Causes of pseudocapsules after breast augmentation

MMed, Dr. Ho Cao Vu, currently working in the surgical department of Cho Ray Hospital in Ho Chi Minh City, said that pseudocapsules are a common complication after breast augmentation.

Many women experience hardness in their breasts but are unaware that this is a sign of a complication.

While pseudocapsule shares some similarities with capsular contracture, which causes stiffness in both standing and lying positions compared to implants outside the body on palpation, they differ in their underlying causes.

Both complications, if left untreated over time, can lead to premature implant rupture and aging at breast fold sites due to pressure in the pocket.

In some cases, fibrocystic breast tissues, due to genetic factors or extensive breastfeeding and frequent milk expression, do not improve even after implant placement.

Causes of pseudocapsule

According to Dr. Vu, women should choose implant sizes that are compatible with their anatomical structures.

Many surgeons fail to assess three common abnormalities in chest structure: protruding, concave, and irregularly shaped chests.

This leads to the selection of implants that are not suitable in terms of diameter, projection, gel consistency, softness, and pressure within the pocket, which then creates pressure on the implants.

Consequently, this results in the implant being compressed, leading to a sensation of breast hardness immediately after surgery that does not soften over time.

Research, compare, and understand different types of breast implants to minimize complications and breast implant-associated cancer risks, experts say. Photo courtesy of Dung Ho

Some breast implants on the market lack the softness of certain well-known brands.

Implants that do not feel as soft as or softer than natural breast tissue may be unsuitable for individuals with abnormal anatomical structures, thin skin, or limited glandular tissue.

"This can result in implant exposure, hard implants, and palpable rippling at certain border areas of the pocket where tissue coverage is minimal or too thin," said Dr. Vu.

Inaccurate creation of the implant pocket. Creating an implant pocket that is too small or not appropriately shaped for the size and contour of the implant can lead to complications, especially in individuals with unusual anatomical structures.

If the pocket diameter is smaller than the implant diameter, or if the pocket is incorrectly positioned, the implant will not be evenly distributed in the upper, lower, inner, and outer poles.

This creates pressure on the implant, leading to a pseudocapsule shortly after surgery.

Creating an implant pocket that is either too small or too large for the breast implant size is also a cause of pseudocapsules following breast augmentation, according to doctors. Photo courtesy of Dung Ho

Furthermore, prolonged external pressure can cause the implant pocket to expand forward, leading to deformation.

This can also result in the implant sitting predominantly above the nipple (a condition known as "high-riding breast"), below the nipple ("bottoming out"), primarily in the inner area (creating a "symmastia" effect), or mainly in the outer area ("lateral displacement").

Another noticeable sign is when the nipple is not centered within the breast mound.

If the pocket size is larger than the implant, the implant can move within the pocket, leading to an uneven appearance and altered sensation.

Some surgeons may not anticipate the risks associated with patients having abnormal anatomical structures such as chest bones, spine alignment, or the distribution of breast tissue, leading to complications and aesthetic issues over time.

Therefore, the precise creation of the implant pocket is crucial.

Recognizable signs

Many patients experience breast hardness immediately after surgery and assume it is normal. However, this is a sign that should be monitored closely for the first six months post-surgery.

Typically, the implant's softness and breast shape change during this period.

If the breasts do not soften after six months, a consultation with a specialist in breast pathology and aesthetics is necessary.

There is no need for concern in cases where the implants gradually soften over six months. Only if the implants remain hard over time should a specialist be consulted to determine the best course of action.

For breasts harder than pre-implantation: in some instances, implants with a thick shell may feel hard to the touch. After implantation, this hardness usually persists.

Patients may be advised to undergo fat grafting to enhance softness, although this procedure carries risks such as fat necrosis, which can form palpable lumps that might be mistaken for microcalcifications during breast cancer screenings.

Preventive measures and complication management

In order to choose the appropriate implant size, Dr. Vu suggests selecting an implant size that suits the individual's anatomical structure.

Avoid overly large implants with high projection or a lack of softness, especially in cases with unusual anatomical features.

In addition, use precise dissection techniques rather than blunt dissection methods, which rely solely on tactile feedback and do not provide direct visualization of the tissue being dissected.

Using the dissection technique with a new-generation ultrasonic surgical scalpel can significantly reduce the risk of pseudocapsules following breast augmentation. Photo courtesy of Dung Ho

Traditional breast augmentation methods via the armpit, inframammary fold, or periareolar using blunt dissection and electrocautery have several drawbacks.

These include the necessity of injecting large amounts of vasoconstrictors and anesthetics at the attachment points of the pectoralis major muscle, a higher risk of bleeding, tissue trauma, excessive fluid secretion, and difficulties in accurately shaping the implant pocket in the inner and outer poles.

Master of Medicine, Dr. Ho Cao Vu, who graduated with a master's degree from the University of Medicine and Pharmacy in HCMC and currently works at Cho Ray Hospital, specializes in benign and malignant pathology surgery.

Vu has over 15 years of experience and has performed more than 2,000 aesthetic and reconstructive surgeries using the new-generation ultrasonic surgical scalpel technology.

He has also corrected numerous cases of defective, asymmetrical, exposed, or ruptured implants, pseudocapsules, as well as severe grade III and IV capsular contractures.

In 2010, Dr. Ho Cao Vu completed direct training at the Department of Plastic Surgery at MD Anderson Cancer Center (Houston, Texas, U.S.) under the guidance of Professor David Chang.