Capsular contracture reoperation

• The risk of capsular contracture depends on the type of implants, characteristics of implant shell and quality of filler.
• In addition, the results depends on how the capsular contracture is managed in the early stages.
  When foreign substances are inserted in the human body, our body film forms around it. This film is called the capsula, and it is formed around every implant of every patient.
  For most patient, the capsula, and it is formed around implants do not cause problems, but in some cases, the capsula shrinks or hardens severely.
  In such cases, it suppresses implants and causes the hard feeling on implants and in same cases, the implants fall out of place or the breast shape may change. This phenomenon is called capsular contracture.
  Once capsular contracture is formed, the thin capsula around the implants thickens and the breast shape becomes round and hard like a baseball and it causes pain.
  This capsula formation is a normal response of tissue due to surgery, but if blood clumps or it gets infected, it causes problems. Therefore, mixing antibiodics with a saline solution or removal of gathered blood is needed.
  At this time, various methods to widen the narrowed space or remove the capsule by removing the implant are used, but there is no method. In this case, reoperation may be the only method.

• Classification according to contracture

• Grade 1: Implants are soft and natural

  Grade 2: Implants are touched slightly, and there is mark to get surgery, but patient do not have dissatisfaction.

  Grade 3: It becomes to be hardened to the medium degree, and patient can feel it.

  Grade 4: Implants are seen by appearance and the breast is very hard.

  As for Grade 1 and 2, it would not matter too much. And it is possible to prevent or correct capsular contracture with massaging. When it becomes hardened to Grade 3 or 4, the problem can be resolved through several treatments such as removing the capsula around the insertion. In the case that the implant is inserted under the mammary gland of breast, then reinserting it under the pectoralis major muscle etc.

Implants size reoperation

• In the case that the size are not matched, it should be exchanged with one of suitable size. It is recorrected to consult your physician after six months. Reoperation is often more difficult than the initial surgery, so it is recommened to visit a specialist with abundant experience.
  To control wrong size of implants is very important to exchange opinions certainly though it is very careful between the patient and the doctor before surgery. It is important to select proper size of implants from the beginning. It is very important to exchange opinions with the patient before surgery to avoid choosing the wrong size of implants. Many patients who get breast augmentation surgery answered that they wanted bigger breast after one year. Some doctors recognize this tendency and make suggestions like "How about making it big from the beginning?"
  Breast size is determined by the doctor and patient together according to direct precise measurement, not by subjective cup size. Corrently, there is no method to measure breast size precisely. If the patient and the doctor can not come to an agreement on the implant size, then you should not proceed with surgery. At the same time, you and the doctor should be honest about what you really want. The bigger the implants are, the worse the results are and as time passes, the risk of complications increases.
  If the patient is tall and thin, but implants that are too large compared to her figure or in cases that implants of insufficient size were put in to a woman who has considerable bust size, it may not be balanced. During the first surgery, implants were sized according to the patients physique, but when changes in the breasts occur due to events such as childbirth etc or implants are mismatched due to an increase or decrease in weight, the size of implants could be mismatched. In these cases, the implant size should be changed and it is good to receive consultation after six months. Reoperation is more difficult than the first surgery, so it is good to get surgery from an experienced specialist.

• Side effects due to too large implants
• • Skin droops.
  • Sagging of breasts.
  • Disappearing fullness of upper part compared with lower part of breast.
  • Skin layer becomes thin.
  • Breast tissue of the patient is shrunk due to pressure of implant.
  • The boundary of implants is seen.
  • Wrinkles come to be seen by heavy implants pulling down skin toward the bottom.
  • Change of breast shape.
• Loosing of breast skin during pregnancy or breast feeding is a natural phenomenon that occurs over a long time. In addition, there are limitations in size. However, the phenomenon of breast augmentation surgery causes rapid expansion of breast skin and the amount is determined according to the desire of the patient.
  By selecting large implants, you may feel satisfaction for a while, but consequently, there are undesirable risks in the long term, too. Breast skin does not get better with age. Imagine the breasts of a senior citizen. Whether implants are inserted or not, skin becomes thinner and loosens due to gravity. The bigger the implants are, the heavier it is, and it makes that tissue become thinner and looser more rapidly.

Dissatisfaction of breast shape and mismatched breast

• Every breast is different, so after breast augmentation surgery, the shape of breasts may differ, too. Doctors cannot change the tissue of the patient. It is only possible to increase the breast size of patient.
  Every breast has unique characteristics and problems.
  Both breasts of women cannot be the same, and there are no two women with breast that are alike. No doctor can make both breast the same. Breasts of every kind have their own problem and every surgery has limitations and costs may vary.
  Appearance before surgery is the biggest factor that influences the surgical results. Breast augmentation surgery is a surgery for improvement not perfection.

• 01. Dissatisfaction of breast shape
• • Dissatisfaction is caused because implants may move after surgery or it was not put in the correct place from the beginning. After surgery, the center and bottom part of the breast should project outward to give it a nice and glamouous look. But wrong placement of implants may cause the upper part of breast to protrude and the bottom of the breast looks poor. Sometimes, it looks like muscle bulges on a male chest.
  • There are cases in which the undesirable form of breasts is caused by symmetry or when implants are inserted too closely to gather the breasts together which causes the nipples to face outward.

• 02. Dissatisfaction due to asymmetry of both sides.

• Both sides are always different. Do not expect doctors to make both breasts the same. If they are similar, that is excellent already. When one breast is smaller, do not fall into the trap of thinking that it would be okay to get implants or fillers to make them even. It is not that simple. The smaller breast has less skin, so if you put more filler then the upper breast could bulge out forerver. The difference in the shape of upper breast stands out more than the difference in size.

• 03. Dissatisfaction of shape due to breakaway of implants

• When implants start breaking away from their original placement, corrcetion is very difficult. To set the space of implants, the created space should be blocked. Sounds simple enough, but it is not easy to block the created space to prevent re-breakingaway. The bigger the implants are, and the thinner the tissue is, it is difficult to rectify in the long term. Therefore, do not make the mistake of selecting implants that are too lagre from the beginning.

• 04. Rapid change of the size or shape

• Rapid change of size means that implants are leaking or ruptured. At this time, implants should be substituted. The rapid change in shape means that the space created by the blocked or capsula is suppressing the implants which affects shape and location. The treatment is to remove capsula partially or completely and insert implants again.

Problems of rupture, shrink, leak of implants

• Breast implants are not lifelong devices. Some implants start to shrink or rupture within a few months after surgery, some are not damaged even after 10 years. Any device, especially breast implants, cannot be kept forever. There are many factors that influence the life of implants. Implants and techniques which are used today are the most excellent in history, but it is still impossible to predict its life span.
  So, it is important to use high quality implants.

• Optima Plastic Surgery Clinic uses implants of authenticity which got FDA approval.

• Optima protects your Beauty and safety! Optima never uses cheap implants. And we can guarantee our products after surgery.
  Presently, numerous kinds of implants are made in Europe, Central and South America, China, Eastern Europe, Korea etc are provided at cheap prices.
  However, Optima Plastic Surgery Clinic uses products of authenticity from two companies, Mentor and McGhan (INAMED), certified by the FDA.
  We use implants which are safety certified, and you can get product guarantee after surgery. In addition, we use various types of implants such as round water drop textured , smooth etc according to the characteristics of each patient.

• What is rupture?

• A rupture means that the outer shell of an implant has torn slightly. In the case of saline solution implants, breast size would be reduced greatly, so it is easy to notice a rupture. Generally, saline implants can be blown up by air so a rupture has the same effect as 'shrinking'. Remember that your body forms capsula around implants.
  If saline solution implants are ruptured and remain in the capsula just as it is, then breast tissue will absorb the saline solution. In the case of silicone implants, if the capsula is ruptured, the capsula remains as it is and most of the silicone stays in the capsula. It can then be removed when exchanging implants. In the case of existing silicone gel implants, through silicone gel leaks into the closed tissue or breast from capsula, it is very rare that considerable amounts of silicone get out through the closed capsula.

• What is leak?

• A leak accurs when small amounts of filler leaks from implants without any sign of rupturing of implants ; the term leak has no definite meaning. If saline solution is leaking, it means that it has shrunk partially or completely, but for every silicone gel implant that has a leak, it is possible to see the trace of the leak from the shell of implants. This phenomenon is called 'gel bleeding'
  The important thing is "How much leaking is there?" and "How much has it shrunk?" With gel bleed, a very small amount of silicone actually leaks. "How much shrinking occurs?" Well, the answer is subjective.
  Silicone is contained in many cosmetics that women use every day. Many preparation matters to neutralize acid contain simethicone. Silicone was used in various devices that can transplant from contact lenses to shunt of brain for decades. Most of needles and syringes which are using every day in medical world are made smooth by liquid silicone.

Saline solution implants reoperation

• Saline solution implants are weaker than gel implants.
  When saline solution implants start to shrink, it shrinks with rapid speed.
  In that case, implants should be removed by surgery, and if the patient wants, it can be substituted again.
  As salt water exists in the body naturally, the body does not respond to leaked saline solution as a foreign substance, but absorbs it.
  It is certain that rate of saline solution implants depends on various factors such as product standard of the manufacturing company or product's own life etc. However, it is not known in which cases that rupture occurs more frequently. Due to injury of breast or abrasion of implants, implants come to leak saline solution.
  Because the rate of rupture of saline solution of breast implants was not removed correctly, the FDA recommended that manufacturing companies research the frequency of rupture in the female body over ten years. This research should be included in the application form to sell in the market. This research which was completed in 1996 or 1997 started in 1994 with saline solution implants. As a result, saline solution implants survived in this market under agreement with FDA.
  Saline solution implants are not weak naturally. Actually, to check the strength of its shell, it was placed on a hard floor in a filled state and a person stood on it. Also, every saline solution implant have a valve. However, every additional device which was installed in the shell has caused an increase in the probability that implants may have problems after insertion.
  It is impossible to verify everything. The reason that saline solution implants have a shorter life span compared to silicone gel implants would be for the following reasons: Filler which has less adhering ability tends to move and impacts the shell, and it is less filled and it has a valve. Since there are lots of factors that influence the life of implants, it would be very difficult or almost impossible to predict the life of implants precisely under any research. In conclusion, the time to replace implants can come at any time. If you do not want to get surgery to replace it, then you should not get the augmentation surgery.

Silicone gel implants reoperation

• When silicone gel implants are ruptured, some women might feel reduction of breast size, bulging, uneveness of breast, pain or sensitiveness, prickliness, timidity, paralysis, soreness, change of sensitivity etc. Some women might not feel any difference though implants are ruptured. If the problem is serious, then implants should be removed. If you are considering inserting other things after removal of implants, then you should receive consultation to determine the benefits and price with a doctor.
  The results of a ruptured silicone gel implant would be different according to various factors. The major factor is whether the capsule around the implants remain as is.
  If the gel remains inside the surrounding tissue, it could form a stiff boil (granuloma) around the gel.
  There are cases to replace new saline solution implants or remove silicone which was put before by complications of silicone implants, and being have worries for breast cancer by women who got surgery entering middle age, and breast is sagging according to loosed skin due to aging. In reoperation, the work to replace new implants or remove existing implants would be done. First of all, it is important to analyze the failure factors and dissatisfaction of former surgery and comprehend that the thing to want fulfill and change. In addition, patients should accept things which are impossoble. The bottom part if saline solution implants which are using recently are made with volume similar to human breast, so it is stable anatomically, si it helps lots of patients.

Breast cleavage reoperation

• Breast cleavage - How is it make and how much would be formed?

• Usually, breasts do not have cleavage. Bras create breast cleavage. While breasts start maturing during puberty, breast tissue develops in the shape of a curve. Due to gravity, breasts sag slightly outward and most breasts face outward. Very few women's breasts face inward.

• The gap between breasts is determined according to the following two factors.
• • Area of breast in the face
  • Area of upper body

• If the gap between breasts is wide, the degree of narrowing is determined according to the following two factors:
• • Area, amount, and density if breast tissue of patient
  • Area and size of breast implants
  • The wider implants are, the narrower the gap, but it costly and has some post-operative risk. If the implants are wider than breast tissue of the patient, the tissue may not cover implants sufficiently, and the boundary would be located under the thin tissue between breasts.

• Side effects that can occur when trying to increase breast cleavage.

• In the case that shallow tissue covers the boundary of implants, patients should endure the risk that implants may be noticeable in the area of breast cleavage. What should you remember? When you are asking to reduce the gap between breasts, you should tell doctor that you want to know how much is possible without the risk that implants can be seen. If you want to reduce the gap even after the explanation by your doctor, you will be asked to sign an agreement that you understand and accept the risk that the boundary of implants may be seen.
  If you use wider implants to reduce the gap between breasts, the boundary of implants can be seen like ribs. Furthermore, fullness of the middle section of the breasts face outward more seriously.

Reoperation due to direction of nipple

• Nipples have various orientations. To control them surgically could be dangerous.
  Nipples are surrounded by tinted skin which is called areola, and its ideal location is at the center of the breast mound. However, the location of the nipples and areola vary significantly from woman to woman.
  In most cases, the basic direction after surgery and direction of nipples before surgery are the same. Even with the insertion of implants, it is only possible to modify the angle and location of nipple a little. Without rearrangement surgically, there is no special change.
  If you don't like the location of nipple-areola, additional surgery is necessary to correct this. In some cases of breast augmentation surgery, it is possible to rectify nipple location to some degree. Otherwise, it is possible to get nipple-areola rearrangement surgery.
  This surgery can make the breast shape more beautiful, but it has higher risk of loss of sensitivity and breast feeding could become impossible. Also, a scar may remain visible around the areola, so consultation with a doctor regarding its risks is needed bofore surgery.