this high-volume procedure, the value of an evidence-based approach to decrease its incidence by even a small percentage is important. Incision choice is one of the many variables in this procedure and yet, despite the fact that almost all augmentations are performed through one of three incisions, a direct comparison of these options does not currently exist.
Consistent with the scant amount of published literature specific to this issue, this study demonstrates the lowest CC rate with inframammary incisions. What is striking about these data is that they show a fivefold increase in contracture rate with periareolar incisions and a 13-fold increase with transaxillary incisions. The 13-fold increased rate seen with transaxillary incisions compared with inframammary incisions was statistically-significant, whereas the fivefold increased rate seen with periareolar incisions compared with inframammary incisions did not reach statistical significance. The theory that bacterial contamination is responsible for CC is entirely possible, but our data do not provide any specific scientific support for that hypothesis. Therefore, a more conclusive study proving the causality of bacterial contamination and capsular contracture is needed. An ideal study would include the investigators taking cultures, looking for evidence of bacteria-contaminated biofilm, and sending capsule specimens for microbiology and pathology when a revision is performed for CC.
While our study is a modest-size, single-surgeon retrospective analysis, it certainly has encouraged us to look more carefully at this issue. If this were a larger, randomized, prospective trial with the same results, it would be potentially practice-altering for surgeons who perform breast augmentation. However, at this point, our report should be interpreted with care as it raises some important questions and suffers from a few limitations. This study was intended to serve as a preliminary or pilot analysis to justify a future larger multicenter study, which would have sufficient power to provide more conclusive evidence.
It is notable that, throughout our study, our choice of incision was never made with consideration of CC risk. We chose incisions based exclusively on patient preference and patient-specific breast anatomy. An inframammary incision was our default choice, particularly when the patient had a well-defined inframammary fold in the appropriate location. A periareolar incision was favored in patients with larger areolas and patients who we predicted might need a mastopexy in the future. A transaxillary incision was favored in small-breasted patients with poorly defined inframammary folds and small areolas. Because we were systematically favoring specific incisions in specific types of patients, it is possible that any of the observed anatomic factors that guided our thinking might have been confounding variables.
Additionally, although our breakdown of incision choices was well representative of all three options, we performed significantly more inframammary fold incisions, raising the possibility that our technique for this approach is more refined through increased repetition. It is also worth noting that all of our transaxillary augmentations were performed with an endoscope. Since the transaxillary approach was significantly more prone to CC and this is the only approach that made use of the tool, there exists the possibility that either for technical or institutional reasons, this was a contributing factor.
Besides CC, other well-known complications of breast augmentation such as hematoma and infection occurred in our patients. Our rate of hematoma was 1.6% and infection was 0.5%. All hematomas and the one infection occurred in patients with inframammary incisions. Our overall number of complications is very low, so drawing any significant conclusions correlating incision type to risk of hematoma or infection is not possible. That said, there are clearly inherent differences between the three approaches, including transecting more ductal and glandular tissue with the periareolar incision and more blunt dissection with the transaxillary incision. With a higher-powered study, the significance of these other complications might be more clearly elucidated.
There are, as in any retrospective study, many potential confounding factors. Two of these include plane of placement and fill material. In this study, 93% of all implants were subpectoral or dual plane. As a plane of placement, subpectoral has been supported by the literature to have a lower rate of CC than subglandular placement. Of all the subglandularly-placed implants (30 in total), seven were periareolar incisions (23.3%), two were transaxillary (6.7%), and 21 were inframammary (70%). Only two of the transaxillary augmentations were subglandular, and neither of these patients experienced contracture. None of the breasts with contractures had subglandular placement. Therefore, we believe subglandular placement is not a confounding factor in the results of our study. We also examined the transaxillary and periareolar incisions in terms of type of fill material. The study population as a whole showed that the majority of implants placed (60.7%) were silicone gel. The patients with periareolar incisions had 55% silicone gel implants (or 46 of 84 breasts), and 47% of transaxillary incisions corresponded to silicone gel implants (22 of 47). Given that the majority of transaxillary augmentations were performed with saline devices and all contractures in this group were silicone gel, saline fill is not likely to be a confounding factor. The literature is varied in outcomes investigating the role of silicone gel in causing higher rates of CC. While silicone gel fill could theoretically cause higher rates of contracture, it is unlikely that silicone gel itself confounded our finding of interest, which is the effect of incision type on the rates of CC.
The strength of this study is its avoidance of subjective grading and bias through its objective end point of reoperation, which was applied to all patients regardless of previous incision. This end point allowed us to identify a discrete, indisputable occurrence of contracture that was by definition clinically significant, removing any observer bias between incision types.
To further investigate the observed difference in CC rates between these incisions, a valuable next step would be to examine multicenter retrospective data, since it would correct for many of our study’s noted limitations. Despite these limitations, we believe this study to be a valuable addition to our current knowledge of CC because it represents the first direct comparison of inframammary, periareolar, and transaxillary incisions.
Conclusions
The risk of clinically-significant CC appears to be higher with transaxillary incisions as compared with periareolar or the inframammary alternatives. This increase was statistically-significant. There is also the suggestion that there is an increased risk of CC after a periareolar incision as compared with an inframammary one, although this increase did not reach statistical significance. These preliminary, retrospective data should be considered as one of many factors when planning a patient’s breast augmentation.
Disclosures
Dr. Spear is a paid consultant for LifeCell Corp. (Branchburg, New Jersey) and Allergan, Inc. (Irvine, California). Drs. Jacobson, Gatti, Schaffner, and Hill have no financial interest in any of the products, devices, or drugs mentioned in this article.
problems with breast implants under the muscle
Sometimes, no matter how skilled a patient’s plastic surgeon is, complications arise during or after surgery. This is the case because everyone’s body is different. The composition of connective tissue varies widely from one patient to another, for instance, and this means that each patient’s healing process is entirely unique. This is why some people tend to develop thick scar tissue after any kind of penetrating skin injury, while others can sustain deep cuts and develop only subtle scarring that fades over time. Another good example of this difference is the way some women will develop severe stretch marks during pregnancy no matter what they do to prevent them, whereas other women emerge from pregnancy nearly stretch mark-free. Additionally, everyone’s immune system responds differently to stimuli, and some patients’ immune systems react poorly to medical implants.
Of course, complications during plastic surgery are now very rare, both because of advances in surgical techniques and because we’ve gotten better at predicting which patients are likely to experience surgical complications. Patients who are prone to developing thick scar tissue may be advised to avoid having plastic surgery, or their surgeon will use special surgical techniques that allow incisions to be placed remotely (e.g., inserting breast implants through an incision in the underarm) in order to keep scarring largely out of sight. Patients who have compromised immune systems or autoimmune diseases are often advised to forego surgery and choose less invasive forms of cosmetic enhancement. Likewise, there are a number of procedures that can be used after surgery, such as the Aspen Rehabilitation Technique, in order to treat complications and improve the patient’s appearance. One of the most common areas where Aspen is used is in the treatment of capsular contracture after breast augmentation surgery.
What is capsular contracture?
The formation of a “capsule” of scar tissue around any kind of implant (medical or cosmetic) is a normal part of the healing process. The body automatically reacts to any foreign object it detects within it and attempts to isolate said object by creating a barrier of scar tissue around it. In the case of breast implants, this is usually a good thing – the capsule helps to keep the breast implants in place, preventing slippage. In some patients, however, this capsule of scar tissue becomes unusually hard and starts to contract around the implant. This can lead to both aesthetic problems and, in extreme cases, pain in the breasts. Research shows that about one in six breast augmentation patients experience some degree of capsular contracture, though not all cases present with obvious symptoms. The severity of capsular contracture is rated using a grading system:
Generally, capsular contracture occurs during the healing process. About 75% of all capsular contractures will occur within two years of the patient’s implants being placed. Sometimes capsular contractures occur many years after breast augmentation surgery, but this is the exception rather than the rule. If this does occur, the patient’s breast implants should be checked for ruptures. Ruptured implants are the most common cause of late-onset capsular contraction.
What causes capsular contracture?
Clinicians have a number of theories on what causes capsular contracture, and it’s likely that the exact causes of this condition vary from patient to patient. As a breast augmentation patient, it’s important to understand that this condition is not caused by breast implants being in any way toxic or dangerous. Saline implants contain only saline solution, which can be safely reabsorbed by the body with no ill effects, and silicone gel implants are made of medically inert silicone. Indeed, capsular contracture can happen after any kind of medical implant is inserted into the body; the condition is not unique to breast augmentation surgery. Capsular contracture is just particularly troubling when it occurs after breast augmentation because it often alters the appearance of the breasts, thereby jeopardizing the aesthetic improvements that the patient had surgery to create. Capsular contracture is not usually dangerous to the patient’s health unless her implants have ruptured (in the case of gel implants, rupture can sometimes lead to infection).
Researchers believe genetics play a role in who develops capsular contraction and who does not. If you have a family history of autoimmune disease or you have relatives who frequently develop thick scar tissue after injury (or who have had difficulties with medical implants), then you may have a slightly heightened risk of developing this condition. However, it’s impossible to accurately predict who will develop a “random” case of capsular contracture (i.e., one that is not caused by any identifiable external factors) and who will not. Because capsular contracture is highly treatable, you shouldn’t let a fear of developing this condition hold you back from getting breast augmentation surgery.
Sometimes, capsular contracture is caused by something other than the patient’s own body reacting poorly to the presence of breast implants. In addition to implant ruptures, it is now believed that something called “biofilm” often leads to the development of this condition. Biofilm is a thin layer of bacteria that develops around implants after a type of bacteria (often staph bacteria) is introduced to the breast cavity during surgery. This bacterium causes a kind of chronic, low-grade infection that may not produce noticeable symptoms (such as fever or severe fatigue). However, as the body combats this infection, it produces more and more fibrous scar tissue, eventually leading to capsular contracture. The biofilm theory of capsular contracture was given credence by a recent study conducted on pigs who were implanted with medical-grade silicone implants. This study showed that there was a significant increase in the likelihood of capsular contracture in those pigs who had staph bacteria on their skin at the time of implant placement. It’s important to note that staph contamination during breast augmentation surgery does not necessarily result from an unhygienic working environment. Some people are natural carriers of staph bacteria; it’s always present on their skin and usually causes no symptoms. Only when these individuals have their skin penetrated does this bacterium have a chance to cause any serious issues. While ensuring a clean working environment can certainly help to lower the risk of staph contamination, it’s not always possible to eliminate 100% of the bacteria that are present.
Other rare complications of breast augmentation surgery, such as hematomas and seromas (blood clots that sometimes form after invasive surgery), are also believed to increase the risk of capsular contracture. Some researchers believe these blood clots increase the likelihood of capsular contracture by providing a rich supply of nutrients (in the form of blood) for bacteria, thereby encouraging the growth of biofilm. How can capsular contracture be prevented?
While it’s impossible to prevent capsular contracture from occurring in every patient, there are several ways to lower a patient’s risk of developing this condition. To that end, plastic surgeons now employ a number of different preventative strategies, as outlined below:
How does Aspen treat and reverse capsular contracture?
In the past, the treatment options available for breast augmentation patients with capsular contracture left much to be desired. Revision surgery was often required—a lengthy, costly and uncomfortable solution. During this process, the patient’s implants were removed, she was treated with antibiotics and eventually (once the infection had subsided), she could choose to have breast implants inserted again. However, because this surgical approach makes the body vulnerable to a second bacterial invasion, many of these patients experienced repeated incidences of capsular contracture.
Aspen multi-energy therapy is different. It’s completely noninvasive, so it doesn’t cause the patient pain or inconvenience, nor does it increase her risk of developing capsular contracture again in the future. During Aspen therapy, a special device (the Aspen harmonizer) is applied to the patient’s breast tissue, without any incisions being made. The Aspen harmonizer delivers precisely controlled ultrasound waves to the patient’s tissue, encouraging the growth of healthy collagen. This increases elasticity within the breast capsule around the implant, making the breasts feel soft and pliable again. Furthermore, the ultrasound waves used during Aspen therapy have been shown to increase the effectiveness of antibiotics in combating biofilm. Aspen therapy is usually administered over two to three weeks in combination with antibiotic therapy to target the root cause of capsular contracture. The Aspen method has been shown to be effective for grade two and grade three cases of capsular contracture. Grade four cases may require more aggressive surgical intervention.
armpit incision healing
Sometimes, no matter how skilled a patient’s plastic surgeon is, complications arise during or after surgery. This is the case because everyone’s body is different. The composition of connective tissue varies widely from one patient to another, for instance, and this means that each patient’s healing process is entirely unique. This is why some people tend to develop thick scar tissue after any kind of penetrating skin injury, while others can sustain deep cuts and develop only subtle scarring that fades over time. Another good example of this difference is the way some women will develop severe stretch marks during pregnancy no matter what they do to prevent them, whereas other women emerge from pregnancy nearly stretch mark-free. Additionally, everyone’s immune system responds differently to stimuli, and some patients’ immune systems react poorly to medical implants.
Of course, complications during plastic surgery are now very rare, both because of advances in surgical techniques and because we’ve gotten better at predicting which patients are likely to experience surgical complications. Patients who are prone to developing thick scar tissue may be advised to avoid having plastic surgery, or their surgeon will use special surgical techniques that allow incisions to be placed remotely (e.g., inserting breast implants through an incision in the underarm) in order to keep scarring largely out of sight. Patients who have compromised immune systems or autoimmune diseases are often advised to forego surgery and choose less invasive forms of cosmetic enhancement. Likewise, there are a number of procedures that can be used after surgery, such as the Aspen Rehabilitation Technique, in order to treat complications and improve the patient’s appearance. One of the most common areas where Aspen is used is in the treatment of capsular contracture after breast augmentation surgery.
What is capsular contracture?
The formation of a “capsule” of scar tissue around any kind of implant (medical or cosmetic) is a normal part of the healing process. The body automatically reacts to any foreign object it detects within it and attempts to isolate said object by creating a barrier of scar tissue around it. In the case of breast implants, this is usually a good thing – the capsule helps to keep the breast implants in place, preventing slippage. In some patients, however, this capsule of scar tissue becomes unusually hard and starts to contract around the implant. This can lead to both aesthetic problems and, in extreme cases, pain in the breasts. Research shows that about one in six breast augmentation patients experience some degree of capsular contracture, though not all cases present with obvious symptoms. The severity of capsular contracture is rated using a grading system:
Generally, capsular contracture occurs during the healing process. About 75% of all capsular contractures will occur within two years of the patient’s implants being placed. Sometimes capsular contractures occur many years after breast augmentation surgery, but this is the exception rather than the rule. If this does occur, the patient’s breast implants should be checked for ruptures. Ruptured implants are the most common cause of late-onset capsular contraction.
What causes capsular contracture?
Clinicians have a number of theories on what causes capsular contracture, and it’s likely that the exact causes of this condition vary from patient to patient. As a breast augmentation patient, it’s important to understand that this condition is not caused by breast implants being in any way toxic or dangerous. Saline implants contain only saline solution, which can be safely reabsorbed by the body with no ill effects, and silicone gel implants are made of medically inert silicone. Indeed, capsular contracture can happen after any kind of medical implant is inserted into the body; the condition is not unique to breast augmentation surgery. Capsular contracture is just particularly troubling when it occurs after breast augmentation because it often alters the appearance of the breasts, thereby jeopardizing the aesthetic improvements that the patient had surgery to create. Capsular contracture is not usually dangerous to the patient’s health unless her implants have ruptured (in the case of gel implants, rupture can sometimes lead to infection).
Researchers believe genetics play a role in who develops capsular contraction and who does not. If you have a family history of autoimmune disease or you have relatives who frequently develop thick scar tissue after injury (or who have had difficulties with medical implants), then you may have a slightly heightened risk of developing this condition. However, it’s impossible to accurately predict who will develop a “random” case of capsular contracture (i.e., one that is not caused by any identifiable external factors) and who will not. Because capsular contracture is highly treatable, you shouldn’t let a fear of developing this condition hold you back from getting breast augmentation surgery.
Sometimes, capsular contracture is caused by something other than the patient’s own body reacting poorly to the presence of breast implants. In addition to implant ruptures, it is now believed that something called “biofilm” often leads to the development of this condition. Biofilm is a thin layer of bacteria that develops around implants after a type of bacteria (often staph bacteria) is introduced to the breast cavity during surgery. This bacterium causes a kind of chronic, low-grade infection that may not produce noticeable symptoms (such as fever or severe fatigue). However, as the body combats this infection, it produces more and more fibrous scar tissue, eventually leading to capsular contracture. The biofilm theory of capsular contracture was given credence by a recent study conducted on pigs who were implanted with medical-grade silicone implants. This study showed that there was a significant increase in the likelihood of capsular contracture in those pigs who had staph bacteria on their skin at the time of implant placement. It’s important to note that staph contamination during breast augmentation surgery does not necessarily result from an unhygienic working environment. Some people are natural carriers of staph bacteria; it’s always present on their skin and usually causes no symptoms. Only when these individuals have their skin penetrated does this bacterium have a chance to cause any serious issues. While ensuring a clean working environment can certainly help to lower the risk of staph contamination, it’s not always possible to eliminate 100% of the bacteria that are present.
Other rare complications of breast augmentation surgery, such as hematomas and seromas (blood clots that sometimes form after invasive surgery), are also believed to increase the risk of capsular contracture. Some researchers believe these blood clots increase the likelihood of capsular contracture by providing a rich supply of nutrients (in the form of blood) for bacteria, thereby encouraging the growth of biofilm. How can capsular contracture be prevented?
While it’s impossible to prevent capsular contracture from occurring in every patient, there are several ways to lower a patient’s risk of developing this condition. To that end, plastic surgeons now employ a number of different preventative strategies, as outlined below:
How does Aspen treat and reverse capsular contracture?
In the past, the treatment options available for breast augmentation patients with capsular contracture left much to be desired. Revision surgery was often required—a lengthy, costly and uncomfortable solution. During this process, the patient’s implants were removed, she was treated with antibiotics and eventually (once the infection had subsided), she could choose to have breast implants inserted again. However, because this surgical approach makes the body vulnerable to a second bacterial invasion, many of these patients experienced repeated incidences of capsular contracture.
Aspen multi-energy therapy is different. It’s completely noninvasive, so it doesn’t cause the patient pain or inconvenience, nor does it increase her risk of developing capsular contracture again in the future. During Aspen therapy, a special device (the Aspen harmonizer) is applied to the patient’s breast tissue, without any incisions being made. The Aspen harmonizer delivers precisely controlled ultrasound waves to the patient’s tissue, encouraging the growth of healthy collagen. This increases elasticity within the breast capsule around the implant, making the breasts feel soft and pliable again. Furthermore, the ultrasound waves used during Aspen therapy have been shown to increase the effectiveness of antibiotics in combating biofilm. Aspen therapy is usually administered over two to three weeks in combination with antibiotic therapy to target the root cause of capsular contracture. The Aspen method has been shown to be effective for grade two and grade three cases of capsular contracture. Grade four cases may require more aggressive surgical intervention.