Potential Surgical Complications in Breast Implant Surgery

This could be classified in pre- and intra-operative complications and early and late post-operative complications.

Pre-operative and intra-operative complications derive from poor planning (wrong choice of the surgical access, incorrect measurement) or poor surgical technique (over-dissection of the implant pocket, implant mispositioning, excessive bleeding).

Early post-operative complications are hematoma, seroma, infection, implant malposition and pain. Late post-operative complications are infection, seroma, capsular contracture, poor muscular animations (excessive, unusual, painful) or distortions, implant visibility, implant malposition (descent, double bubble, waterfall deformity, etc.), implant rippling, wrinkling and palpability, implant rupture, symmastia (uni-boob), poor scar healing or scar hypertrophy.

The role of bacterial biofilm in implant-associated infection, capsular contracture, late seromas (implant disease) and breast implant associated anaplastic large cell lymphoma (BIA-ALCL)

Breast implants are placed in a potentially contaminated pocket, bacteria being present in breast ducts and glandular tissue. Several studies has demonstrated how bacteria could bind to breast implants’ surface regardless the type of surface.

These bacteria could form a living biological thin layer called the biofilm, which is a layer of combination of glycoprotein (A sugar-protein complex) and dormant bacteria binding to the breast implant silicone shell. When forming a biofilm, bacteria are resistant to antibiotics.

Once overcoming the local host defenses (i.e. the immune system), the biofilm will continue proliferating leading to local inflammation and fibrosis, causing capsular contracture.

A great T-cell (A cell of the immune system) response to the presence of bacteria has been, shown in studies, particularly in textured implants when compared with smooth implants, texturization representing a more ideal surface for biofilm formation.

Chronic biofilm infection of breast implants and the predominant T-cell lymphocytic infiltrate could acquire a particular importance in the evolution of late seromas (fluid surrounding the implant, pericapsular fluid) and breast-implant associated Anaplastic Large Cell Lymphoma (BIA-ALCL, tumor formation) as well.

Chronic bacterial infection has been shown to be associated with the development of lymphomas and similarly chronically infected breast implants could be extremely rarely linked with inflammatory processes leading to T-cell lymphoma development.

The treatment option of such clinical condition would be the surgical removal of the tumor with the diseased capsule as well as removing the biofilm coated implant.

 The Double Capsule Formation

Double capsule could be defined as two distinct capsular layers around a breast implant with an intercapsular space: the inner layer adheres to the implant envelope and the outer one to the breast tissue. Between the two capsular layers could have been described the presence of seroma-like fluid. Double capsules could be partial or complete.

Although controversial four hypothesis have been described to cause the complication. the most prevailing one would be the mechanical sheering forces leading to the detachment of the capsule formed around the capsule leaving a space to eventually be evolving in a new capsule in the inner aspect adhering to the implant, whilst leaving a fluid trapped in between both layers.

How to prevent complication in Breast Augmentation Surgery

Our medical team advice their patients with several recommendations to minimize the contamination of the implants and biofilm formation

-Minimizing implant contamination starts pre-operatively advising patients to perform an accurate skin cleaning, taking a shower with an antibacterial foam gel before undergoing surgery.

-Starting with the antibiotic prophylaxis at anesthetic induction.

-Suggesting avoiding parenchymal dissections by preferring the subfascial or dual-plane  techniques.

-Accurate surgery should be pursued by reducing bleedings and tissue devascularization, though careful atraumatic manipulation of tissue.

-Advice the rigorous washing of the implant pocked prior to the implant placement with triple antibiotic solution.

-Using iodine drapes to cover the breast skin prior to introduction to prevent any possible contamination. 

-Closing the inscion immediately after the implant placement to prevent contamination.