Hearing about breast implants gone wrong is something we've become accustomed to. Problems with breast implants can range from the uncomfortable to disfiguring. These problems can affect your health, your self-esteem and your active lifestyle. If you have breast implants, it is very likely that within your lifetime, you will need to have your implants redone.
Dr. Lisa Cassileth & Dr. Kelly Killeen are two of the top Beverly Hills plastic surgeons specializing in solving & repairing breast implant problems for their patients. They're sought-after as a breast specialists, with patients who travel from around the world seeking their surgical artistry and excellence. A large percentage of their practice consists of repairing situations in which breast implant surgery performed by other surgeons, have been done incorrectly or have developed problems over time. Whatever the issue is, you don’t have to live with it. Our plastic surgeons have the training, skill, and use of advanced technology, allowing them to repair, correct and give you the breasts that you have always wanted.
If your breast implants feel increasingly firm, or have moved from their original position, it’s not just uncomfortable, it’s a condition known as capsular contracture. Capsular contracture (sometimes called capsular contraction) occurs in about 26.9% of breast implants cases.* Capsular contracture will not resolve by itself or improve over time. Instead, it can become worse, causing one or both of your breasts to become deformed in appearance, and cause you pain. Capsular contracture is ranked from mild, where the breast feels slightly firm, to severe, where the breast is pulled upward and feels very hard.
A “capsule” is the body’s natural response to a foreign object of any kind. It is a scar tissue that forms around the implant.
The body forms a thin, possibly even transparent capsule around your breast implant. How extensive, strong or thick that capsule is depends on several factors, but most importantly on your own genetics and on the degree to which bacteria may be present when the implant is put in the body.
When you have a capsular contracture, the capsule surrounding your breast implant has become dense. This is because your body is producing extra collagen from the inflammation which causes fibrosis (the thickening and scarring of connective tissue).
Why does that happen in some patients and not others, and sometimes in one breast and not the other? There are three reasons:
1. It may be your genetic makeup. Just as some patients form thicker scars, some patients form thicker capsules. Certain surgical factors, like formation of a fluid collection around the implant from the initial surgery, or multiple correctional procedures, may make the body react more severely as it forms the capsule and can increase the likelihood of contracture.
2. Many patients with capsular contracture are diagnosed with a low-grade bacterial contamination of the implant. This can be determined by taking a culture during your revision surgery.
3. Your body may be reacting to free silicone – silicone that has leaked out of the implant. Free silicone creates a hotbed for inflammation, causing the capsule to thicken as your body attempts to further "wall off" the problem. In these cases, there is overproduction of collagen which compounds and hardens, the capsule tightens and squeezes the implant. The implant then feels hard and can move upwards or sideways.
You will need surgery to correct this condition. Cassileth Plastic Surgery has developed a treatment plan for women suffering from hard breast implants caused by capsular contracture that has an excellent success rate. The capsular contraction treatment plan involves treating each aspect of the problem.
First, the implant and the entire capsule is removed, known as a capsulectomy. If free silicone is present, all intracapsular (inside of the capsule) and extracapsular (outside of the capsule) silicone is completely removed. The capsule is then sent to a microbiology lab, where we have found that almost 50% of patients have a positive culture result, usually growing strep bacteria.
The now clean and empty cavity is aggressively decontaminated with pulsed antibiotic irrigation - a high flow system designed to remove and minimize bacterial contamination of the tissue. An internal bra, made up of the pectoral muscle, and acellular dermal matrix (substance to supplement your own tissues to better cover/support implant), is then used to completely cover the new implant. This internal bra is dynamic, soft, and effective, protecting the implant from future scar tissue contraction.
This same surgical method is also successful for breast reconstruction after mastectomy and in patients who have had multiple prior surgeries for capsular contracture. Read more about capsular contracture.
*Dancey A, Nassimizadeh A, Levick P . J Plast Reconstr Aesthet Surg. Capsular contracture - What are the risk factors? A 14 year series of 1400 consecutive augmentations. More on this study on Capsular Contracture page
When a woman with breast implants reaches out to open a door, or is lifting weights at the gym, or even picks up a heavy bag, she may notice that one or both of her implants is moving abnormally. It may shift down, causing her to suddenly have a dip in her chest, or it may pop upward so that it seems to sit unnaturally high on her chest.
Both of these situations are called “muscle flexion deformities.” They can begin happening right after a woman has her implant surgery, or more commonly, develop months later.
Breast implants can be placed either on top of or beneath the pectoral muscles. If your implant has been placed below the muscle, you are less likely to have serious complications, such as capsular contracture.
However, for some people placing the implant beneath the muscle can make it too dynamic, causing flexion deformities because the implant moves too much when the muscle is flexed. In cases where the implants rise up when the muscle is flexed, this is because the capsule containing the implant is simply too large for the implant.
The large capsule allows the implant to shift when placed under tension. In cases where the implant shifts downward while flexing, this is usually from an abnormal connection between the pectoral muscle and the front portion of the capsule, squeezing the upper capsule when the pectoral muscle flexes. This squeeze can even make a "double bubble" under the breast, which is where the implant pops down underneath the breast.
A flexion deformity will get worse over time, and it will continue to be a problem until it is fixed with surgery. Your treatment for a flexion deformity will depend on how your breast implant is reacting to movement. If your implants can float up to your collarbones, then the upper part of the pocket needs to be closed so that your implant is in a normal, lower position. If your flexing creates a divot or groove under the breast, the solution is to control the location of the muscle so it no longer allows the skin and breast to divot when flexed.
Often, we will use a tissue matrix or ADM (acellular dermal matrix - substance to supplement your own tissues to better cover/support implant), to provide new support for your implant. The ADM and the interface of the pectoral muscle are secured together to properly anchor your breast implant in place. In some cases, using just your existing capsule and manipulating it to control the implant position is sufficient.
Our surgeons at Cassileth Plastic Surgery are specialists of breast implant revision in Beverly Hills & Los Angeles. Schedule an examination with Cassileth Plastic Surgery to find out the exact treatment you’ll need to correct this condition.
If you are unhappy because your breasts look too close together after your implant surgery, you aren’t alone. Plastic surgeons call this condition “breadloafing” and, while it may not be a hazard to your health, it certainly is not the result that you had in mind when you decided to have a breast augmentation.
Often, this is caused by where the implant was placed. Implants placed below the mammary gland instead of below the pectoral muscle, as well as larger implants, or a patient insisting on narrow cleavage can contribute to the implants being too close together. These factors cause the implant is placed to be closer to the sternum.
If, however, after surgery your breasts were not too close together, but became more so over time, then the situation happened because of implant movement post-surgery. This is more likely to occur in patients that formed thin capsules, which may allow implants to move after surgery. These patients also tend to have visible implant rippling and never have capsular contracture.
You will need another surgery if you want to restore your breast implants to their proper position. For this type of breast augmentation revision, our surgeons will use a tissue matrix or ADM (acellular dermal matrix) to provide new support for your implants, securing them into a more natural position. Making sure that the correct implants are selected is also important, as the implant width should always fit comfortably just within the natural base width of the breast.
Schedule an examination with Cassileth Plastic Surgery to find out the exact treatment needed to correct your breast implants gone wrong.
Many women complain that their implants look unnatural because their breasts appear to be too far apart, or because their now-larger breasts droop toward their sides instead of sitting firmly in the center of their chest. Again, this is breast implant deformity that can be remedied. The implants may also have been misplaced in too low a position, causing an overall disproportionate look.
If your breasts looked like this right after your surgery, then it may be that your surgeon placed your implant lower than recommended. Often, the crease under the breast, called the infra-mammary crease, is purposely lowered. This is done to accommodate the extra volume added to the breast. Also, a slightly lower implant can make the nipple position look better if the nipple was slightly low in the first place. However, if the nipple is too low, the top of the breast will be empty, and the breast will appear lower or more lateral.
Alternately, if your breasts looked normal after surgery and moved lower or further apart over time, then the situation happened because of implant movement post-surgery. This problem is extremely common, as gravity pulls the implant down and out, and the movement of the pectoral muscle also can push the implant down and out. If you had your breast implant surgery after breast feeding, this is more likely to happen, as the breast tissue can stretched out and loose.
While you are healing from surgery your body naturally forms a “capsule” or smooth scar tissue around the implants. This happens to everyone, and your surgeon allows room for this capsule to develop and cradle your implant within your chest. However, everyone heals a bit differently and if you heal without forming this capsule, then your implants can migrate slowly over time.
You will need another surgery if you want to restore your breast implants to their proper position. Often, our surgeons will use a tissue matrix or ADM (acellular dermal matrix) to provide new support for your implants, securing them into a more natural position. The newly positioned implant is secured in place under a complete sub-muscular bra, which controls the position of the implants on your chest wall, keeps the implants soft, and does not allow for movement over time.
Schedule an examination with Cassileth Plastic Surgery to find out the exact treatment needed to correct this condition.
Sometimes a woman will notice that she can see the outline and texture of the breast implant through her skin, creating an effect doctors call “rippling”.
While you are healing, your body forms a “capsule” or smooth scar tissue naturally around the implants. This happens to everyone, and your surgeon allows room for this capsule to develop naturally and cradle your implant within the chest. But everyone heals a bit differently. If you heal without forming a strong enough capsule, this can cause rippling. The rippling may be noticeable if you don't have a lot of breast tissue and the capsule is thin.
Surgery can be performed to position your implants a bit differently and reduce the rippling. If the rippling is only in a small area, the area could be resolved by covering the area with your own fat (fat grafting). Another options that works for some patients is to change the implant type to a to a highly cohesive shaped gel implant that may work better, as this type of implant is far less likely to ripple. In cases where rippling is caused by too thin a capsule, or the implant being too close to the surface, a sub-muscular bra may be created using your pectoral muscle and acellular dermal matrix, which covers the implant and keeps it in place.
Schedule an examination with Cassileth Plastic Surgery to find out the exact treatment needed to correct this type of breast implant problem.
Implants, unfortunately, always have the possibility of rupture. New symptoms of your implants hardening (capsular contracture or capsular contraction), soreness, or hard spots next to your breast implant may all be signs of leaking silicone implants. It is also important to know that often there are no symptoms for ruptured implants, the rupture will only being discovered during a routine mammogram or ultrasound. Removal of an implant is called explantation.
On the left side of this image is a ruptured implant. You can see the hole in the implant with the gel coming out through the capsule which is what the implant is packaged in.
On the right-hand side is the capsule. The capsule is the patient's own reaction to the implant. When someone is reacting to an implant that has free silicone and this reaction has been present for years, we get what is called chronic inflammation. You get this kind of white substance that you can see on the right-hand image.
The white substance is actually chronic calcifications -- chronic means long-term; we also call these eggshell calcifications. If the body is a little bit mad and it is a little bit mad for a very long time, you get these crispy, white chunky crusts that are within the capsule.
From a clinical perspective, if you touch a breast with this in it, it feels rock hard. It is not that the implant is hard, it is that the capsule, the capsule your own body made, is hard. As this comes out, the breast immediately gets soft, almost breathes a sigh of relief and you see the soft tissue go back to normal again. It is important not just to get the ruptured implant out but to get the entire reaction out as these chunky capsules also have free bits of silicone in them.
The most current silicone implants used in breast augmentation today are cohesive gel implants that provide excellent results. They are much less likely to rupture than earlier breast implants, and even if they do rupture, they are likely to simply stay together in a cohesive form until they can be removed and replaced.
Older silicone implants, however, such as those placed prior to 1992, will leak liquid silicone when they are ruptured. If you have capsular contracture (a hardening of your implant), and older silicone implants, there is an extremely high likelihood that your implant is ruptured.
When an implant is ruptured, its contents can begin to leak into the capsule surrounding the implant, causing calcification of the capsule and hardening, much as in a capsular contracture. This is called an intra-capsular rupture, which you can see in the following video.
Dr. Cassileth discusses capsular contracture and you can see a dissection of an encapsulated implant that has ruptured.
Alternately, the implant can leak silicone outside of the capsule. That is called an extra-capsular rupture, and cause hard areas next to the implant and capsule. The silicone can also migrate to adjacent structures and lymph nodes.
People react differently to the release of silicone into the body. Some have little or no reaction, some develop hard pockets or nodules, and others have fluid pockets or massive inflammation around the free silicone. Silicone has been linked to autoimmune disease, but after a great deal of research, physicians did not note increased incidences of autoimmune disease in patients with silicone implants. This being said, patients with autoimmune disease are more predisposed to all inflammation, and often have a vigorous reaction to leaking implants. Leaking breast implants can cause such people to feel sick and tired, exacerbating their disorder and undermining their overall health and well being.
Regardless of the reaction each patient has to the rupture, for this type of breast implant revision Los Angeles plastic surgeons Dr. Cassileth or Dr. Killeen will remove ruptured implants and the capsules surrounding them to extract all free silicone. The implants are then replaced if desired.
If a patient decides they no longer want implants our surgeons can perform an internal breast lift to avoid sagging after surgery.
To discover the all of the options available to successfully treating your breast implant problems and achieve the natural, beautiful breasts that you want, call our office at 310.278.8200 or click here to schedule a consultation with our top Beverly Hills plastic surgeons.