Fibrocapsular contracture is a possible complication due to surgery on the chest. The problem is that even an experienced surgeon can not always guarantee the absence of complications. Contracture may appear unpredictably, even if all activities were carried out extremely correctly and in high quality. On average, one in ten women who have undergone breast plastic surgery contractures.
What is it about?
Capsular breast contracture is a compacted formation, the components of which are connective tissue fibers. It resembles a capsule and surrounds implanted materials. This leads to increased pressure and deformation of the site. Capsule formation is the body's natural response to the introduction of a foreign object. After the operation to install the implant, such a formation can appear unpredictably in different parts of the body - it depends on where the intervention was performed. For example, contracture is also possible in the gluteus, if the operation was done here. If the thickness of the formation is within normal limits, this is considered an adequate reaction 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 health, but can even cause death.
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 fail to make an incision incorrectly. There is a chance of infection in the wound, the incorrect choice of the moment of installation of the drainage system. There is a likelihood of contracture if a thorough study was not performed before the operation to determine the presence of inflammatory foci, or such tests gave a false negative result.
Specialized reference books showing photos of capsular contracture forming near the implant also usually show in detail the images of the installed prostheses themselves - often they provoke a pathological phenomenon. If the prosthesis is not suitable in size or shape to the pocket that was created for it in organic tissue, there is a chance of complications. Specific features of the material from which the implant is made, and even the filler of this object, can provoke a contracture.
About the reasons
As is known from the reviews, capsular contracture after mammoplasty is sometimes explained by the specific features of the patient’s body that underwent surgery. Individual reactions to the implant are possible. Different people have different body susceptibilities to deep scarring of tissues.
There is a likelihood of an external effect provoking contracture. It is known, for example, that the risk of complications is higher if the patient has bad habits, if the woman is forced to use medications with prolonged courses. Certain risks involve injury to the area near the implanted object, especially if it provokes a gray, hematoma.
Pathology factors
According to medical guides explaining the causes of the appearance and showing the capsular contracture that appears after mammoplasty in the photo, there is a higher risk of learning from experience how the process proceeds if after surgery hematomas form in the damaged area. 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 volumes of subcutaneous structures exfoliate, 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 under it, and the base turned out to be smaller than the implanted object. The following factors can become factors in the appearance of contracture: a low level of quality of the operation performed by the doctor, inattentive observance by the patient of recommendations for recovery during rehabilitation, the formation of a focus of inflammation after the intervention. There is a high risk of contracture if the implant ruptures and silicone-containing liquid penetrates between the organic capsule and the object.
One of the explanations for contracture is considered fibroblastic theory. As the doctors explain, myofibroblasts are reduced, due to which peculiar fibers are generated - they make up the contracture. To minimize the risk of complications, prostheses whose surface is textured should be chosen.
How to notice?
Symptoms of capsular contracture may appear symmetrically on both mammary glands, they can cover only one implant. In some, the prosthesis loses its original shape under the influence of compression years after the operation, but in the majority the pathology can be detected in the first 12 months after the intervention. The breast becomes denser, its shape changes. At first, the mammary gland resembling a triangle becomes more and more like an egg, then - like a ball, and the shape looks completely unnatural. Many patients note discomfort in the chest. The area is worried about soreness.
Estimating the timing of the development of a pathological condition, they speak of one of two stages. Signs of capsular contracture of an early form appear during the first year after the intervention. Typically, the cause is tissue infection, which initiates inflammation and scarring. Late develops years after surgery. It is often caused by a violation of the integrity of the installed object, effusion containing silicone filler. The prosthesis may become obsolete. Sometimes contracture is associated with an inflammatory focus in this area.
Step by step
Signs of capsular contracture after mammoplasty increase gradually. Four consecutive steps of the pathological process are identified. At first, the mammary gland does not differ in density from that in the preoperative period; soft tissue surrounds the prosthesis. The capsule formed by fibrin fibers is elastic; its dimensions are within the normal range.
As the condition progresses, you can feel the edges of the implanted object during breast examination. The gland around it acquires an increased density when compared with the condition before surgery.
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 roundness, which were not initially foreseen.
At the fourth stage of the pathological process, the membrane formed by fibrin acquires a special hardness, and smoothness is more inherent in it. 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 whether it is a question of pathology, it is necessary to do an ultrasound scan, an MRI scan, to assess the condition of the chest visually and by palpation.
Unpleasant aspects of the phenomenon
Capsular contracture in itself is not a threat to life, but the formation of such a capsule makes the result of the operation visually unattractive. The woman is unhappy with her appearance and wants to fix it. The surgeon's task is to eliminate deformation. Secondary surgery is more complicated 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 the patient is shown surgery - this is determined based on the state of fibrin tissue. If 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 given orally, and they may also be advised to take a course of anti-inflammatory. The drugs are injected topically, and the implant is chipped.
Capsular contracture at the third and fourth stages requires a more thorough and complex treatment, including the operation of the patient. There are several ways and methods of intervention.
How is everything going?
Capsular contracture can be corrected by open capsulotomy. This is the name of the intervention, during which the capsule is cut, its condition is evaluated, the position of the implanted object is changed, or the implant is replaced completely based on the state of the mammary gland.
A good alternative is to use an endoscope. Such capsulotomy involves the use of specialized surgical instruments. Significantly less harm is done to the tissues, and only minor traces of punctures remain through the body, through which the devices are inserted into the gland. Compared with the open form, such an operation requires a short recovery period. True, not everything is so good: endoscopic surgery also has drawbacks. Neither replace the prosthesis, nor adjust its location will work.
Capsulectomy
Such an operation may be partial or absolute. The operation involves the removal of the capsule from the body. The implant is either replaced 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 another part of the chest.
How to warn?
To minimize the likelihood of developing contracture, you should responsibly choose a surgeon so that you can not be afraid for the quality of the event. Compliance with rehabilitation rules is equally important. It is believed that contracture is less likely if a prosthesis whose surface is textured is used. Such a product will not move, move, which means friction is minimized. The weaker it is, the smaller the thickness of the fibrin formation will be. True, such an opinion is not shared by all modern surgeons specializing in such plastic surgeries.
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. Make sure that you have quality certificates, make sure that the manufacturer has checked all the products. Currently, products of the fourth and fifth generations are available to patients - they are more perfect and reliable. Many doctors advise you to abandon implants filled with a silicone-containing liquid, since this substance has the ability to penetrate outside an established object, as a result, there is a higher risk of fibrin capsule formation. An alternative is cohesive gel. This is a viscous substance that is less able to seep beyond the boundaries of an established foreign object.
Features of preventive measures
As practice shows, in order to minimize the risk of contracture, it is necessary to correctly prepare the patient for surgical measures. To do this, you need to undergo a thorough examination before the operation. It is important to evaluate all the features of health, to exclude the likelihood of injuries of the operated area, so that there are no seals, scars 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 risks of developing many complications, of which the pathological capsule is not the worst. Many are also advised to wear special underwear for a couple of months after the intervention, which helps to maintain the anatomically correct shape of the chest. Compression garments allow you to stabilize and fix the implanted object, it will not move. Lingerie minimizes the risk of sagging of the implant in the future.
Responsibility and Security
Sometimes a doctor may recommend breast massage. The doctor will explain how to properly act on the tissue, how often and how long the procedure is needed. Without the advice of a doctor, breast massage should not be. 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 the 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 independently see that the situation is developing incorrectly. At this time, the need for intervention can be noticed only by a qualified specialist.
Do I need any help?
If there is discomfort in the chest after the operation, if there are any signs of doubt in your health, do not hesitate to visit the doctor, even if the previous visit was relatively recent. Responsible attitude to yourself and your health is the key to long and happy years of life.