Mastectomy & Immediate Breast Reconstruction

Change of Implants

Breast Surgery

A capsulectomy is the removal of the scar tissue (capsule) that forms around an implant. A capsule is an entirely normal response to any foreign body. However, in some instances, the scar (capsule) around the implant may thicken and contract (capsular contracture). As a result, the breasts may feel much harder. With worsening capsular contracture, the shape may become significantly distorted and the breast can become painful or uncomfortable. Performing a capsulectomy and replacement of the breast implants should alleviate the discomfort and improve the appearance and feel of the breasts.

What does the surgery involve?

The surgery is performed through the same incisions created for the breast augmentation surgery. The capsule surrounding the implant is removed and a new implant is inserted into the pocket. If a patient has capsular contracture, then I recommend replacement of the implants with polyurethane implants. These have less risk of capsular contracture than a standard silicone implant. The skin incision is then closed.

The procedure takes an hour and is most commonly performed under a general anaesthetic (you will be fully asleep during the procedure). You are likely to stay in hospital for one night, although, on occasions, you may be able to go home the same day as your surgery. You will feel stiff and sore for a few days. Expect the most discomfort to be within the first 72 hours. Usually only simple pain killers are all that is required.

What are the risks and side effects of surgery?

Having cosmetic surgery can be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and you should be aware of any possible problems.

Scars

Scars are hidden in the crease under the breast and tend to settle remarkably well, so that the scars are barely perceptible. However, some people heal with thick scars and this can make them more noticeable.

Bruising and swelling

Swelling is very common and may take a couple of weeks to settle. Bruising is less common.

Haematoma

This can happen if a bleed occurs in the breast pocket, allowing a large blood clot to form. If this does occur, it is likely to be within four to six hours of surgery. Any increase in swelling or pain should be reported immediately so that treatment can be given. Sometimes patients need to have this blood removed with another short operation.

Infection

Infection on the rare occasion when this occurs, the breast implant may have to be removed to allow this to settle. The implant will be replaced once the infection has settled. You will be given antibiotics to cover you during the post-operative period to prevent infection.

Rotation/displacement

Occasionally implants can sit in the wrong position or move position in the post-operative period. This may need a further procedure to return the implants to the correct position.

Numbness, reduced sensation or oversensitivity

Numbness, reduced sensation or oversensitivity can occur in the nipple or breast. This is usually temporary, but occasionally these changes can remain to some degree.

Implant rippling or wrinkling

Implant rippling or wrinkling can be more of a problem in very slim patients or those who have very little breast tissue. However, the chances are reduced if the implant is placed behind the chest muscles.

Asymmetry

Each breast is slightly different and will continue to be following surgery; they are ‘sisters and not twins’.

Rupture

The implants I use are all guaranteed for your lifetime. However, as a medical product, they can still fail. If an implant is known to have ruptured, then it should be removed. The ruptured implant is contained within the capsule of scar tissue, so it will not ‘spill out’ into your breast tissue.

DVT/PE

Following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. To reduce any risks of this we give you special stockings to wear in bed and a blood thinning injection if you are not mobile.

Anaplastic Large Cell Lymphoma (ALCL)

In January 2016, the United States FDA announced a possible association between breast implants and the development of ALCL, a rare type of non-Hodgkin’s lymphoma. According to the World Health Organization, BI-ALCL is not a breast cancer or cancer of the breast tissue; it is a lymphoma, which is a cancer of immune cells. Women with breast implants have a very low, but increased risk of developing ALCL. In women with breast implants, ALCL is generally found next to the implant itself and is usually contained within the fibrous capsule that the body forms around the implant. The exact risk of ALCL is unknown and health organization’s from around the world are pooling data to try and establish this risk. An observation of reported cases indicates a predominance of textured device involvement. The association with breast implants is likely multifactorial and is currently being extensively studied.

Most of the breast implant patients found to have ALCL were diagnosed after they sought medical treatment for implant-related symptoms such as pain, lumps, swelling, or asymmetry that developed after their initial surgical sites had fully healed. In most cases, the ALCL was treated with surgery to remove the implant and surrounding scar tissue. Some patients also received radiation therapy, chemotherapy or both. The condition has a very good prognosis and a high probability of cure if it is treated appropriately.

I recommend that you seek medical help if you notice swelling, fluid collection or sudden and unexpected changes in breast shape either from myself or another suitably qualified healthcare professional. If you require more information then please feel free to contact me at any stage.

For more information on what is known about BI-ALCL please visit these useful links from the American Society of Plastic Surgeons or the FDA website. FDA Patient Information - Breast Implant Complications
Joint-ASPS-ASAPS-Statement-On-Breast-Implant-Associated-ALCL.pdf

Stretching of your breast tissue

The larger the implant you choose, the more likely it is to stretch your skin with time and this may require an uplift at a later stage. There is no evidence linking silicone or saline filled implants to any form of disease and it does not increase the risks of breast cancer. You will still be able to examine your breasts with the implants in place and have a mammogram as normal. Breast feeding is still possible with implants, as the implant sits behind the breast tissue, leaving all the milk ducts untouched.

All the risks will be discussed in detail at your consultation. However, if you have further questions or concerns, do not hesitate to discuss them. Decisions about cosmetic surgery should never be rushed.

What happens after the operation?

Your incisions will be closed with dissolvable sutures which do not need to be removed. I use a waterproof glue dressing that is not visible and dissolves after approximately 2 weeks.

You can shower as soon as you like after surgery and do not require any dressing changes. I will prescribe you 3 doses of antibiotics after surgery and I recommend that you wear a support bra for 6 weeks. You will need to purchase this before your surgery.

Initially, your breasts may seem larger than you expected. This is normal, and it will take some months for the post operative swelling to reduce and for your implants to settle into position.

Before you leave the hospital, you will be given a follow up appointment to see the nurse at one week to check your incisions and an appointment to see me in 3-6 weeks. You will also be given full details of your implants. These include the manufacturer, style, catalogue and batch/ lot number. You should keep this information in a safe place. You will not be able to drive yourself home from hospital and, ideally, you should have someone to stay with you for a few days to lend a hand.

What is the estimated time for recovery, absence from work and return to usual activities?

When you get home, you should take things easy for the first week or so. Most people take 2 weeks off from work. You can drive from 2 weeks, return to the gym for lower body work at 4 weeks and begin upper body exercises at 6 weeks. You will need to wear your support bra for 6 weeks.

What is the estimated time for recovery, absence from work and return to usual activities?