Capsular contracture is associated with up to 16% of women who have had primary breast augmentation associated with scar tissue formation, hardening around the implant causing palpable and visible distortion.
DOUBLE-BUBBLE DEFORMITY OR HIGH RIDING IMPLANTS
This can occur when implants are either placed in the improper position, especially with transax or transumbilical where there is severe malposition and the implants are just too high. This will often require release of the scar tissue or capsulotomy versus capsulectomy as well as replacement of the implants either saline or silicone. The majority of these cases we correct are associated with implants improperly placed by previous surgeries.
Implants that are not round, such as teardrop shape or anatomical, may cause severe rotation or deformity which may cause the implants to have an absolutely bizarre and abnormal appearance, which would require open capsulectomy, capsulotomy and/or replacement with smooth round saline or silicone implants.
Bottoming out is associated with gravitational lowering of the implant in the pocket with giving out of the pocket. This can be associated with very large implants or with weakened tissue, including fascia, muscle and glandular and/or fatty tissue. This often will require reconstruction of the capsule internally, but this is not always possible and often a mastopexy with removal of skin along the inframammary fold, bottom of the breast, is required.
Implants can rupture at any time, either saline and/or saline. Therefore, it is absolutely essential that when an implant is ruptured that it be replaced as soon as possible to reduce scar tissue formation, which is very, very possible. The longer an implant is ruptured, the greater scar tissue contracture in order to close the pocket around the ruptured bag. We prefer high profile saline and silicone implants in all of our patients by either Mentor or Allergen Corporation which are FDA approved, lifetime guaranteed and warranted. We do not use textured coated implants at this time. I believe that they stick too high, adhere at a significantly higher rate of crease crack and thereby rupture.
DESIRE FOR DIFFERENT SIZE IMPLANTS (CHANGE IN VOLUME)
It is not infrequent that women want to go larger and if so, placing larger implants can certainly be performed safely if there is ample tissue coverage and/or volume spaces. On the other hand, some women desire to go smaller. Smaller implants can be placed, but in some women, however, this may require a breast lift in order to remove the extra skin associated with the smaller implant.