A Difficult Case

Breast Augmentation with oversized implants is not an oxymoron, even in Beverly Hills. Yes, it happens, and it happens all too often in the City of Angels.

Recently in the office, I saw a young woman who had a breast augmentation about a year ago with 750 cc breast implants. She was unhappy about the shape of the breasts. She reported developing an infection in the right breast shortly after surgery. In addition, she was unhappy because her breasts appeared to be droopy. Upon evaluation, it was clear that a few things were going on. Number one, she probably has some component of capsular contracture in both breasts. Capsular contracture is when the scar tissue around the breast implant hardens. It can distort the implant and make it ride high on the chest wall. One strong risk factor for capsular contracture is a prior infection. Other risk factors include prior hematoma, infrequent massaging, and possibly smoking.

Another risk factor for capsular contracture may be the size of the breast implants. Large implants do cause more tissue “issues” than smaller implants.  They may even be harder to massage.  And because larger implants have more capsule surface area, there is more area to potentially develop contracture.

The Dreaded Capsular Contracture

Correcting capsular contractures, particular in the setting of droopy breasts, can  present a very large problem. For one, the skin envelope is already stretched out to accommodate the large implants. Two, to raise the nipple after a large augmentation with breast lift or mastopexy may just put the nipple areolar complex at risk for poor blood flow and total nipple loss and secondary necrosis, particularly if the augmentation was ‘over the muscle’ (subglandular) and the contracted capsule had to be removed. Poor healing from inadequate blood flow can be a disastrous complication as one can imagine.

To tackle this this combination of problems, the safest approach in this patient would be to remove these excessively large implants and replace them with smaller ones or none at all and remove the capsules and just wait for things to heal. Once healed and we are sure there is no indolent infection, the breasts can be lifted with or without an implant. Or, one could remove the implants and capsule and perform a lift, then revisit the idea for an augmentation 6 months down the road.

I am publishing this post to remind potential patients that bigger is not always better. In fact, the bigger implants mean bigger problems. Anything over 450 cc will exponentially raise the complication during a breast augmentation surgery. Patients should know this before they decide to get such large breast augmentations.

For more information on breast augmentation, please visit the procedure page or flip through the blogs.  You may also visit the media page and hear Dr. Neavin discuss advantages and disadvantages of the different types of implants and breast augmentation incisions. For before and afters related to the subject, please check out the gallery.

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