Definition: Whenever an implant is placed into the body, the body recognizes that it is a foreign substance, and essentially walls it off with what is called a capsule. A capsule is a glistening layer of tissue that creates a barrier between the implant and the rest of the body. As stated, all patients with implants will have capsules. A normal capsule should wall off a pocket which is larger than the implant, and therefore the implant will feel soft to touch. Capsular contracture occurs when, for reasons frequently not completely understood, the capsule contracts and squeezes the implant. This is the cause of women with implants having breasts which appear round and high, and may feel very hard to touch.
Fortunately, during recent years, there is increased understanding of this phenomenon and the incidence of capsular contracture has been reduced significantly, basically by following two principles. One is exercising extreme care in minimizing bleeding: it is well established that blood around the implant can lead to capsular contracture. Of note, it is also for this reason that Dr. Rapaport advises his patients not to engage in aerobic activity, including sexual activity, for 10 days following surgery, so as to minimize the risk of small amounts of bleeding, which can lead to contracture. The second advance has been paying meticulous care to avoid any contamination of the operation with particles or bacteria. All gloves are powder free, and Dr. Rapaport uses the “no touch” technique for augmentation, whenever physically possible. This means that he uses a specially designed insertion funnel (Keller Funnel) for his implant insertion so that the implant can be transferred from its box after soaking in antibiotic solution, directly into the funnel and then into the body without ever touching the surgeon’s glove or the patient’s skin. Finally, because the nipple is not considered sterile, Dr. Rapaport generally advises against the periareolar scar, and uses sterile plastic covers over the nipple area when performing breast augmentation to avoid that source of bacterial contamination.
See the Keller Funnel in action
This is a fairly rare complication that occurs in 1% or less of patients. It correlates to the size of the pocket made to accommodate the breast implant. Therefore, this problem will be seen more commonly with patients requesting extremely large size breast implants. Basically, the nerve to the nipple areolar area comes in from the side, and when a large pocket is made, the nerve may be injured.
Sometimes after surgery, patients note increased sensitivity of the nipple. This resolves within a period of weeks to months.
Migration refers to the breast implant moving, generally either downward or to the side, over time. In some cases, this could be the result of not positioning the breast implant perfectly to begin with, but in other cases, it can be seen as a negative tradeoff of having “weak” scar tissue. A patient with an extremely soft capsule may have what appears to be a perfect result early after surgery. This type of patient needs to be educated in terms of support for her breast to avoid downward migration of her implant. This is one of the reasons that Dr. Rapaport will see all of his breast implant patients approximately one, two, and three months after surgery. Because of his experience, he will be able to detect very slight evidence of migration and will be able to advise the patient on proper support to prevent such problems from escalating.
All surgeries by their nature can have bleeding complications. Our patients are educated in great detail on steps needed to reduce the risk of bleeding as well as the risk of infection. These include but are not limited to stopping aspirin, motrin, and a variety of supplements as well as red wine, which can increase the risk of bleeding. Our patients are educated also in detailed post-operative instructions to reduce the risk of post-operative bleeding. Similarly, with regard to infection, patients are advised to wash with a specific antibacterial soap prior to surgery, and as noted above, surgery is performed with utmost care to reduce risks of both bleeding and infection. Indeed, in Dr. Rapaport’s hands, both of these complications are truly extraordinarily rare.
The precise nature of a patient’s future scar can never be predicted. NYC Plastic Surgeon Dr. David Rapaport takes all possible steps to both place scars in optimal locations and to close wounds with meticulous plastic surgical technique, thereby minimizing the appearance of future post-operative scars. We will also advise on appropriate topical treatments post-operatively to aid with scar fading.
All patients virtually without exception have some degree of asymmetry in their breasts. It is almost impossible to achieve perfect symmetry, as perfect symmetry is extraordinarily rare. However, many steps can be taken to improve upon preexisting breast asymmetry, either as a result of different volumes in the breasts and/or differences in what we call the “skin envelope” of the breast, including nipple position. It is during an individual evaluation and consultation that Dr. Rapaport will review whether such steps are needed.