MMed, Dr. Ho Cao Vu, who currently works in the surgical department of Cho Ray Hospital in Ho Chi Minh City, said pseudocapsules are a common complication after breast augmentation.
Many women experience hardness in their breasts but do not know that this is a sign of a complication.
While pseudocapsule has some similarities to capsular contracture, which causes stiffness in both the standing and supine position compared to implants outside the body on palpation, they differ in their underlying causes.
Both complications, if left untreated over time, can lead to premature rupture of the implant and aging at the breast fold points due to pressure on the pouch.
In some cases, fibrocystic breast tissues, due to genetic factors or extensive breastfeeding and frequent milk expression, do not improve even after implant placement.
Causes of pseudocapsule
According to Dr. Wu, women should choose implant sizes that are compatible with their anatomical structures.
Many surgeons fail to assess three common abnormalities in the structure of the chest: the prominent, concave, and irregularly shaped chest.
This leads to the selection of implants that are not suitable in terms of diameter, projection, gel consistency, softness and pressure within the pocket, which then puts pressure on the implants.
Consequently, this has the effect of compressing the implant, leading to a feeling of breast stiffness immediately after surgery that does not soften over time.
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Research, compare and understand different types of breast implants to minimize the complications and cancer risks associated with breast implants, experts say. Photo courtesy of Dung Ho |
Some breast implants on the market lack the softness of some well-known brands.
Implants that do not feel as soft as or softer than natural breast tissue may be unsuitable for people with abnormal anatomical structures, thin skin or limited glandular tissue.
“This can lead to implant exposure, hard implants, and palpable ripples in certain marginal areas of the pocket where tissue coverage is minimal or very thin,” said Dr. Vu.
Inaccurate creation of the implant pocket. Creating an implant pocket that is too small or not properly shaped for the size and contour of the implant can lead to complications, especially in people with unusual anatomic structures.
If the diameter of the pocket is smaller than the diameter of the implant or if the pocket is not positioned correctly, the implant will not be evenly distributed in the upper, lower, inner and outer poles.
This creates pressure on the implant, leading to a pseudocapsule shortly after surgery.
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Creating an implant pocket that is either too small or too large for the size of the breast implant is also a cause of pseudocapsule after breast augmentation, according to doctors. Photo courtesy of Dung Ho |
In addition, prolonged external pressure can cause the implant pocket to expand forward, leading to distortion.
This can also result in the implant sitting mostly above the nipple (a condition known as “high-riding breast”), below the nipple (“sticking out”), mostly in the inner area (creating a “symastias”) or mainly in the outer region (“lateral displacement”).
Another noticeable sign is when the nipple is not centered within the breast mound.
If the size of the pocket is larger than the implant, the implant may move within the pocket, leading to an uneven appearance and altered feel.
Some surgeons may not anticipate the risks associated with patients who have abnormal anatomical structures such as breast bones, spinal alignment, or distribution of breast tissue, leading to complications and cosmetic problems over time.
Therefore, accurate creation of the implant pocket is crucial.
Recognizable signs
Many patients experience breast tenderness immediately after surgery and assume it is normal. However, this is a sign that should be monitored closely for the first six months after surgery.
Usually, the softness and shape of the breast implant changes during this time.
If the breasts do not soften after six months, consultation with a specialist in breast pathology and aesthetics is necessary.
There is no cause for concern in cases where the implants gradually soften over a period of six months. Only if the implants remain hard over time should you consult a specialist to determine the best course of action.
For breasts harder than pre-implant: in some cases, thick-shell implants may feel hard to the touch. After implantation, this hardness usually remains.
Patients may be advised to undergo fat grafting to enhance softness, although this procedure carries risks such as fat necrosis, which can form palpable lumps that may be mistaken for microcalcifications during cancer screenings of breast.
Preventive measures and treatment of complications
To select the appropriate implant size, Dr. Vu suggests choosing an implant size that fits the person’s anatomical structure.
Avoid overly large implants with high projection or lack of softness, especially in cases with unusual anatomical features.
Additionally, use precise dissection techniques rather than blunt dissection methods, which rely solely on tactile feedback and do not provide direct visualization of the tissue being dissected.
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The use of the new generation ultrasound scalpel dissection technique can significantly reduce the risk of pseudocapsules after breast augmentation. Photo courtesy of Dung Ho |
Traditional methods of breast augmentation through the axilla, inframammary fold or periaqueum with blunt dissection and electrocautery have several disadvantages.
These include the need to inject large amounts of vasoconstrictors and anesthetics into the pectoralis major muscle attachment sites, a higher risk of bleeding, tissue trauma, excessive fluid secretion, and difficulties in accurately shaping the implant pocket at the inner and outer poles.
The Master of Medicine, Dr. Ho Cao Vu, who graduated with a master’s degree from the University of Medicine and Pharmacy in HCMC and currently works at Cho Ray Hospital, specializes in benign and malignant pathology surgery.
Vu has over 15 years of experience and has performed more than 2,000 cosmetic and reconstructive procedures using new generation ultrasonic scalpel surgical technology.
He has also corrected numerous cases of defective, asymmetric, exposed or ruptured implants, pseudocapsules, as well as severe III and IV capsular contractures.
In 2010, Dr. Ho Cao Vu completed direct training in the Department of Plastic Surgery at MD Anderson Cancer Center (Houston, TX, USA) under the guidance of Professor David Chang.
