A previous patient of mine came to my office recently for a left breast implant deflation. She had saline breast implants placed in 2006, and now had an obvious asymmetry on the left side. On examination, the left and right breasts were soft to touch, with no masses or tenderness. The right breast was significantly larger than the left, consistent with a left breast implant deflation.
As a background, ALL breast implants will eventually leak and ALL breast implants will form a capsule around them. The capsule is basically our body’s way of “ignoring” the implant, which is a foreign body. Typically, the capsule is very thin (sometimes almost transparent) and very pliable. If the capsule becomes thick, it can become tight and squeeze the implant into a tight ball. This is called capsular contracture and depending on the severity, may require surgery to remove the tight capsule. In cases of implant deflation, the capsule always closes a bit, and is easily opened up during surgery. This is not capsular contracture, is as much as the capsule closes a bit due to the deflated implant.
Given the softness of the left breast, I anticipated a relatively easy implant exchange. Was I in for a surprise! I found the capsule to be very thick (up to 3mm in some areas) and very tight. When I placed the new implant in, it became obvious early on that the patient had developed a significant capsular contracture. Could the contracture have caused the implant to leak? If the capsule was so tight, why did the patient have no complaints prior to the deflation?
I performed a near complete capsulectomy (removal of capsule) which was very difficult, as the capsule was adherent to the breast tissue, followed by placement of a new implant. I did recommend bilateral breast lift to position the nipple over the center of the implant. However, the patient did not wish to have the procedure done at this time.
The patient is one week after her surgery, and the implants and the breasts are soft. As expected, the left breast is more swollen due to the surgery, and will take several months to “settle in”.
This is an unusual case and shows even an experienced surgeon can sometimes be fooled by clinical findings.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 12 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call (714) 834-0101.
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