What is an encapsulated breast implant?
An encapsulated breast implant refers to when scar tissue forms around the implant, creating a capsule that separates the implant from the surrounding breast tissue. This is a natural response as the body views the implant as a foreign object and walls it off. However, in some cases the scar tissue capsule contracts and squeezes the implant, which can cause pain, distortion, and other issues. This is known as capsular contracture.
What causes capsular contracture?
The exact cause of capsular contracture is not fully understood. Factors that may contribute include:
– Bacterial contamination during surgery leading to infection
– Hematoma or bleeding around the implant
– Silicone leakage from the implant
– Genetic predisposition
– The surface texture of the implant – smoother surfaces tend to have higher contracture rates
However even with perfect surgical technique, there is still a possibility of capsular contracture occurring in some patients. The risk has been estimated between 10-20% over the lifetime of the implants.
What are the Baker grades for assessing capsular contracture severity?
The Baker grading system is used to classify the severity of capsular contracture:
| Baker Grade | Description |
|---|---|
| Grade I | Breast is normally soft and appears natural |
| Grade II | Breast is a little firm but appears normal |
| Grade III | Breast is firm and appears abnormal |
| Grade IV | Breast is hard, painful, and appears abnormal |
Higher Baker grades indicate more severe contracture. Grade III/IV is considered clinically significant capsular contracture.
What does capsular contracture feel like?
The symptoms of capsular contracture can range from mild firmness to severe pain and distortion:
Mild Contracture
– Slight firmness in the breast
– The implant may feel less soft and natural
– The breast shape may be slightly distorted
Moderate Contracture
– Breast firmness increases and feels distinctly abnormal
– Discomfort may occur, especially when lying down
– Noticeable distortion in breast shape
– Restricted implant movement inside the capsule
Severe Contracture
– Breast becomes excessively firm, hard, or even rock-hard
– Pain and tenderness in the breast
– Severe misshapen appearance
– Tight contracted breast
– Difficulty moving the implant at all within the capsule
So in summary, mild contracture may just feel like slight firmness, while severe contracture can be extremely painful and make the breast feel abnormally hard. The tightening capsule compresses the implant, nerves, and breast tissue.
When does capsular contracture typically occur?
Capsular contracture can develop at any time after breast augmentation or reconstruction surgery. However, most cases occur within the first year after the procedure.
– Early contracture occurs within the first 6 months post-op. This may be due to hematoma or early infection.
– Intermediate contracture occurs between 6 months to 2 years after surgery. This timeframe accounts for the majority of contracture cases.
– Late contracture occurs more than 2 years after the operation. The cause is often unknown but may be due to silicone gel bleed.
It’s important for patients to be aware of the symptoms of contracture even years after surgery. While capsular contracture is most common in the first year, it can still occur at any time throughout the implant duration.
What does it feel like to have a ruptured silicone implant?
A ruptured silicone breast implant occurs when the implant’s outer silicone shell develops a tear or hole and the inner silicone gel leaks out. Here are some symptoms of what a ruptured implant may feel like:
– Change in breast shape – The breast may appear deflated or asymmetrical compared to the other side.
– Decreased breast size – Loss of volume as the silicone gel escapes can cause the breast to appear smaller.
– Siliconoma – Silicone gel that leaks outside the fibrous capsule may feel like a lump in the breast tissue.
– Pain or tenderness – Especially if the leak causes inflammation. However, many times ruptures are “silent” and don’t cause pain.
– Hard knots – Granulomas, or scar tissue that forms around leaked silicone, may feel like hard knots or lumps.
– Nipple discharge – Silicone gel that travels outside the capsule could drain into the milk ducts and leak out the nipple.
– No obvious changes – In some cases there are no noticeable changes if the rupture is small or contained within the implant pocket.
If a person experiences these symptoms, they should have an MRI scan to confirm if their implants are ruptured. Silicone implant ruptures are not considered emergencies, but the implants will need surgical replacement.
What are common side effects after breast augmentation?
Breast augmentation surgery involves risks and side effects that patients should be prepared for during recovery:
Early Side Effects
– Swelling – Post-surgical swelling peaks at 3-5 days, may persist for weeks
– Bruising – Also normal and resolves within 1-2 weeks
– Numbness – Numbness or nerve pain due to trauma from surgical incisions
– Discomfort – Mild-moderate pain, soreness, tightness in the chest and breasts
– Asymmetry – Temporary uneven shape/position due to swelling and healing
Intermediate Side Effects
– Capsular contracture – Scar tissue tightening around the implant
– Infection – Uncommon but serious complication, often treated with IV antibiotics
– Hematoma – Blood collecting around the implant pocket, requires surgical drainage
– Implant displacement – Rare shifting in the implant’s position or noticeable edges
– Rippling/wrinkling – Visible implant folds may occur, more common with saline implants
Long-term Side Effects
– Implant rupture – Shell tear/silicone leak may occur years later
– Breast pain – Can occur from capsular contracture or implant rupture
– Implant visibility – Edges may become noticeable over time
– Additional surgeries – Like repositioning, removing, or replacing implants
Patients must weigh the benefits versus potential risks when considering breast implants. Side effects can happen weeks, months, or years after surgery.
What does double bubble deformity feel and look like?
Double bubble deformity is a potential complication after breast augmentation where the implant drops into a lower position, creating a visible “double bubble” shape. Here are the signs:
– Visible double contour – The lower breast appears full while the upper pole above the implant appears empty or flattened.
– Well-defined crease – There is often a noticeable fold separating the upper and lower breast mounds.
– Teardrop implant shape – Instead of fullness at the top, the implant sinks to the bottom in a teardrop position.
– Bottoming out – The bottom curve of the implant can be felt distinctly sitting too low on the chest.
– Wrinkling of the breast skin – This occurs above the crease due to lack of underlying breast tissue coverage.
– Synmastia – The implant displacement can pull the breast tissues together, causing synmastia or “uniboob” shape.
– Pain or discomfort – The abnormal implant position may cause pain in some patients depending on the severity.
Double bubble deformity makes the breasts appear very unnatural and rippled. It occurs due to weak internal support structures and tissues that fail to properly cover and stabilize the implants.
Can textured breast implants feel different? What about silicone vs saline?
Breast implant type and texturing can influence how implants look and feel:
Smooth vs Textured Implant Shell
– Smooth implants have a glossy, slick outer surface that feels slippery and slides easily under the skin tissues.
– Textured implants have a rougher, sandpaper-like shell. They adhere to surrounding tissues rather than sliding around, providing more friction.
Silicone Gel Implants
– Silicone gel has a viscous, liquid-like feel that retains shape. Gel hugs the contours of the implant shell.
– Silicone implants feel soft and natural, similar to real breast tissue. They have a supple jiggle.
– Silicone is considered to have a more natural look and feel compared to saline.
Saline-Filled Implants
– Saline has a watery feel and flows freely within the shell. It conforms to the shape of the implant pocket.
– Saline implants tend to have a firmer feel compared to the softer silicone gel.
– Due to the watery fill, saline implants are more prone to noticeable wrinkling or rippling, especially when deflated.
– Saline implants are heavier since saline is denser than silicone gel. Weight difference is more noticeable in larger implants.
Overall, smooth silicone implants most closely mimic the look and feel of natural breast tissue for most patients. But breast implant types have different trade-offs to consider.
What does encapsulation of an implant feel like when exercising? How is sensation affected?
Physical activity with breast implants that develop capsular contracture can feel more uncomfortable as the implants may become painful and rigid. Here’s what exercising can feel like with encapsulated implants:
– General discomfort during movement – Any high impact activity causes breasts to bounce and shift which is increasingly painful with hardened capsules. Even light jiggling movements during walking may cause soreness.
– Stabbing sensation – Some patients describe sharp, stabbing pains when the abnormally firm breasts move and compress. Nerves can get pinched by the tightened tissue.
– Inflamed, swollen breasts after exercising – The friction and irritation of the implants rubbing against the contracted capsule often leads to swelling and inflammation after working out.
– Burning around the implant – Rigid capsules put pressure on breast tissue that can feel like burning, especially around the lower half of the implant pocket.
– Lack of sensation – Numbness or loss of sensation may occur around the implants as nerves get damaged from sustained compression.
– Difficulty raising arms – Restricted arm mobility due to pain and tightness from contracted scar tissue in the armpit region.
– Trouble finding comfortable sleep positions – Capsular contracture often makes it difficult to sleep, especially on the side or stomach where the breasts get squeezed.
For these reasons, physical activity is challenging for those with severe capsular contracture. Exercising tends to exacerbate the pain and inflammation. Encapsulated implants interfere with both comfort and sensation.
Can I still breastfeed after breast augmentation? How will it feel different?
Many women are able to successfully breastfeed after getting breast implants, however there are some important considerations regarding potential effects on lactation:
– Reduced milk production – Implants can interfere with milk production by severing milk ducts/nerves, though changes are usually minor. Having implants under the muscle preserves more function.
– Breast fullness/engorgement will feel tighter – Implants take up space in the breast, so fullness during breastfeeding may cause firmer, harder breasts until milk drains.
– Less skin elasticity – Incisions around the areola can reduce skin stretching needed for milk duct dilation. This may contribute to engorgement discomfort.
– Numbness around the nipples – Loss of sensation around the areolas can make nipple latching more difficult. Complete loss of sensation is rare.
– Asymmetry in milk supply – One breast may produce more milk than the other, potentially due to differences in surgical trauma to the breast tissue or nerves.
– Baby difficulty latching – Due to nipple numbness or less malleable breast tissue for the baby to “latch on” to. Try various positioning techniques.
– No change in comfort – Some women report no issues breastfeeding with implants. Anecdotal experiences vary greatly.
Proper implant placement under the muscle, at least 1.5 cm above or below the crease under the breast, provides the best chance at successful breastfeeding later on.
What are signs of normal vs abnormal healing after breast augmentation? What should I expect?
Monitoring your recovery for signs of normal vs abnormal healing is important after breast augmentation surgery. Here are guidelines on what to expect:
Normal Healing Signs:
– Mild to moderate postoperative pain and discomfort that is manageable with medication
– Temporary numbness, tingling, or hypersensitivity around the breasts and incision sites
– Expected swelling, bruising, and potentially some minor fluid discharge from incisions
– Slightly misshapen or asymmetrical breasts for the first few weeks as swelling resolves
– Fatigue and general weakness as your body recovers its strength
Abnormal Healing Signs:
– Uncontrolled pain not responding to medications
– Bleeding from the incisions that steadily worsens over time rather than subsiding
– Significantly misshapen breasts that do not start to improve within 2-3 weeks after surgery
– Severe, worsening asymmetry that persists beyond the initial post-op period
– Areas of concerning discoloration or noticeable drainage from incisions once drainage should have stopped
– Fever over 100.4°F that could be indicative of infection
– Overall worsening of symptoms rather than gradual improvement
Contact your surgeon immediately if you have any abnormal healing symptoms or other concerns that something may be wrong. Monitor for potential infection, hematoma, or seroma that could require intervention.
Conclusion
Breast implants can lead to short and long term side effects like capsular contracture, rupture, and displacement that cause visible deformity and symptoms like breast pain, hardness, and lack of sensation. Implants also impact breastfeeding comfort and ability in some women. Monitoring your healing and being aware of abnormal symptoms allows early treatment of complications. In general, maintain realistic expectations for living comfortably with breast implants.