Most implant failures happen due to poor, deficient, scarred, or radiated soft tissue envelope around them. The larger the implant, the smaller the amount of healthy tissue around them, and the higher the likelihood of complications. Compared to implant failures after cosmetic augmentation, the problem after mastectomy is more severe since the normal soft tissue has been surgically excised and scarred by additional interventions. When the soft tissues are deficient and radiated, it is only a matter of time until the implant reconstruction fails.
What are the most common problems women can have after breast reconstruction with implants?
Infection
Infection after an implant reconstruction can happen at any time, but is most common within the first 3 weeks after surgery. Signs of infection include redness of the skin and breast swelling. Antibiotics are used to treat the infection initially, but unfortunately this is not always successful. If antibiotics don’t cure the infection, the implant should be removed.
Visible implant rippling and “breast animation”
The remaining breast skin envelope after a mastectomy can be quite thin and lead to visible implant “ripples” when there isn’t enough tissue covering the implant. This can be particularly bothersome in the cleavage area. To decrease the amount of rippling, most plastic surgeons prefer to place implants under the chest (“pec”) muscle to maximize the amount of tissue over the implant. Unfortunately, this often creates a very unnatural breast movement when patients use their chest muscle – as the muscle contracts, it squeezes down on the implant and temporarily deforms the breast. This doesn’t cause any harm and the breast returns to normal when the muscle relaxes, but patients quickly learn which movements to avoid in public.
Capsular contracture
Capsular contracture is caused by tightening of the breast tissue and scar capsule around the implant. When this occurs, the breast becomes firm and hard. This can be very painful and can cause significant breast asymmetry.
Implant displacement or asymmetry
No two breasts are alike, so slight differences will always be apparent, but sometimes breast implants can shift or become displaced causing dramatic asymmetry, even in the absence of capsular contracture.
Feeling cold
The goal of a mastectomy is to remove as close to 100% of the breast tissue as possible. As already mentioned, the remaining breast skin envelope after a mastectomy can be quite thin. This means that in many cases there isn’t a great deal of tissue covering the implant. For this reason, coupled with the fact that the implants themselves don’t have a blood supply, many women complain of their reconstructed breast(s) feeling cold.
Chronic pain
Causes of chronic pain after implant placement can be caused by numerous factors but the most common cause is capsular contracture. Living with chronic pain can dramatically reduce quality of life.
Implant rupture
A rupture occurs when there is a tear in the breast implant causing the saline or silicone to disperse. Ruptured implants need to be replaced.
Implant exposure
Wound healing problems can occasionally happen after a mastectomy that can lead to breakdown of the incision site, or even a new wound. This can lead to exposure of the tissue expander or implant. Some women can also experience skin thinning over time, especially if they have had previous radiation, which can lead to implant exposure some time after completion of the reconstruction.
Problems because of radiation therapy
Radiation therapy and implants do not mix well. Radiation either before or after implant reconstruction significantly increases the risk of infection, wound healing problems, capsular contracture, breast tightness, chronic pain, implant exposure, need for implant removal and reconstructive failure.
What can be done?
After a failed implant reconstruction, we typically recommend removal of the implant and surrounding scar tissue, and further reconstruction using the patient’s own tissue (an autologous “flap”). There is no better substitute than new, healthy tissue to recreate a “natural”, soft, warm breast. Our preferred flap technique, and gold standard in Breast reconstruction in general, is the DIEP flap procedure. The DIEP, which is the most advanced form of breast reconstruction available today, uses the patient’s abdominal skin and fat to reconstruct a natural, warm, soft breast while completely preserving the underlying abdominal muscles. Saving the abdominal muscles means patients experience less pain, enjoy a faster recovery, maintain their core strength long-term, and have a lower risk of complications.
