Fibrocapsular contracture is a possible complication of breast surgery. The problem is that even an experienced surgeon cannot always guarantee the absence of complications. Contracture can appear unpredictably, even if all the activities were carried out with the utmost correctness and high quality. On average, contracture develops in every tenth woman who has undergone breast plastic surgery.
What is it about?
Capsular contracture of the breast is a compacted formation, the components of which are connective tissue fibers. It resembles a capsule and surrounds the implanted materials. This leads to an increase in pressure and deformation of the site. Capsule formation is the body's natural response to the introduction of a foreign object. After implant surgery, such a formation can appear unpredictably in different parts of the body - depending on whereintervention was carried out. For example, contracture is also possible in the gluteal zone, if the operation was performed here. If the thickness of the formation is within the normal range, this is considered an adequate response of the body and does not require special treatment. Acceptable dimensions are tenths of a millimeter.
Sometimes capsular contracture after mammoplasty actively progresses, the size of this area becomes larger, which leads to pressure on the implanted materials. The prosthesis can rupture, which is not only dangerous for a woman's he alth, but can even provoke a fatal outcome.
What provokes?
Capsular contracture after mammoplasty appears largely due to the intervention itself, since such an event is associated with the formation of hematomas. Surgery is a rather crude, traumatic method that requires the use of technology. The doctor may unsuccessfully, incorrectly make an incision. There is a possibility of infection in the wound, incorrect choice of the moment of installation of the drainage system. There is a possibility of contracture if a thorough examination to determine the presence of inflammatory foci was not carried out before the operation, or such tests gave a false negative result.
Specialized guides that show photos of capsular contracture that forms near the implant, also usually show in detail images of the installed prostheses themselves - often they provoke a pathological phenomenon. If the prosthesis does not fit in size or shape to the pocket thatunder it is created in organic tissue, there is a possibility of complications. Contracture can be provoked by the specific features of the material from which the implant is made, and even the filler of this object.
About the reasons
As is known from the reviews, capsular contracture after mammoplasty is sometimes explained by the specific characteristics of the body of the patient who underwent surgery. Individual reactions to the implant are possible. Different people have different susceptibility of the body to deep tissue scarring.
There is a possibility of an external influence that provokes contracture. It is known, for example, that the risk of complications is higher if the patient has bad habits, if the woman is often forced to use medications for long courses. There are certain risks associated with injury to the area near the implanted object, especially if it provokes gray, hematoma.
Pathological factors
According to medical reference books explaining the causes of the appearance and demonstrating the capsular contracture that occurs after mammoplasty in the photo, there is a higher danger of learning from your own experience how the process proceeds if hematomas have formed in the damaged area after the operation. Such foci usually lead to the appearance of fibrous compacted organic tissues enriched with calcium. Serous discharge may accumulate around the implanted object. This is observed if large amounts of subcutaneous structures are exfoliated, and also causes contracture.
An excessively large prosthesis can become a factor in the formation of contracture, especially if the doctor incorrectly formed a bed for it, and the base turned out to be smaller than the implanted object. The following factors can become factors for the appearance of contracture: a low level of the quality of the operation performed by the doctor, inattentive compliance by the patient with recommendations for recovery during rehabilitation, the formation of an inflammation focus after the intervention. There is a high risk of contracture if the implant ruptures and fluid containing silicone penetrates between the organic capsule and the object.
Fibroblast theory is considered one of the explanations for contracture. As the doctors explain, myofibroblasts contract, due to which peculiar fibers are generated - they constitute the contracture. To minimize the risk of complications, dentures should be chosen with a textured surface.
How to notice?
Symptoms of capsular contracture may appear symmetrically on both breasts, may involve only one implant. For some, the prosthesis loses its original shape under the influence of compression years after the operation, but for the majority, the pathology can be detected in the first 12 months after the intervention. The chest becomes denser, its shape changes. At first, the mammary gland, resembling a triangle, becomes more and more like an egg, then a ball, and the shape looks completely unnatural. Many patients report chest discomfort. The area is disturbed by soreness.
Assessing the timing of the development of a pathological condition, they speak of one of two stages. Signs of early capsular contracture appear within the first year after the intervention. Usually the cause is tissue infection, which initiates inflammation and scarring. Late develops years after the operation. It is more often caused by a violation of the integrity of the installed object, effusion containing silicone filler. The prosthesis can become outdated, wear out. Sometimes contracture is associated with an inflammatory focus in this area.
Step by step
Signs of capsular contracture after mammoplasty increase gradually. Four successive steps of the pathological process have been identified. At first, the mammary gland does not differ in density from that in the preoperative period, the prosthesis is surrounded by soft tissues. The capsule formed by fibrin fibers is elastic, its dimensions are within the normal range.
As the condition progresses, it is possible to feel the edges of the implanted object when examining the breast. The gland around becomes more dense compared to the state before the operation.
The third step in the development of signs of capsular contracture involves a significant increase in the hardness of organic tissues. On palpation, you can feel the contours of the prosthesis, with a visual examination it can be seen with the naked eye. From the side, it is noticeable how and where the implant is deformed, what dents appeared on it, irregular, originally unforeseen roundness.
At the fourth stage of the pathological process, the membrane formed by fibrinacquires a special hardness, it is more inherent in smoothness. When feeling this area, the patient feels severe pain. To assess how far the condition has gone, whether the processes can be considered normal or it is a pathology, you need to do an ultrasound, MRI, assess the condition of the breast visually and by palpation.
Unpleasant aspects of the phenomenon
Capsular contracture in itself is not yet a threat to life, but the formation of such a capsule makes the result of the operation visually unattractive. The woman is dissatisfied with her appearance and wants to correct it. The task of the surgeon is to exclude deformation. Secondary surgery is more complex than the first surgical intervention, because the surgeon must simultaneously provide a solution to several problems. The event is carried out under local anesthesia, which is harmful to blood vessels and the heart.
What to do?
Capsular contracture is corrected by an integrated approach. To choose the right treatment option, it is necessary to assess the degree of the pathological process. In some cases, conservative treatment is sufficient, sometimes an operation is indicated for the patient - this is determined based on the state of the fibrin tissue. If a contracture of the first two degrees is detected, to eliminate it, you need to constantly massage the gland. The patient will be prescribed a course of physiotherapy. Vitamin E is orally prescribed, and a course of anti-inflammatory drugs may also be recommended. The drugs are injected locally, the implant is chipped.
Capsular contracture in the third and fourth stages requires more thorough and complex treatment,including surgery on the patient. There are several ways and methods of intervention.
How is it going?
Capsular contracture can be corrected with an open capsulotomy. This is the name of the intervention, during which the capsule is cut, its condition is assessed, the position of the implanted object is changed or the implant is completely replaced based on the condition of the breast.
A good alternative is to use an endoscope. This capsulotomy involves the use of specialized surgical instruments. Significantly less damage is done to the tissues, and only minor traces of punctures remain on the body, through which the devices are inserted into the gland. Compared to the open form, this operation requires a short recovery period. True, not everything is so good: endoscopic surgery also has disadvantages. It will not be possible to replace the prosthesis or adjust its location.
Capsulectomy
Such operation can be partial or absolute. The operation involves the removal of the capsule from the body. The implant is either changed or removed. Radical intervention is associated with injuries, so in most cases there is no question of replacing the prosthesis - the risk of relapse is too high. In some cases, replacement is allowed, but the implant is placed in a different area of the breast.
How to warn?
To minimize the chance of developing contracture, choose responsiblysurgeon, so that you can not be afraid for the quality of the event. Equally important is compliance with the rehabilitation rules. It is believed that the likelihood of contracture is less if a prosthesis is used, the surface of which is textured. Such a product will not move, move, which means that friction is minimized. The weaker it is, the less will be the thickness of the fibrin formation. True, not all modern surgeons specializing in such plastic surgeries share this opinion.
To reduce the risk of pathological contracture formation, it is reasonable to use modern implants, even if this is not the cheapest offer on the market. You should make sure that there are quality certificates, make sure that the manufacturer has checked all products. Currently, patients have access to products of the fourth and fifth generations - they are more perfect and reliable. Many doctors advise against implants filled with liquid containing silicone, since this substance has the ability to penetrate outside the installed object, as a result, there is a higher risk of fibrin capsule formation. An alternative is a cohesive gel. This is a viscous substance that is less able to seep beyond the installed foreign object.
Features of preventive measures
As practice shows, in order to minimize the risk of contracture, it is necessary to properly prepare the patient for surgical interventions. To do this, you need to undergo a thorough examination before the operation. It is important to evaluate all the features of he alth, to exclude the possibility of injuries to the operated area, so that seals and scars do not appear in the future.
The patient's task is to carefully follow the doctor's recommendations during the recovery period. By following the rules, a person reduces the risk of developing many complications, of which the pathological capsule is not the worst. Many also advise wearing special underwear for a couple of months after the intervention, which helps maintain the anatomically correct shape of the breast. Compression garments allow you to stabilize and fix the implanted object, it will not move. Underwear minimizes the risk of implant sagging in the future.
Responsibility and safety
Sometimes a doctor may recommend a breast massage. The doctor will explain how to properly influence the tissues, how often and how long the procedure is needed. Breast massage should not be done without the advice of a doctor. In some cases, the doctor also selects a set of exercises to activate blood flow.
After the operation, the patient's task is to regularly come for preventive examinations. The doctor can notice risk factors that can provoke contracture in time, and refer the woman to physiotherapy. Treatment of contracture without surgery is allowed only in the first two stages, but it is impossible to see for yourself that the situation is developing incorrectly. At this time, the need for intervention can only be noticed by a qualified specialist.
Do I need help?
If there is discomfort in the chest after the operation, if there are any signs that cause doubts about your he alth, you should not hesitate to visit the doctor, even if the previous visit was relatively recent. Responsible attitude towards yourself and your he alth is the key to long and happy years of life.
