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When a breast becomes hard after an augmentation mammaplasty, the fibrous capsule around the implant can be ruptured, in most cases, by closed compression of the breast-resulting in immediate softness of the breast. As yet the duration of this improvement is unknown, but follow-up examinations to date indicate that it is persisting in about 3 or 4 patients so treated.
Fibrous tissue capsules, from around silicone breast implants, were examined by light microscopy, and by transmission and scanning electron microscopy, the latter combined with energy dispersive X-ray analysis. Contractile fibroblasts (myofibroblasts) were found in most of these fibrous capsules, and especially in those recently formed or manipulated. The element silicon was positively identified by X-ray analysis in half the tissue specimens. This material was found only around gel-filled implants. In the specimens studied, the clinical hardness of the breast was unrelated to the presence of silicon in the capsule.
An exposed breast implant was salvaged on one occasion by a lateral muscle flap from the serratus anterior and a second time medially by a fascia lata graft.
An investigation, by scanning electron microscopy of the capsules formed around silicone breast implants revealed that they consist almost entirely of connective tissue. In contrast, the capsules around the Y-prostheses (with a polyurethane foam surface) showed a foreign body reaction. We believe that excessive capsule formation around silicone implants is, among other factors, most likely due to discrete or moderate bleeding with subsequent hematoma formation. Therefore, we favor a two-stage procedure for subcutaneous mastectomy with insertion of the implant at 4 to 6 months after the excision.
We present a patient who bled into the pocket around a breast implant 2 1/2 years after an augmentation mammaplasty. She had received inflatible silicone prostheses, each containing 40 mg of triamcinolone acetonide. Our belief is that this large dosage of corticosteroid was responsible for the late erosion of the medium-sized artery, which caused the hemorrhage. Exploration and evacuation of the hematoma was followed by an uneventful postoperative course.
The use of a pneumatic tourniquet to release fibrous capsular contracture around a breast implant is described. This method protects the operator's hands and, we believe, is potentially safer for the patient and for the breast prosthesis.
We present a case in which the silicone rubber bag of a bag-gel breast implant was ruptured during the performance of a closed capsulotomy.
A previously unreported complication of closed capsulotomy is presented--rupture of a silicone bag-gel breast implant with silicone granuloma formation. We make some suggestions as the pathophysiology involved, and speculate that the complication might be more likely with an implant containing a less cohesive gel.
We present evidence of the following. 1. Modern silicone bag-gel breast implants leak silicone gel through the bag. 2. The amount of silicone leaked by an intact implant varies from one implant to another, and is not constant for any type or brand. 3. The leaked silicone, together with fibrous thickening and various degrees of inflammation will be found in capsules surrounding the implants if extensive biopsies are taken and many sections are examined.
We present our technique of doing an abdominal lipectomy and augmentation mammaplasty in the same operation, through the same incision, in selected patients. We introduce the breast implants through tunnels made from the top of the abdominal pocket into the breast areas. We have had no complications in 12 patients in whom we have done this operation.
In a retrospective study of 41 infected breasts following the insertion of implants, a high incidence of postoperative hematoma was noted. When infection occurred, cultures usually demonstrated the causative organism to be Staphylococcus aureus. Treatment by conservative drainage and vigorous antibiotics was generally successful in salvaging those implants which had been inserted through an areolar incision for simple augmentation, or under the pectoralis muscle (or a dermal pedicle) after a subcutaneous mastectomy. Those patients whose augmentations had been done through an inframammary incision, or whose implant after a subcutaneous mastectomy was under the skin flap, had a statistically higher incidence of implant loss. Most breasts will salvaged implants became firm.
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A case is presented showing disintegration of a solid pair of preformed silicone rubber foam breast prostheses, implanted 16 years ago. The only presenting symptoms were discomfort with extreme hardness and distortion of the breasts.
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