The popularity of plastic surgery on the mammary gland is constantly growing. Moreover, breast surgery is in demand not only to enlarge it or change its shape. The number of operations for lifting ptosis of the mammary gland and its reduction is growing, i.e. reduction in breast size.
With the growing number of plastic surgeries on the mammary gland, cases of
poor-quality execution of the surgical procedure itself for cosmetic lifting, breast augmentation or reduction. The question here is, rather, a statistical increase in the volume of mammoplasty operations performed, rather than the incompetence of plastic surgeons and cosmetologists. However, it is worth considering possible problems and complications that some patients may experience after mammoplasty.
Problems and complications during surgical breast augmentation.
Among the complications after plastic surgery on the mammary gland, the most common is fibrosis of the mammary glands, or fibrous capsular contracture, that is, a fibrous compaction, as in the photo below:
The formation of such seals is caused by the body's rejection reaction to a foreign body, such as a breast implant. This complication is not medical error and not the incompetence of the surgeon, this is a normal reaction of the body with healthy immunity. Fibrous capsular contracture occurs in the early and middle postoperative periods, usually six months to a year after mammoplasty. Fibrous compactions can appear on one mammary gland or on both at once. Fibrosis can lead to severe and extensive breast deformation, loss of its natural shape and symmetry. Lumps in the chest with fibrous growth can be very painful, and they can go away without pain syndrome. Unfortunately, fibrous capsular contracture will not resolve on its own, and such complications after mammoplasty must be treated with repeated surgery. In this regard, the issue of using only high-quality mammary gland implants, as in the following photo, arises:
When using the right implants, the risk of fibrotic complications is significantly reduced, although it does not go away completely. Sometimes a woman patient is not satisfied with the aesthetic result of breast surgery - the mammary glands do not look symmetrical, they come in different sizes and shapes, in such cases the implants need to be removed. In addition, sometimes the patient complains of a change (decrease or increase) in the sensitivity of the areola and nipple. Sometimes colostrum is released, but these complications go away on their own after some time, usually after a few months and without additional treatment.
Problems and complications with breast lifts.
When eliminating breast ptosis and cosmetic lifts, implantation of artificial endoprostheses is usually not a problem. Therefore, the risk of fibrosis of breast tissue during such operations is negligible. But, as with other types of mammoplasty, there is always a risk of postoperative hematomas. Due to tissue bleeding, a postoperative hematoma (simply bruises in the area of the operation) occurs in places adjacent to the incisions. Usually hematomas are not very large and go away on their own or are eliminated with medication. Although in fairly rare cases, cyanosis and swelling are expressed in a large volume and over a large area. If large hematomas do not resolve over a long period of time, repeat surgery may be necessary with new excision of breast tissue to remove blood clots and eliminate the bleeding that is fueling the hematomas.
In the photo above, the patient before and after a breast lift.
Quite rarely, after mammoplasty, inflammatory processes in the mammary gland may occur, most often this occurs in the first week after surgery. Sometimes, just as rarely, inflammatory processes can become active much later. The risk of inflammation remains throughout the rest of life. Inflammatory processes in the mammary glands, like any inflammation, are accompanied by a pronounced increase in temperature, pain and swelling of the site of inflammation appears. The problem of treating inflammatory complications is usually solved with the help of antibiotics. And when plastic surgery for mammary gland enlargement, the problem of inflammation is solved by temporary removal breast implant for a period of six months. The choice between antibiotic treatment and removal of the prosthesis depends on the patient’s condition and the danger of the situation to his health.
Features and consequences of breast reduction surgery?
The following photo shows the patient before and after breast reduction surgery:
Many women dream of big breasts. For others, massive mammary glands cause grief and trouble with posture and the health of the back and spine. Certainly, big breasts- not a very common problem for women. However, the problem exists, and sometimes the effect of heavy breasts on a woman’s health or some aesthetic problems require surgical intervention by a plastic surgeon.
The reduction breast reduction operation is considered the most difficult in mammoplasty and requires high professionalism, experience and skill of the surgeon. It practically does not have any special complications. All complications and problems are the same as with other types of mammoplasty. Although dissatisfaction with operations still occurs among patients, it is associated with cosmetic problems. The fact is that many women, after breast reduction, are dissatisfied with the fact that surgeons are forced to make stitches in fairly visible places. Whereas with breast augmentation and with most lifts, they are left in less visible places, that is, under the breasts. Unfortunately, the vertical seams rub against clothing while walking and involuntarily remind you of the operation. If you don’t feel complex or get upset, then within six months to a year the stitches will no longer be sensitive and noticeable.
About proper washing of your hair and hair before and after washing your hair.
Breast enhancement surgeries are among the most popular. After all, such an intervention solves not only aesthetic, but also psychological problems, often getting rid of complexes. But mammoplasty can also cause complications. There are problems of different nature, and there are many reasons for their appearance.
Read in this article
Possible problems
Mammoplasty is a serious surgical procedure performed under general anesthesia. During the operation, living tissue is damaged, which must then heal. All this does not exclude the emergence of problems inherent in any surgical manipulation. Their occurrence is not at all necessary, but possible. Complications can be divided into general and specific.
Surgical
To complications general include the following:
- Development infectious process . The problem is detected a few days, less often weeks, after the operation. The pain characteristic of this period does not subside as it should, but intensifies. Swelling and redness of the skin also increase, and purulent fluid is released from the sutures. If you encounter a complication initial stage, it can be eliminated by taking antibiotics. In other cases, you have to remove the implant, carry out treatment and only then do mammoplasty again.
A - skin necrosis; B - suture gap; C—fat necrosis; D — necrosis of the nipple-areolar zone Leaving the problem unattended is dangerous. The infection can develop to toxic shock, manifested by a sudden rise in temperature, vomiting, diarrhea, skin rashes, and loss of consciousness. This is a deadly condition.
- Hematoma and seroma. They are accumulations of blood and serous fluid. A hematoma can form as a result of leakage from a vessel damaged during the intervention. Sometimes its walls are injured in postoperative period. Seroma occurs in a similar pattern, but contains serous fluid. Small formations disappear without intervention.
Hematoma But if fluid continues to flow into them, increasing the problem to a significant size, it is necessary to drain the formation and suture the vessel. Otherwise, complications can lead to infection and more complex conditions.
- Formation of rough scars. Normally, healed sutures should be barely noticeable. But if the body has a tendency to hypertrophic tissue fusion or the appearance of keloid scars, a problem will arise. When mammoplasty is the first surgical intervention, this feature cannot be predicted. But if it is known before the operation, better surgery not to do, but to correct the breasts in other ways.
Hypertrophic scar However, a hypertrophic suture can form due to difficult healing caused by improper care and suppuration. In any case, additional treatment will be needed to get rid of the problem.
- Changes in the sensitivity of the nipples and areolas, and the mammary glands in general. The complication has two manifestations - pain or numbness in this area.
The first is justified by tissue damage. But if the nerves are injured or pinched, there is no freedom of muscle contraction, the pain will continue to be present for a considerable time after the operation. This already needs to be treated. Damaged nerves can lead to loss of sensation, which also needs to be addressed.
- Increased body temperature. If it is slightly higher than normal, the symptom is considered as a natural reaction to surgical intervention. But the cause of a rise in temperature can also be developed inflammation. Here you will need to take antibiotics, whereas in the first case simple observation is enough.
Specific
Complications after mammoplasty can also be of a special nature, directly related to damage to mammary gland tissue and the introduction of implants into this area:
- Capsular contracture. The endoprosthesis must acquire a shell of fibrous tissue during the healing process. But if it is too thick and dense, it causes discomfort. The chest becomes hard, painful, and feels full. And the implant is compressed, which can cause damage, displacement, and protrusion through the skin. This requires intervention to remove the endoprosthesis, remove the contracture, and then install a new one. But no one can guarantee that the complication will not recur.
- Implant shell rupture. If it is salty, the breast will immediately change its shape, becoming wrinkled. When a silicone endoprosthesis ruptures, the problem is not always obvious. It is detected during hardware examination. But this complication will in any case require replacement of the implant.
- Breast asymmetry. More often occurs against the background of implant displacement. The problem is also caused by defects in engraftment even if it is in the correct position. Your own tissues can behave unpredictably due to individual characteristics. The complication can be eliminated by repeated surgery.
Implant displacement - Breast deformity. An external defect in the mammary gland zone can be expressed not only by their asymmetry. For example, there is such a disadvantage as . These are additional hemispheres just below the mammary glands. A problem arises when implants slip shortly after surgery or after a year and a half.
Another defect is symmastia, in which the mammary glands appear fused. Both problems are treated surgically, that is, by performing repeat mammoplasty.
Symmastia - Allergy to the implant. This is a rare complication, typical for those who, in principle, have an intolerance to many substances and materials. Manifested by breast swelling, skin rashes, and redness. If it doesn't help conservative treatment, you will have to remove the implant.
- Calcification. Under the influence of the presence of a foreign object in the thickness of living tissue, islands of compaction can form. This is a deposit of calcium salts, which, although not common, causes problems. If the complication is extensive, it is necessary to remove the implants.
- Necrosis of breast tissue. The areas around the implant are subject to death. The scar tissue formed here is deprived of normal blood supply due to the pressure of the endoprostheses. More often the skin suffers due to the peculiarities of their installation.
- Breast tissue atrophy. It appears over time after long-term placement of implants in the mammary glands or their removal without replacement with new ones. The tissues become thinner, the breasts take on an unaesthetic appearance, unevenness, and sagging.
- Impossibility of lactation after the birth of a child. Surgeons claim that high-quality intervention does not affect the ability to breastfeed. But according to statistics, 67% of women with implants do not have lactation, despite the preservation milk ducts. Among mothers who have not had mammoplasty, this number is 7%.
Others
Mammoplasty gives complications after surgery that seem to be not directly related to the presence of implants:
- Pathologies connective tissue. Statistically, the impact of endoprostheses on the occurrence of autoimmune diseases not proven. But it cannot be denied that surgery and tissue adaptation to the presence foreign body are forced immune system work hard. This weakens it, which may provide a chance for systemic disease.
- Malignant tumors of the mammary glands. It is known that the presence of an implant does not affect their appearance. But after installation, mammographic examination of the breast, which is the most informative in diagnosing cancer, is difficult. And unnoticed in time benign tumor has time to be reborn.
- Deterioration of sex life. Loss of breast sensation, which persists for some for a long time, deprives a woman of the usual sensations during lovemaking. And this area by nature should be an erogenous zone.
To learn about the most common complications after mammoplasty, watch this video:
Factors that will affect the result
The possibility of getting a complication after mammoplasty surgery is not at all predetermined. What determines a successful outcome of the operation and a problem-free life with implants:
- Choosing an operating doctor and clinic. Many complications arise due to incorrect installation of the implant, violations of sterility during surgery, and careless manipulation of surgical instruments. These are infections, necrosis, hematomas, seromas, damage to areas that should remain untouched during the intervention.
Postoperative care provided in the hospital also affects the outcome. Equally important is the doctor’s taking into account the characteristics of the patient’s body at the stage of preparation for mammoplasty.
- Preparation for surgery and rehabilitation. The results of tests taken to identify contraindications cannot be ignored. It is important to make efforts to prepare the body for it and facilitate recovery after. Drinking alcohol, smoking and taking blood thinning medications are prohibited.
It is mandatory to wear compression garments while avoiding exposure to heat. Careful care of sutures and timely consultation with a doctor if anything is alarming are important.
Mammoplasty gives a chance to correct what nature has done wrong or what merciless time has done. But she demands more attentive attitude to health, work on oneself, a lot of money, constant control. If you correct your breasts with implants and avoid complications, you still need to be prepared to replace them in 5 to 15 years.
Usually, many patients of plastic surgeons diligently ignore the topic of complications after surgery to correct the shape and volume of the breast, so as not to get upset. Plastic surgeons themselves are also in no hurry to talk about possible adverse consequences, limiting themselves to only noting that a positive attitude helps to survive the operation and rehabilitation period no problem.
A positive attitude is actually great. But it is better if it is combined with knowledge about what problems can arise with the operated breast, and what can be done to eliminate these problems.
Complications can arise after any breast surgery, but most often this concerns breast augmentation surgery with implants, since such patients are the majority of those who undergo breast surgery.
Conventionally, all complications can be divided into those that develop immediately after surgery, and those that appear after 1-2 months or even later.
Breast swelling
It happens to everyone without exception. Associated with tissue trauma during surgery. Swelling becomes a problem when it does not subside for more than 2 weeks.
Typically the cause of persistent swelling is:
- early refusal of compression garments;
- thermal procedures and any exposure to heat, even in a bathhouse, on the beach, or in a bath;
- untimely physical activity.
Therefore, if you follow the doctor’s recommendations, there will be no problems with the subsidence of swelling.
The photo shows the development of seroma on one side.
Seroma is an accumulation of serous (intercellular) fluid in the cavity around the implant. At the same time, the mammary gland increases significantly in size.
If seroma develops, fluid is removed from the cavity with a syringe under ultrasound guidance.
Bleeding
Photo: hematoma around the implant It happens that the surgeon may not see the bleeding vessel and may not stitch it up. But this is casuistry. It happens that a damaged vessel, in which the blood has clotted, for a number of reasons begins to bleed again after the end of the operation. In both cases, a hematoma forms in the cavity around the implant.
It manifests itself as a change in the shape and symmetry of the mammary glands. The part of the chest in which it is located becomes larger in size, sometimes the accumulation of blood is visible to the eye as a brown clot on the skin.
Pain is not in in this case indicator, since after the operation strong painkillers are prescribed.
The blood, even if the bleeding has stopped, will not resolve on its own, so the only way to eliminate it is to make a puncture or incision and drain the postoperative pocket for the prosthesis.
Video: Possible consequences of breast augmentation surgery
Loss of skin elasticity and mastoptosis
Typically, mastotosis develops faster when the prosthesis is placed under the mammary gland than under the muscle. It is difficult to predict the rate of its development before surgery. But ptosis develops quickly in those who had the first signs of sagging breasts even before surgery.
Photo: mastoptosis Contouring the implant under the skin
It happens in very slender girls whose skin is practically devoid of subcutaneous fatty tissue, in girls whose own mammary glands do not have a sufficient layer of fatty tissue to cover the prosthesis, in those who decide to lose weight after surgery.
The solution to the problem is the introduction of fillers or lipofilling of the breast.
Any implant migrates before it is firmly fixed in the tissues. But the degree of its displacement is small and is usually controlled by using compression garments, limiting physical activity and sleeping on the side and back.
Implants can migrate symmetrically, in which case the breast loses its desired shape due to the fact that the part of the breast above the nipple collapses, and the part below the nipple becomes disproportionately large.
It may also be that the implants are displaced asymmetrically, which becomes a serious cosmetic defect and requires repeated surgery.
Unnatural breast appearance
Not many people think about the shape of their breasts when agreeing to surgery. The only thing that occupies our minds is how to choose a good surgeon, and where to get money for the operation. The photo shows stars whose new forms look unnatural.
Photo: Janet Jackson 
Photo: Victoria Beckham 
Photo: Tara Reid 
Photo: Tila Tequila 
Photo: Heidi Montag 
Photo: Pamela Anderson The quality of the result suffers from this. Enlarged breasts become easily recognizable both to the touch and visually.
Most main feature artificial breast is a wide distance between the mammary glands. The biggest problem modern women, this is gigantomania– the desire to do more, without taking into account the amount of your own tissue to close the implant, subsequent convenience in Everyday life breast sizes 3-4-5.
Photo: Sheila Hershey In order to accommodate a large volume, surgeons are forced to use “high” prostheses, i.e. those in which the diameter is equal to or less than the diameter of the mammary gland, and the height is much greater than what a woman actually needs. The result is an excessively protruding chest, which looks unnatural.
Photo: Soft Touch implant The second problem is the preference for a breast height that does not correspond to age. As a result, they choose a very high placement of implants, which looks good on a girl 18-20 years old, but looks unnatural on a woman 30 years old and older.
Well, the third problem is the fear of soft and elastic breasts, which, without the support of a bra, do not stick out forward like the stern of a ship.
Natural breasts without the support of underwear in most cases do not have the same shape as in a bra. The same effect is achieved by Soft Touch implants, which have the same density as breast tissue.
But more often, patients of plastic surgeons choose something harder. Hence there are so many opponents silicone breasts among men, and there is so much criticism of breast enlargement from women.
Suppuration after mammoplasty
There may be several reasons why suppuration develops. The main ones are the rejection of the implant by the woman’s body, and the development of a purulent process when pathogenic bacteria enter the wound.
It all starts with an increase in body temperature and severe pain, which painkillers can only dull, but rarely relieve. Above the area of inflammation, the skin becomes sharply red and hot to the touch. Sometimes redness and pain can be throughout the entire mammary gland.
Treatment tactics for the development of suppuration are as follows:
- first, drainage tubes are installed in the area of suppuration, rinsing and intensive antibacterial therapy are carried out (large doses of antibiotics are given);
- if drainage is ineffective, the implant is removed.
If drainage helps, then in the long term complications such as severe fibrosis and breast asymmetry may develop.
Scars
What postoperative scars will look like largely depends on the body’s tendency to form keloid and hypertrophic scars, as well as on the thoroughness of care for the area of surgical incisions.
Even before starting, you need to agree that thin scars will remain, since they do not disappear without a trace in anyone. But they shouldn’t be too noticeable either.
The most important rule of care is to minimize tissue tension on both sides of the scar. For this, paper strips (adhesive strips that prevent the edges of the wound from spreading), and silicone stickers on the seams, and wearing compression garments all the time until the scars are completely formed will be good.
Also, do not over-massage the scars, intensively rub any ointments and creams into them, or start using Contractubex cream too early.
Photo: keloid scar Any absorbable drugs can be used only when the connective tissue in the scar area has matured. Before you do, you will only do harm.
Therefore, if you are not satisfied with the appearance of the scars, you can again contact a cosmetologist to have the scars “polished” with a laser or made less noticeable in other ways.
With such a feature of the body as the formation of convex wide scars, nothing can be done.
If keloid scars have already formed in the past, then from any operation that is not performed according to emergency indications, it's better to refuse.
After breast surgery, a woman may feel quite severe discomfort, skin tension at the site of swelling, and even moderate pain. Details in the article -.
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Loss of skin sensitivity
Loss of sensation is due to the fact that during the operation the nerves that go to the skin are damaged. This complication most often occurs when making an incision around the nipple. But it can also happen when the operation is performed from the axillary or inframammary approach.
Sensitivity rarely goes away forever. In most cases, it recovers within 2-6 months after surgery.
Cracks and ruptures of implants
Third generation implants from reputable manufacturers are safe. These include McGan, Mentor, Silimed. Typically, high-quality breast prostheses are made of non-flowing, sticky silicone, which does not spread even if the implant ruptures, and if it is squeezed out of the shell (in case of severe chest trauma, for example), it remains in the cavity that was surgically created for the prosthesis. The shell of modern implants is two-layer. Inner layer silicone, external prevents the leakage of gel from the implant cavity.
The reason for the ruptures of the prostheses of previous generations was the wear of the walls due to constant flexion and extension under the influence of breathing movements chest.
Therefore, such implants had to be changed every five years. Modern third-generation implants are designed for 300 years of regular flexion and extension during breathing, therefore spontaneous rupture of the third-generation prosthesis is excluded.
If under the influence mechanical injury If the breast implant ruptures, it must be removed or replaced as planned.
But there are still cases where low-quality implants enter the market and cause serious complications when they rupture, form cracks, or when the gel leaks through the shell.
An example of such implants were products from the French company PolyImplantProsthesis (PIP), which were filled with technical silicone, which could migrate and have a toxic effect on the body, and a single-layer shell that did not prevent the gel from seeping from the implant into the tissue.
If silicone gel gets into the tissue, it can migrate under the skin of the chest and abdomen, forming tumor-like seals - silicones. The gel may also migrate down the intermuscular channels of the arm. The gel can also accumulate in the lymph nodes.
Any such spread of silicone gel requires extensive surgery to remove the implant and tissue damaged by the silicone.
Video: Replacing the PIP-1 implant
The video shows the process of replacing an implant, through the shell of which gel seeps. This video shows the process of removing a ruptured implant. The gel soaked the nearby lymph nodes.
Video: Removing the PiP-2 implant
The photo shows the result of an unoperated rupture of the implant: the contents of the implant are released along with pus through a skin fistula (a hole in the skin that forms independently during the purulent process). The last photo shows the shell of the implant.
If you are planning to undergo breast augmentation in a serious clinic that purchases prosthetics from serious manufacturers, then you have nothing to worry about.
If you think that dentures are not the main thing and you can save on them by buying cheaper implants yourself (and in many places you can now buy a pair of implants very cheaply), then be prepared for any result of your decision.
Capsular contracture
The development of connective tissue occurs around any foreign body in the body. A breast implant is no exception. The fibrous capsule becomes a problem when it begins to shrink around the implant and deform it.
Until now, the reasons for the formation of contracture are not known. It has been suggested that infection, regular physical activity, a tendency to form hypertrophic scars, or improper preparation of the implant before surgery may contribute to its development. But no one can still predict the body’s reaction.
In order to distinguish between normal and pathological cases of fibrous capsule formation, the Baker classification was created:
- 1st degree– the breasts look natural and are soft to the touch;
- 2nd degree– the breasts look natural, the implants do not change shape, but feel firm to the touch;
- 3rd degree– a change in the shape of the breast becomes noticeable, the breast feels firm to the touch;
- 4th degree– the breast is deformed, heavy and very dense, sometimes painful.
For the first and second degrees, no correction is required. In the third degree, the capsule is surgically excised (capsulectomy is performed).
If capsular contracture of the fourth degree develops, the implant must be replaced or completely removed. The likelihood of contracture developing again is very high.
To prevent the development of capsular contracture, implants with a textured surface are used, breast massage courses are carried out, ultrasound therapy procedures are carried out, and vitamin E intake is recommended.
Typically, skin ripples are not static. It may appear or disappear depending on changes in body position or movement. She may have varying degrees expressiveness. Waves can be noticeable on the skin without clothing, or they can only be felt.
The appearance of skin ripples can be affected by: 
- the condition of the patient’s skin, its elasticity, a sufficient layer of subcutaneous fat;
- shape and size of the implant;
- technique of the operation.
Most often, the “washboard effect” manifests itself in thin women with a small volume of their own breast. How larger size prosthesis, the more likely the appearance of “waves” will be, especially if the width of the prosthesis is greater than the width of your own breast.
The manifestation of skin ripples is enhanced by saline implants, which are specially overfilled in order to avoid splashing and rolling of liquid inside the prosthesis. Soft gel dentures will create less ripples.
Implants with a textured surface create more ripples than smooth ones because they are held in place more tightly by tissue.
The risk of developing “waves” is lower when the implant is installed partially or completely under the muscle.
To eliminate skin ripples, you can: 
- add volume around the implant using feeders such as Macroline or Alloderm;
- carry out lipofilling of the breast around the implant;
- replacing a saline implant with a gel one;
- transplantation of an implant under the muscle, if previously it was located between the muscle and the mammary gland;
- replacing the implant with a smaller one.
In fact, not everyone agrees to repeat surgery, especially to replace the implant with a smaller one, since skin ripples in most cases do not become a serious cosmetic problem.
Damage to ducts and breast tissue
This does not happen after every operation. Those who:
- make an incision around the nipple;
- An implant is placed under the glandular part of the mammary gland.
If a woman is no longer going to breastfeed her children, then this will not cause her much trouble. If pregnancy is planned or expected, the child will have to be immediately switched to artificial feeding.
If the ducts or gland tissue are damaged, then it will no longer be possible to restore integrity and patency.
Like any surgical intervention, breast augmentation surgery has its own risks and complications, which depend both on the qualifications of the surgeon and on the individual characteristics of the patient’s body and the combination of various circumstances.
Seroma
One of the complications that occurs after augmentation mammoplasty is the accumulation of fluid around the implant.
There are two types of fluid that can accumulate: serous and lymph.
Seroma is the aqueous component of the blood and is a serous fluid containing, in addition to water, blood plasma proteins and a certain amount of blood cells.
The presence of red blood cells can give seroma a red tint of varying intensity. However, most often seroma has yellow and a consistency similar to jelly.
As a rule, liquid accumulation occurs in the “dead space zone”, i.e. in the place that remains after suturing the wound. During breast augmentation, the favorite place for serous fluid to accumulate is Bottom part mammary gland between soft tissues and the implant.
Reasons for the formation of sulfur ohms
1. The cavity is too large for the implant without drainage
2. Violations of the postoperative regimen by the patient
3. Early physical activity
4. Avoiding compression garments
5. Neglecting to install drains
The formation of seroma occurs due to the reaction of soft tissues to surgical trauma and a foreign body, i.e. implant The formation of serous fluid begins with excessive aseptic inflammation, expressed by a violent reaction of the tissues surrounding the implant. As a result, soft fabrics surrounding the implant release a large amount of fluid, which accumulates around the implant and is not removed due to the lack of drainage tubes.
The composition of seroma includes leukocytes, erythrocytes, macrophages, mast cells, blood serum from damaged venous and lymphatic capillaries.
Clinical signs of seroma usually appear 2-3 days after surgery in the form of the formation of a tumor-like swelling, fluctuation and fever. Patients may experience minor discomfort or painful sensations. To confirm the diagnosis of fluid accumulation, an ultrasound scan is necessary.
It is necessary to know that the reaction to injury or foreign body, expressed in the accumulation of a small amount of fluid, is completely normal occurrence and is not considered a complication. It becomes a complication only when the reaction is severe.
It is for this reason that the implantation pocket must be drained with special drainage tubes for 1-2 days. Thanks to them, the serous fluid is removed and does not cause further irritation to the surrounding tissues.
If the diagnosis of seroma is confirmed by ultrasound, then the most best treatment This means installing a small drainage and prescribing anti-inflammatory medications. In 90% of cases, gray can be cured within 5-7 days, and sometimes faster.
Prevention of seroma formation
1. Carefully suturing the edges of the wound so that no cavities are formed
2.Usage various types vacuum drainage
3. Putting on compression garments immediately after surgery
4. Strictly observe asepsis during the operation
5. Use of antibiotics and anti-inflammatory drugs for prophylactic purposes in the early postoperative period.
Hematoma after enlargement I breast
A hematoma is a limited accumulation of blood resulting from bleeding of a vessel damaged during surgery.
During breast augmentation surgery, a hematoma accumulates in the implantation pocket in the space between the implant and the soft tissue.Hematomas have nothing in common with ordinary superficial bruises. This is explained by the fact that complications that arise after hematomas can be very serious and cannot go away on their own. Ordinary bruises resolve on their own without consequences, but a hematoma should always be removed.
Causes of hematoma development
The cause of hematoma development is always trauma blood vessels which is inevitable during any surgical operation. To stop bleeding, surgeons use cauterization of bleeding vessels, however, in the early postoperative period, various reasons bleeding may resume.
Treatment hematomas
Treatment of hematoma after breast augmentation is only surgical, since a large accumulation of blood near the implant will certainly lead to complications after some time. The sooner the hematoma is removed and the bleeding is stopped, the better.
The operation is performed under general anesthesia or local anesthesia depending on the volume and location of the hematoma. If the surgeon removes the hematoma in time, then the risk of complications is reduced to zero. Aesthetic result with proper treatment will not be harmed.
Lymphostasis of the breast
The cause of lymphorrhea is injury to medium and large lymphatic vessels during surgery.
Unlike blood, lymph does not clot, which leads to the formation of lymphorrhea, i.e. constant expiration lymph. For each patient, the location of the lymphatic vessels is different and very variable, which sometimes leads to their damage.
Lymph has a transparent, slightly yellowish color, which makes it invisible in the surgical wound. The flow of lymph is not intense and therefore often goes unnoticed.
Lymphorrhea is manifested by the accumulation of lymphatic fluid around the implant, similar to a seroma, but with the difference that this is not a reaction of surrounding tissues to the implant, but the result of damage to the lymphatic vessel.
In this case, it is necessary to drain the implantation pocket and carry out drug treatment. Most often, lymphorrhea stops within a few days. It is extremely rare to remove the implant and cauterize the damaged lymphatic vessel.
To prevent the formation of postoperative lymphorrhea, the surgeon must first of all perform the operation very carefully. Careful separation of the soft breast tissue, careful hemostasis, and installation of an implant of a reasonable volume for the patient guarantee the absence of such complications after surgery.
Capsular contracture
Around any foreign body that enters the human body, a thin capsule from connective tissue - this is normal biological process, the purpose of which is to isolate a foreign object from the body.
The same thing, i.e. The formation of a connective tissue capsule occurs around the breast implant, which lasts for several months after surgery.
Capsular contracture is hardened and thickened fibrous tissue of the capsule that compresses the implant and causes deformation of the mammary glands.
Reasons for development
The main reason causing capsular contracture is considered to be an excessive reaction of the body to the presence of a foreign body, i.e. implant. At some point, the normal process of formation of connective tissue around the implant gets out of control and intensive formation of connective tissue begins. As a result, the capsule, which should normally be 0.3mm thick, thickens to 5-7mm
1) Reasons caused by surgery
These include:
- hematoma formation
- accumulation of serous fluid around the implant
- insufficient size of the formed pocket
- rough handling of tissue by a surgeon
- infection of the implantation pocket cavity
2) Reasons caused by implants
3) Reasons related to patients
Individual feature associated with an excessive reaction to the material from which the implant is made
4) Causes caused by exogenous (external) factors
injuries in the early or late postoperative period, which can be immediate (impact) or chronic, for example, wearing uncomfortable compressive underwear
the presence of chronic intoxication associated with a chronic source of infection, for example, sinusitis, tonsillitis, which are subject to regular exacerbations.
As the experience of surgeons shows, the most common cause of the formation of capsular contracture is an excessive reaction of the body to the implant. Other reasons may contribute to the development or act together, but the main reason is still a hyperreaction to the material from which the implants are made.
Treatment of capsular contracture
Treatment this complication can be carried out both by conservative methods and by surgery. At the same time, we must immediately make a reservation that conservative treatment is now practically not used by surgeons.
Conservative method
TO conservative method refers to capsulotomy, which involves squeezing the gland with your hands until the capsule ruptures. As a result of these actions, the breasts become soft. But, among most surgeons, the method was not approved due to high trauma, the risk of implant rupture, hematoma formation and migration of the gel into the surrounding tissues.
Surgical method
The surgical treatment method is the most effective and consists of an operation during which the implant is removed, the capsule is excised (removed) and a new implant is installed. This is the most effective method combating capsular contracture.
Infection after mammoplasty
One of the complications that can develop after breast augmentation surgery is infection. The operation is accompanied by an inevitable violation of integrity skin which are a natural barrier to infection.
Despite all the precautions used in surgery, there is a small chance of infection through the surgical wound.
In addition, very often there are chronic sources of infection in the body, for example, chronic tonsillitis, chronic sinusitis, which after surgery can become a “donor” of infection. In this case, the infection spreads through the blood or lymph.
Surgical infection is a wound infection caused by the entry of pathogenic microorganisms into the surgical wound. Occurs in the early postoperative period. Most often, the cause is the entry of microorganisms from outside during the operation.
Types of infections
Currently, there are two types of infections:
1. Primary surgical infection that occurs shortly after surgery.
2. Secondary infection that occurs later long time after surgery and, as a rule, not directly related to the operation.
Reasons for the development of infection
1. Violation of asepsis rules
2. Bleeding inside the wound
3. Prolonged seroma, etc.
Treatment of infection after breast augmentation
Infection is a serious complication; if left untreated, it can cause suppuration of the implantation pocket, which in turn will lead to the need to remove the implant.
There are two methods of treating an infectious complication
Conservative method
On initial period development of inflammation, treatment is aimed at combating microflora and influencing inflammatory process using special means:
- prescribing regular dressings with antibacterial water-soluble ointments
- appointment antibacterial therapy
- use of antiseptics
- anti-inflammatory and decongestant drugs
- administration of infusion therapy
- physiotherapy appointment
The effectiveness of conservative measures should not be overestimated. They can help with local inflammation in the wound area, but if the suppuration spreads into the area of the implantation pocket, then these measures will not lead to success and sooner or later the implant will have to be removed.
Operative method
In cases where drug treatment does not lead to improvement and does not cause recovery, surgical intervention is resorted to. During the operation, the implant is removed, and the implantation pocket is washed with solutions of antiseptics and antibiotics. For several days, the surgical wound remains unsutured; regular washing and dressings are carried out. Once the wound is clean, you can stitch it up. In this case, the implant may be reinstalled six months or a year after removal.
Loss of sensitivity and numbness of the nipples
Loss of sensitivity and numbness of the nipples or other areas of the skin of the mammary glands is a fairly common complication.
Sensory impairment after breast augmentation surgery occurs in 21% of cases.
Causes of loss of breast sensation
- As a rule, the cause of sensitivity and numbness in the chest is damage to small nerve fibers. By stretching the branches of the tactile nerves that go to the skin, the surgeon can injure them during the formation of a pocket for the implant.
- Damage to the branches of the fourth intercostal nerve
As is known, the branch of the fourth intercostal nerve is responsible for the sensitivity of the nipple and areola.
Complete and partial damage to the anterolateral or anteromedial branch of this nerve occurs during improper installation of the implant, incorrect selection of the implant size and is accompanied by stabbing pains in the nipple.
- Large implant size
Installing an implant that is too large can also affect the sensitivity of the skin of the mammary glands or the nipple-areolar complex. The reason in this case is a strong stretch of the nerve fibers, which is essentially the same injury. In this case, restoration of sensitivity will definitely occur, it just takes time.
- Implant location
According to the observations of surgeons, it was revealed that when installing an implant under a large pectoral muscle, the risk of sensitivity and numbness is less than with installation under the mammary gland.
The nerve endings that connect to the nipple are very small and thin, and very often the surgeon, without noticing, stretches or cauterizes them during surgery.
If the nerve fibers were stretched during surgery, their sensitivity is restored fairly quickly. If they are cauterized, it will take a longer time for them to recover, depending on the degree of their damage.
Return of sensitivity
As a rule, restoration of sensitivity occurs within several months after surgery. But sometimes, when the degree of damage to the nerve fibers is high enough, it can take quite a while to recover. a long period time.
In some cases, the decrease in sensitivity may be persistent and not fully recover. Experience shows that this happens very rarely, but even in cases where the decrease in sensitivity is persistent, it does not bring significant discomfort to patients.
Before breast augmentation surgery, the surgeon must not only explain to the patient what risks it carries surgery but also ensure that her expectations for the aesthetic outcome are reasonable. The doctor then takes linear measurements to determine the initial breast size.
Modern preoperative 3D modeling technology allows you to more accurately measure breast volume, determine the location of the gland, and assess the projection and symmetry of the breast. Using laser beams, the breast is divided into several areas, the parameters of which are then used to create a three-dimensional image that allows modeling the future breast, taking into account the implantation of prostheses of various sizes and configurations.
3D modeling also helps to predict in advance the position that implants will take after installation. Numerous studies, for example, have proven that the breast volume that can be achieved with high-projection implants is 20-23% lower than indicated in advertising materials. Taking this data into account, 3D modeling systems allow you to individually select the shape and size of the breast. In addition, thanks to such images, patients know in advance what their breasts will look like after surgery.
During the operation
To place the implant in the breast and straighten it, the surgeon must make an incision, and in a place where the future scar will be least noticeable. The size of the incision depends on the type of implant and its location. For example, in the USA, the most popular is the submammary approach, the scar from which is hidden in the fold under the breast.
When installing implants, many surgeons prefer submammary or periareolar types of access. However, in the first case, there is a possibility that the breast will not be large enough to hide the scar underneath. In addition, according to the results of one study, patients with implants installed through an incision under the breast are more likely than others to undergo repeat surgery to correct asymmetry, ptosis, or replace prostheses. The periareolar installation method also has its disadvantages, for example, the likelihood of forming a noticeable scar, more high risk capsular contracture and decreased sensitivity of the nipple. A limitation to the use of this method may be that the areola is too small to accommodate implant placement.
Patients often ask surgeons to install implants through the axillary approach, that is, through armpit, because in this case the scar is less noticeable. However, despite its attractiveness from an aesthetic point of view, this installation method does not always allow implants to be placed with the required accuracy, which threatens increased risk capsular contracture and damage to surrounding tissues.
To minimize incision length and facilitate implant placement, the Keller funnel™ sleeve has been developed for non-contact placement of breast prostheses.
Breast implants are usually placed under the pectoral muscle or breast. When installing implants under the muscle, the risk of capsular contracture is reduced, but in patients with significant breast ptosis, there is a high probability of developing the so-called “double bubble” effect, or double fold. Moreover, due to natural process contraction of the pectoral muscle may cause the implant to dislodge. All these effects are excluded when installing an implant under the mammary gland. But if the patient’s own tissue is deficient, the prosthesis placed under the gland will most likely be easily palpable or even visually noticeable. In addition, the stability of the implant position with this method of placement leaves much to be desired: it can rotate or fall below the fold under the breast. Placing an implant under the pectoral muscle fascia reduces the risk of deformation, displacement, contouring and the formation of visible waves on the surface of the breast. But this approach requires considerable skill of the surgeon.
Also, some surgeons practice a combined method of implant installation, in which top part The prosthesis is placed under the pectoral muscle, and the lower one is placed under the gland. The advantages of this approach include a low risk of capsular contracture, non-palpability of the implant and more natural shape breasts Some experts believe that the combined approach increases the likelihood of implant deformation and visible retraction of the pectoral muscle. However, this method of breast implant placement is becoming increasingly popular.
Complications
- Seromas and hematomas
Collections of blood and serous fluid are common complications after surgical procedures involving cavity formation. Both seromas and hematomas can cause swelling and tenderness. Hematomas form in 0.9-3% of cases, and their formation does not depend on the age of the patient, the type of implant or the surgical approach used. Seromas resolve on their own in most cases, but sometimes ultrasound-guided drainage is required. - Infections
The highest risk of infection is breast augmentation through the armpit. This is due to the many manipulations required to install the implant. In addition to pain and implant failure, even moderate infection can cause capsular contracture. As for taking systemic antibiotics, the results various studies and reports on the effectiveness of antibiotic therapy before surgery are very conflicting. Therefore, there is no clear opinion regarding the importance of antibacterial therapy for the safety of breast augmentation.
- Capsular contracture
This is a contraction of the fibrous membrane around the implant, which leads to a painful, palpable and visible deformation of the breast. Capsular contracture is one of the most common complications after breast augmentation using implants. There are several ways to prevent the formation of capsular contracture, including irrigation surgical pocket antibiotic solution and placing the implant under the pectoral muscle. Various methods are also used to eliminate capsular contracture: implant removal, capsulotomy, capsule stretching, reconstructive surgery using an acellular dermal matrix. Non-surgical methods of reducing the manifestations of capsular contracture - capsule massage, ultrasound and shock wave therapy - are not effective in all cases. - Systemic diseases
As is known, in the United States, from 1992 to 2006, there was a moratorium on the use of silicone breast implants, the reason for which was the suspicion that the latter increased the risk of developing systemic diseases. In the course of multiple studies, scientists have not been able to establish a relationship between the installation of silicone implants and the occurrence of symptoms of systemic diseases. Experts have identified pro-inflammatory proteins that, when attached to the surface of a silicone implant, stimulate the formation of capsule fibrosis and can also cause autoimmune diseases in patients predisposed to them. However, the exact relationship between such pro-inflammatory proteins and systemic diseases not yet installed. - Loss of nipple sensation
Decreased sensitivity or soreness of the nipple and areola are common consequences of breast augmentation. According to experts, the location of the surgical incision is a key risk factor for the formation of paresthesia of the nipple-areolar complex, the likelihood of which increases threefold when installing an implant through an incision in the areola. Despite this, this method remains the most popular among patients. - Lactation
Many women, having decided to have breast augmentation surgery, worry how the installed implants will affect their ability to breastfeed in the future. Possible surgical operations to eliminate complications such as infection or capsular contracture, carry additional risks of damage to the breast. However, although an experienced surgeon can minimize all possible complications After breast augmentation, installation of implants increases the likelihood of hypolactation by 10%. As for the safety of breast milk, implants do not affect its quality in any way.
Patient satisfaction
Numerous studies have found that on average, 99% of patients 1 month after breast augmentation surgery are extremely satisfied with its results. After 6 years, this figure is 95%. The patient's level of satisfaction includes assessment of her own attractiveness, psychological state and sex life.
But despite these high patient satisfaction rates, numerous studies have shown that the suicide rate among women who have undergone breast augmentation is almost three times higher than among women with natural breasts. The risks are especially high in age group over 40 years of age immediately after surgery or a long time after it. Among probable causes Experts call this relationship the presence of significant psychological problems before the operation, unreasonable expectations from its results and psychological difficulties in case of postoperative complications.
