Capsule fibrosis
Capsule fibrosis (lat. capsular fibrosis) is one of the most frequent complications after breast augmentation with implants. It is a hardening of tissue due to a natural immune reaction of the body against the implant.
Under physiological conditions, this reaction results in the formation of a very tender and elastic capsule around the breast implant, so that no further complications are to be expected. However, in the case of capsule fibrosis, the immune reaction is so strong that a firm, thickened capsule forms around the breast implant and contracts it. This results in a hardening and deformation of the implant.
These consequences manifest themselves in severe pain, tension and deformation of the breast. The development of capsule fibrosis can have many different causes, the validity of which has not yet been clearly proven. These include the condition of the surface of breast implants, which can be either smooth or textured.
The smooth surface of older implants favours fluid leakage due to implant rupture, which significantly increases the risk of capsular fibrosis. In contrast, roughened implant surfaces are less likely to form the fibrous capsule. The position of the implants also has a significant influence on the development of capsular fibrosis.
The risk of disease is higher if the implant is positioned over the pectoral muscle. Therefore, from a medical point of view, placement under the pectoral muscle is preferred. Bruises in the wound cavity are a particular risk factor.
Scar tissue can form from these very quickly, which is why drains are placed after a breast operation to avoid large bruises. Breast cancer patients who have been treated with radiation have a very high risk of developing capsular fibrosis. For this reason, the surgeon to be treated resorts to the method of using autologous tissue for breast reconstruction.
Breast implants after breast cancer
After breast cancer, the breasts can be reconstructed with breast implants, which consist of either silicone gel or saline solution. The skin in the breast area must first be stretched before the implant is inserted. To do this, surgeons use an expander, which is a kind of balloon that is filled with saline solution over a period of time.
At the end of this procedure, the expander is replaced by the implant. However, healthy skin is required for this procedure. A disadvantage of breast reconstruction with silicone implants is that women perceive their breasts to be much firmer than before and it is a rather unpleasant feeling for them.
Breastfeeding with breast implants
In principle, breast implants do not represent an obstacle to breastfeeding and they do not affect the health of the baby. Since the implant is placed under the mammary gland or muscle, there is no direct connection between the latter and the gland. However, in the rarest of cases, sensory disturbances or loss of sensation in the nipple can occur, which would significantly reduce the ability to breastfeed.
Especially if the breast implants were inserted behind the milk ducts, it can be assumed that these and the larger nerves would remain unharmed and that in this case the ability to breastfeed would not be impaired. However, scars may form in the breast as a reaction to the breast implants, which in some cases can lead to pain and discomfort during breastfeeding. The suspicion that silicone may pass into breast milk and cause health problems for the child has not been confirmed so far.
An increased level of harmful substances or silicone in breast milk has not yet been proven with silicone implants. However, pregnancy can lead to changes in the tissue and the fit of the implant can be altered. In principle, it is possible to replace breast implants after pregnancy.
However, it is advisable to have breast implants inserted only after family planning has been completed. Surgical breast augmentation using breast implants has been performed since the end of the 19th century. At that time, a German-Austrian doctor tried to reconstruct the breast of a woman who had had a breast removed because of a tumour by inserting a benign fat tumour (lipoma).
Since then, various materials have been implanted into the female breast, such as sponges, rubber, glass beads. Fluids such as cooking oil or paraffin have been injected into the breast on a trial basis to increase volume. However, many of these procedures were associated with serious complications, and often amputation of the breast was unavoidable.
In the 1960s, the first actual breast implants, which were made of silicone or saline-filled implants, were introduced. Since the 1980s there have been repeated reports of complications caused by silicone implants, which is why the use of this material was banned in the early 1990s. In 2000, there were problems with soya oil implants, which were taken off the market shortly afterwards because there were fears of poisoning consequences if the implant shell was damaged.
After extensive studies, silicone implants were approved for breast augmentation in Europe again in 2004. However, another worldwide scandal occurred in 2010 about the company PIP, whose breast implants contained industrial silicone, which was proven to have a cancer-causing effect.
