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The terrible phrase "capsular contracture." Do I need to remove the implants?
- Any implant, no matter how safe the materials it is made of, is a foreign body for the organism. And it is a normal protective reaction of the body when a capsule forms around a foreign material. If the capsule that has formed around the implant is thin and elastic, does not deform the tissue, it considered a postoperative norm. If even after the end of the postoperative period, the breast tissue is painful, tightened and asymmetry or deformation develops over the years, then this pathological process, called capsular contracture, requires treatment. Often we are talking about repeated surgery. The reasons for the formation of denser capsular contracture are various: it is impossible to predict in advance what kind of capsule will form around the implant.
Today, medical technologies are developing rapidly, the insertion of implants is practiced in various industries. This includes plastic and reconstructive medicine (breast, nose, chin implants), and cardiac surgery (stents, vascular prostheses, artificial heart valves) and orthopedics (artificial joints, intervertebral discs, vertebrae, metal structures), and dentistry (dental implants). It is important to take into account that the formation of a fibrous capsule is not only a problem for breast implants. This problem develops due to the interaction of the organism with a foreign body, and is typical for absolutely any kind of implant.
Of course, when there is a problem, one needs to think about how to solve it. But if there is a high-quality implant and there are no objective reasons for the treatment or removal of the implant, it makes no sense to succumb to general hysteria. The fact is that modern implants are quite inert and the risk of such complications is minimal.
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How often does seroma form after the surgery and is it necessary to remove the implants in this case?
Seroma is an abnormal accumulation of serous fluid, sometimes developing after plastic surgery. It is considered a rare complication of mammoplasty. Usually, seroma resolves on its own in a few weeks. Safe implants give a minimal risk of such a complication. Another problem that is often discussed in the media space is anaplastic large cell lymphoma (BIA-ALCL). Various factors also influence the formation of lymphoma, including the overall health and what kind of implants the clinic uses.
Doctors do not deny that seromas and lymphomas are a possibility. In my practice, only once was there a suspicion that the patient may have a lymphoma complication, judging by the nature of the complaints. After the removal of the implants, we did a histochemical examination, but the presence of ALCL was not confirmed. Here we need to think more about the quality of the implants inserted and how qualified the operation was. Lifestyle is also important, because problems can be provoked by other diseases.
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If my breast implants were inserted 10-15 years ago, do I need to change them?
Everything is very individual. This is not to say that implants of one manufacturer last a lifetime, others do not. Doctors cannot predict how the implant will behave over the years. I repeat: many factors affect the interaction with the implant - the status of the immunity, hormonal background, age, and health status changes.
I want to urge our future, current and former patients not to be hysterical about implants and their removal. When there is a rupture, capsular contracture, suspicion of some kind of infectious or oncological diseases, then of course, you need to check both your health condition and implants. But this does not mean that you need to run to the doctor and demand to take everything out at once! Indeed, this is followed by the next stage - what will happen to the breast afterwards?
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Do I need to remove the implants during pregnancy and the lactation period?
In my opinion, doing this would be wrong. If there is no contracture or any pathological process, a woman can feed a child with implants, this does not affect the physiological processes in any way during pregnancy or during the lactation period. In any case, the shape of the breast will change – with implants or without them. If surgeries inserting and removing the implants are performed too often, another problem may arise: breast fibrosis, deformation.
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If I want to change the shape of my breasts before or after childbirth (insert / remove implants), when is the best time to do so?
I recommend that my patients come in for a consultation 8-12 months after the end of lactation, when the hormonal background is fully restored, when the hydrophilic tissues of the breast are no longer so swollen. Breast skin becomes more elastic and holds its shape better. It is then that you can already think about breast enlargement, changing their shape, lifting.
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What is an EN-BLOC surgery? Is the implant always removed along with the capsule?
Implants are always removed in one block along with the capsule. That is, the implant and the whole complex of tissues that cause the pathological process - contracture or rupture of the implant. Then, already outside the body, visual (the capsule is cut, the integrity of the implant, its contents are checked) and histological examinations are performed. This technique of removing a pathological block, called EN-BLOC or capsulectomy, has been used for a very long time. There is nothing new in this method for professional doctors. Now "EN-BLOC" is just a beautiful term that has filtered into everyday life. We at LIPEX Clinic have been doing these surgeries for a long time.
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What happens to the breast shape after implant removal?
We must be aware that if a certain volume is removed, the stretched tissues will sag and something needs to be done to restore their original appearance. Usually an additional surgery to correct the shape of the breast is required. It can be lifting, it can be delayed lifting when we remove the cause of the pathological processes and observe for six months or a year how the breast heals. But this is a very serious problem and one should not even dare think about it.
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Is it possible to remove the old implants and immediately put in new, more modern ones?
Of course. If there is no pathological process and there are no contraindications, then you can immediately do surgery to augment the breast and improve the shape on the account of other implants - more modern, with a higher degree of guarantee. At the same time, you can tighten or reduce the tissues. That is, after the removal of the pathological process, all types of surgical interventions on breasts are available for the patient.
There are situations where this is not possible, but they are extremely rare. Most often this is due to infection or when there is a risk of cancer. Then the treatment phase is carried out first, and only then everything else.
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How quickly does a woman's body recover after the removal of implants?
Usually, surgery is performed under general combined anesthesia. Removing or replacing breast implants is a simpler operation than breast augmentation, as the “place” for the implants is already formed. The operation lasts 1-2 hours. Everything is removed, as I said, in one block, so the healing process is fast enough. It is necessary to wear corrective compression underwear, see the doctor to change the bandages and be under the supervision of the physician. In the first few days after the surgery, the patient cannot travel by plane - this should be taken into account by those who plan to arrive for the surgery from other countries.
Depending on the condition, the patient spends 1-3 days in the hospital. All the nuances - additional manipulations, the kind of incisions that will be performed and the shape of the breast, possible risks and recommendations are discussed during a personal consultation in the doctor’s office.
In the early postoperative period, the patient should avoid sports. If the implant is installed a second time, the timing of rehabilitation will differ. If the implant is inserted under the muscle, the restrictions for physical activity are longer, if the implant is inserted under the fascia of the pectoralis major muscle, the rehabilitation period will be shorter. The patient can completely forget about the breast surgery in three months if the implants have been inserted under the muscle, if it is a repeated surgery – up to six months: it all depends on the state of the muscles and on the manipulations that are performed.
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I do not want to remove the implants: how often do I need to check my health?
The presence of implants, if there are no pathological processes and health complaints, is not a reason for additional check-ups. As well as other women, owners of breast implants should visit the gynecologist at least once a year, undergo the proposed examinations and screenings, and do breast ultrasonography annually. The doctor may prescribe additional examinations - mammography, computed tomography, biopsy, examination of tumor markers. All women should monitor their health, regardless of whether they have performed mammoplasty or not.
