In 2011, approximately 80 % of the 96277 cases of breast reconstruction were implant-based.1 The same year, breast augmentations saw a rise of 4% and continue to hold the title of ‘top cosmetic surgical procedure’, a title it has held since 20061. Given the invasive nature of surgical fields, no matter how great the technique or the device, complications may occur. Benjamin Franklin once said, ‘in the world nothing can be certain except for death and taxes’. For a surgeon, ‘complications’ should be added to this list.
Complications seen in implant-based breast surgery include haematoma, seroma, infection, alteration in tactile sensation, breast asymmetry, implant displacement, or capsular contracture. Some of these complications can be managed conservatively. However, sometimes operative intervention is needed to correct the problem. In a Danish study that examined 5373 women who had primary breast augmentations, asymmetry/displacement occurred in 5.2% of patients and capsular contracture in 1.7%. These two complications were found to be the most frequent reason for reoperation2. When breast implants are placed in a sub-pectoral position, this can often lead to unnatural movement of the implant with muscle contraction, loss of ideal position of the implant, and exaggerated upper pole fullness3.
In this article, the authors present the case of one patient who had an implant-based breast complication that was treated operatively and included the use of TIGR® Matrix, a new synthetic long-term resorbable mesh4–6. The patient had previously undergone bilateral sub-muscular breast implant augmentation many years previously. The patient developed capsular contracture and underwent eight subsequent surgeries, including vertical mastopexy. She unfortunately developed unacceptable breast asymmetry, synmastia, and abnormal movement that worsened with muscle contraction.
Patient and method
A retrospective review was performed on a patient who presented to a private practice after having undergone bilateral sub-muscular breast implant augmentation and subsequent vertical mastopexy by another surgeon. The patient presented complaining of breast asymmetry that worsened with muscle contraction. After verbal and written consent were given, this patient underwent a bilateral breast augmentation revision. Previous incisions were used to gain access to the capsule. A capsulotomy was performed and the previously placed intact implants were removed. Aggressive capsular scoring was performed to facilitate vascularisation of the mesh. The retracted pectoral muscle was replaced in its original position. The implants were replaced with 325 cc moderate plus profile smooth gel implants. These were placed in the sub-fascial position, where the fascia was present and the TIGR® mesh scaffold was placed above the implant where the fascia was absent.
The female patient was 46 years of age. She was seen in consultation 22 years after her initial breast augmentation. Her initial breast augmentation was complicated by postoperative capsular contracture, leading to eight additional surgeries, including bilateral vertical mastopexy. The authors’ preoperative examination showed the patient to have breast asymmetry, synmastia, and excessive movement that was worsened with muscle contraction (Figure 1). Intraoperatively, it was discovered that the patient’s pectoral muscles had retracted superiorly (Figure 2). The type of implants that the patient had in place were 425 cc high profile gel implants placed in the sub-muscular position. The skin flaps were also noted to be very thin.
Postoperatively, the patient experienced no complications. She had good aesthetic improvements in both breasts with improved symmetry and alleviation of abnormal movement of the implants with muscle contraction. She was quite pleased with the results. Postoperative photographs were taken 3 weeks after treatment (Figure 4). The authors’ opinion of the result of the operative revision was in line with the patient’s.