There are cases in which implants are used for reconstructions after breast cancer surgeries, and there are others, most of them, in which they are placed for aesthetic purposes to increase the size of the bust, to unify different sizes or for lifts in patients who have breastfed. or lost weight.
When a patient undergoes a breast augmentation with implants, a great expectation is generated that in general greatly favours the postoperative evolution. The patient leaves the operating room with her breasts volumized and can see the result almost immediately. Such is the degree of satisfaction that the majority present, that even the slowest evolutions or minor complications are passed with patience and conformity. In the postoperative period, we usually give indications that are well carried out, and after a few weeks, when the patient no longer presents discomfort, and her body has adapted to the new size, the classic question comes: “Am I discharged, doctor?”. And it is at this point where we must stop and analyze the situation.
Breast implants, although they are very safe today, constitute a foreign body that we place inside the body, and as such, they trigger a series of factors that tend to generate defence or protection. The human body is intelligent and builds around the implant a protection and containment capsule that acts as a link for its correct incorporation into the surrounding tissues. This capsule, in general, is soft and lax, allows the implant to slide freely inside it, and gives a natural and anatomical appearance to the breast that makes it impossible with the naked eye to realize that there is an implant inside, but sometimes that capsule becomes more rigid generating complications that require evaluation.
And why is a periodic evaluation of patients important? Because as mentioned, the human body is in constant change and adaptation, and at some point in evolution small changes may arise that should alert the doctor to evaluate the possibility of replacing these implants before reaching an extreme capsule contracture with the risk of rupture and the consequent spillage of silicone in the surgical bed.
However, there are many patients who stopped attending their annual implant check-ups and who adapted so much to have them that they do not perceive the gradual changes that they are generating. These small changes are the ones that should alert patients the most since correct detection could lead to a simple replacement surgery with a short postoperative period and rapid reinsertion to normal activities.
Activate the warning signs and promote a medical consultation before eight classic signs:
1- Appearance of pain. Pain is not common, you do not have to get used to it, and before it appears, you should consult. Pain often precedes signs of changes in shape. When the pain becomes permanent and is accompanied by an extreme hardening of the breast, it should be consulted immediately for the risk of rupture.
2- Changes in the height of the breast groove. While standing and facing the mirror, raise your arms and observe the height of the inframammary groove. If one breast is higher than the other and seen at a different level, it could correspond to an incipient capsule contracture and should be consulted.
3- Changes in the height of the nipple and areola. A difference both in the height of the nipple and in the direction of the same could correspond to capsular contractures. This sign should not be confused with differences in height or direction seen in the immediate postoperative period, which could correspond to normal anatomical variations or errors in technique.
4- Excessive appearance of the upper pole or neckline. In capsule contractures the implants are usually seen with the naked eye, the upper edges are well marked, leaving an unnatural roundness in the neckline.
5- Size changes. A contractured implant usually gives a round and smaller breast, as if the container is too small and the implant wants to escape.
6- Appearance of ripples. Contractures often manifest with small ripples that can be seen on the skin. To the touch, they impress as if it were a badly stretched bedding.
7- Thrust of the gland on the implant. This sign does not correspond to a capsule contracture but to ptosis or descent of the mammary gland above the implant. It can be seen as if they were two superimposed balloons, the one in the back corresponds to the implant in place, and the one in front of the gland slid down. These types of complications are frequent after breastfeeding or sudden weight loss.
Before any of these symptoms, a consultation with a plastic surgeon is necessary. The professional will request studies such as breast ultrasound, mammography or magnetic resonance imaging depending on medical criteria, and the need for an implant replacement will be decided. The timely consultation will avoid risks, and the results of the treatment will be more satisfactory. We must remember that the relationship between the plastic surgeon and a patient with implants is a partnership that begins when we have the first consultation and must last forever.