Wrinkling of Implants
INDIANAPOLIS, IN – Wrinkling of implants usually is felt because there is a lack of breast tissue to cover the implant so that the wrinkles will not be seen or felt. All implants can wrinkle. In my experience, silicone implants wrinkle less than saline implants, high profile implants wrinkle less then lower profile implants, and smooth implants wrinkle less then textured implants. Placing an implant under the muscle will increase “coverage” of the implant; and therefore, decrease the chance of feeling or seeing wrinkles even if they are present. Also tighter tissues (which include tightness from the placement under the muscle) will keep implants from wrinkling more than loose tissues. For example, take a Ziploc baggie or balloon full of water and press it against your chest. Now ease up on the pressure and note how the bag/balloon wrinkles more as you relax the pressure. The wrinkles tend to be more prominent at the top of the baggie or balloon. This is why placing implants under the pectoralis muscle helps decrease the chance of feeling the wrinkles in the upper chest over the top of the implant where the muscle covers the implant.
In summary, we can make choices which can decrease the chance of wrinkling, or at least the chance of feeling the wrinkles. Unfortunately, no implant is perfect and as surgeons we cannot eliminate wrinkles. We can identify patients at higher risk for feeling these wrinkles and decrease this possibility with the choices we make together with the patients regarding implant placement and the type of implant we decide to place.
The person at highest risk is the woman who is very thin with minimal fat and minimal breast tissue that also has stretched or elastic/loose skin.
The decisions she can make which will help in minimizing wrinkles is a higher profile silicone smooth implant placed under the muscle.
Beyond this measure, treatment of implant wrinkles can become very difficult.
Dr Kimberly Short
Breast Implant Contracture
INDIANAPOLIS, IN - Breast implant contracture occurs when the “capsule” or shell that the body forms naturally around the implant becomes thicker and tighter making the breast feel firm or hard. There is not one definitive cause for contractures so they are difficult to eliminate as a potential problem after breast implant surgery.
Patients may notice displacement of their implants and a change in the position or appearance of the implants, which results in asymmetry.
This is because contractures occur more frequently on one side as opposed to both. Contractures are not dangerous to a patient but may become tight enough to cause discomfort.If the contracture is very tight, then it also may cause wrinkling of the implant, which can increase the chance of a crease flaw and lead to implant rupture.
Fortunately, there are many things surgeons can do to decrease the chance of contractures and we are learning more about contracture development all the time. In my office, every effort is made in surgery to decrease the incidence for the known causes of contractures.These include elimination of bacteria or other irritants that would cause an increase response to healing around the implants. Minimizing any bleeding during surgery as well as antibiotics and breast massage after surgery are also felt to have an impact on the formation of contractures.
If any firmness of the implant is noted after the surgery, several medications can be added to arrest or prevent the further development of the contracture.We also routinely perform external ultrasound to help prevent or treat contractures,and patients are encouraged to take an antibiotic prior to any dental work, including teeth cleanings, or surgery for at least the first 6 months after the implants are placed.
This breast augmentation patient developed a contracture which caused her left implant to become more firm and move toward the midline.Dr. Short reshaped both pockets to move the nipples more centrally on the breast and changed her implants from saline to silicone.This gave her a much softer feel and a much nicer breast shape.
Lateral Displacement of Implants (Wide Cleavage)
INDIANAPOLIS, IN – When implants move too far to the outside edge of the chest, the IMD (intermammary distance) is increased and the cleavage is decreased. This is typically most noticeable when lying down.As the implants move laterally, a wide flat space is often left over the breastbone. This can occur when the “pocket” for the implants is too large or when it has been stretched. Sometimes this is because a patient has very loose elastic tissues. Patients should be encouraged not to sleep on their stomach as this will only further stress the lateral (outer) breast tissues.
Correction can be achieved surgically by reinforcing the lateral boundary of the breast pocket (the outer tissues at the side of the chest) and “plicating” or closing this “pocket” around the implant at the side of the chest. After removing the implant the edges of the pocket are sutured together with a permanent suture to essentially “force” the implant more medially, (toward the center of the chest).This restricts the movement of the implants away from the midline and increases the cleavage (and decreases the IMD).
This patient of the Gillian Institute in Indianapolis Indiana came to Dr. Short because her breasts were firm, displaced laterally and she had developed a large space between the breasts due to the contractures.She had her implants placed in another state several years before.Since she was going back to surgery she also decided to “go a little larger”.Dr. Short removed the contracture scar tissue, replaced her implants and reshaped the pocket to give her more cleavage and a prettier breast shape. This was all performed through her previous small incisions.
This patient’s main goal was to increase her cleavage without increasing her size.Dr. Short had previously placed her implants through a transaxillary incision (incision in the armpit).Her implants had moved outward over time due strong muscular contraction as the implants were placed under the muscle.She preferred not to have an increase in size, just more cleavage and she wanted to use the transaxillary incision again.This incision makes it impossible to suture the lateral border of the breast pocket.Dr. Short was able to accomplish a moderate increase in cleavage however, by using a different profile implant which had an increased width (increased diameter) but a similar projection.This approach achieved her increase in cleavage through the transaxillary incision without increasing her size significantly and without suturing of the capsule.
You may also visit indyplasticsurgery.com and indybreastaugmentation.com for further information and examples.
Symmastia
INDIANAPOLIS, IN – Symmastia can occur when breast implants are too wide or too large for a patients chest dimensions, when the tissues between the breasts are too weak or thinned, or when a patient develops a contracture (tightening of the breast capsule or increase in scar tissue around the breast) which pushes one or both breast implants too close to the midline.
Correction can be achieved by reinforcing the tissues between the breast (at the midline or sternum/breast bone) with permanent sutures along with a “thong bra” worn postoperatively to maintain this separation between the breasts. Patients should be cautious about sleeping on their sides because this will push the breasts together and stretch the newly repaired tissues. Sometimes it is necessary to replace the implants with implants that have a more narrow base. This sometimes means decreasing the size. However, in some cases size can be maintained by changing to a higher profile implant which is similar in projection but decreased in width.
This can be a difficult problem to correct and should be analyzed carefully and approached with caution and in a meticulous fashion.
The pictures below demonstrate several patients with symmastia and after their surgery to correct this.
Dr. Kimberly Short
