REHABILITATION IN COSMETIC SURGERY. MAMMOPLASTY
MAMMOPLASTY (breast augmentation or reduction)
This is a surgical procedure aimed at improving the size and shape of the breast for the following reasons:
- Improving the body contour of a woman.
- Correcting a reduction in breast size following pregnancy.
- Raising sagging breasts and increasing their size.
- Balancing a difference in breast size.
- Reconstruction following breast cancer surgery.
- Correcting a congenital deformity.
Types of breasts
- Hypoplastic breast: lack of development of the breast.
- Post-partum atrophy: After pregnancy and childbirth the breast suffers modifications, one of the most frequent being involution.
A breast implant is a silicone elastomer wrapper usually filled with more or less liquid silicone gel (this property is called cohesiveness and there are different degrees). The most cohesive gels conserve the shape and avoid the dispersion of the silicone gel in the case of breakage of the prosthesis. The implants can also be filled with a saline solution called serum.
When introducing a mammary prosthesis, the body surrounds it with a layer called capsule. The human body considers the breast implant a foreign body and forms a protective capsule of fibrous tissue around it. The increase of tissue of this capsule is what is called its contracture.
This capsule is formed by a tissue that is similar to scar tissue. Its behaviour is similar. Some scars retract in some people, and this may mean a decrease in the size of the capsule and therefore of the space where the prosthesis is located. The final effect is that the prosthesis can become rounder and harder, which is called capsular contracture or capsule. Capsular contracture is an exaggerated retraction of the fibrous capsule of the organism (formed around the prosthesis), which determines a certain degree of hardening of the region when palpated.
The capsule may manifest itself as pain in severe cases, and some external deformity may appear. The ultimate cause of this complication is still unknown and appears in around 10 in every 100 patients. Post-surgical fibrosis is a normal response by the organism, which tries to defend itself against a foreign body creating various degrees of encapsulation. In the first stages of development of the contracture, this can be solved, but when the capsule is excessively contracted and causes pain. It is usually necessary to carry out a capsulectomy.
Its prevalence ranges from 12% when the reason for intervention is aesthetic, up to 34% when it is for reconstruction after cancer.
90% or more cases of capsular contracture develop in the first year. A small percentage of patients have developed capsular contracture several years after a breast augmentation.
This complication is most frequent in the case of a prosthesis filled with silicone gel.
Augmentation mammoplasty does not cause real rejection as it is inert silicone.
Treatment of capsular contracture
a) Prevention of the onset of the contraction
– placing the implant behind the pectoral muscle
– production of textured walls on the external part of the implant (textured prosthesis)
– use of implants filled with physiological serum.
b) Rehabilitation treatment, which is medical and physiotherapy treatment, basically ultrasound (in prevention or in treatment)
1. Baker JL, Bartels RJ, Douglas WM. Closed compression technique for rupturing a contracted capsule around a breast implant. Plast Reconstr Surg 58: l 37,1976
2. Planas J. Prophylactic Use of External Ultrasound for Breast Implant Capsular Contracture. Hot Topics, Aesthetic Surgery Journal, March/April 2002