Things We Cannot Control – Tissue Stretching and Wound Healing
Things We Cannot Control
There are a couple of things that as the surgeon and as the patient neither of us have any control over. By making smart decisions based upon science, experience and common sense, we can minimize the risk of problems, but two things in particular are out of our control:
1. Tissue Stretch: When an implant is placed into the breast, the breast tissue will stretch. Sometimes, the lower pole (portion) of the breast will stretch more than desired. This will result in a longer than desired nipple to fold distance, with most of the breast volume in the lower pole of the breast. The nipple will be upturned, with less upper breast fullness. This overstretching of the breast is due to the biology of the patient’s own tissues and as such cannot be controlled. However, you can minimize the risk of this happening by not placing an implant into the breast that is larger than recommended by measurements. Sometimes this overstretch is minimal and not recognized by the patient, in rare cases it can be significant and requires operative correction, which I only needed to do once several years ago.
Mild lower pole stretch
Moderate lower pole stretch
2. Wound Healing/Scarring: I close all breast augmentation wounds with the same technique, designed to give the best possible scar. However, everyone has different biologic propensities for wound healing which cannot be altered. Most scars on the breast heal beautifully. All scars are permanent and visible, but the vast majority, once they heal in the crease are faint enough that upon casual view of the breast they are not an issue. Occasionally, the scars are thickened and more visible (hypertrophic scar). Often times, this can be improved, although not eliminated, with steroid injections into the scar itself.
On the inside of the breast there is scarring as well. The body responds to the placement of any foreign body, breast implant or otherwise, by forming scar tissue around the implant. This is called a capsule. In the vast majority of cases the capsule is thin, pliable and poses no issue for the patient. However, if stimulated, possibly by infection, this scar capsule can become thickened and contract. As it contracts, the breast implant is deformed into a rounder shape, and the breast appears rounder, higher, and becomes firmer to touch. When the capsule is mild, nothing other than observation need be done. If the scar capsule is more problematic, then the scar tissue may need to be removed with replacement of a new implant. It is believed by some that the further risk for scar capsule contracture may be increased after the first episode. As of this writing (January, 2010) the last time I operated upon a capsular contracture was four years ago, and to the best of my knowledge, the few I have re-operated upon did not re-form.
One of the main theories for why capsular contracture occurs is that blood accumulation around the implant after surgery acts as a culture medium for low virulent (potency) bacteria that settle in a film of tissue around the implant, safe from the body’s defenses, and stimulate this process. Using a minimally traumatic technique of surgical dissection which results in negligible blood loss during and after surgery, accompanied by several proactive means to prevent infection, including using three separate antibiotics plus Betadine (an antiseptic) in the solution used to wash out the breast pocket and soak the implant prior to use, I have not had a problem with capsule contracture in several years.
Post Op – several months later with left sided capsule contracture
(breast elevated and nipple pointing downward)
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