A breast implant is a foreign material and not “recognized” by the body. Your body reacts to this foreign material with an inflammatory reaction. Scar tissue develops around the implant, also called a “capsule”. This capsule is thin in the immediate and short-term postoperative period but can grow overtime: it becomes thicker. Symptoms of capsule formation are:
- deformation of the breast and dimpling of the skin
- discomfort or pain, initially during movements and eventually also at rest
- pronounced breast animation with muscle action
- migration of the implant with upper pole fulness
- migration of the implant with distortion of the inframammary fold
- lower pole flattening
- flattening of the breast with loss of natural contours
- nipple retraction
- rupture of the implant
View on breast implants with MRI study.
The implant is always removed and the scar tissue (capsule) is entirely resected. The resected scar tissue will be analyzed to exclude any malignant processes. Over time the implant had an impact on the surrounding tissues: the pectoral muscle as well as the breast gland have been exposed to a certain degree of pressure (due to the implant) and will thin out (tissue atrophy). It is important to restore the tissue integrity of the breast and lipofilling or fat grafting is an elegant technique to restore tissue volume. Some patients request the insertion of new implants but most of the patients will ask for an autologous approach. Lipofilling is performed in the subcutaneous tissue layers of the breast and the surgeon will focus on the aesthetic areas of the breast.
Reoperation rates in breast augmentation are rather high, reaching 24% at 5 years and 36% at 10 years. One of the main causes is related to changes in breast volume and contour deformities (capsule formation). Submuscular breast augmentation showed a volumetric reduction of the muscle of almost 50% at one year. Subglandular breast augmentation showed a volumetric reduction of the breast gland of 23% at one year.
A breast implant induces the formation of scar tissue around the implant. This is called a capsule. The capsule can thicken over time, cause discomfort and distort the contours of the breast. Most patients prefer not have new implants and fat grafting is an elegant technique to replace the lost volume and restore the aesthetic contours of the breast.
When a breast implant is inserted in the retropectoral position the implant will be manipulated by the muscle action. Breast animation will occur and implants will migrate upwards over time due to the muscle action. The breast tissue will eventually hang over the implant; this is called the waterfall effect. Breast implant is removed and replaced or only fat grafting is performed to restore the volume.