Mammoplasty. Complications and diagnostics. Conversation with the MRI doctor.

Recently, the TUT.BY portal held a very interesting conversation with Vesta Petrovna Korolenok, the head of the MRI room at the "Tomography" MC, about plastic surgery. In particular, about breast augmentation surgeries and about those cases when such transformations take place with complications. ️

As part of the interview, Vesta Petrovna answered a number of difficult questions in simple language:

What is mammoplasty?

What are implants?

What are the complications after mammoplasty and how to find out about them?

When is it necessary to replace implants?

What is screening? And which women are recommended to take it?

and etc.

The entire article can be read on the TUT.BY portal in the "Health" section or here.

- Are breast augmentation and mammoplasty the same thing?

- Mammoplasty is a surgical operation that allows you to correct the volume and shape of a woman's breasts, to correct congenital anatomical features. Breast augmentation with implants is the most popular type of mammoplasty and one of the most common plastic surgeries among women in our country.

- Is mammoplasty always associated with the desire of women to have exactly a larger breast size?

- Of course, in addition to the simple desire of a woman to have larger breasts, there are other indications. They can be both aesthetic and medical. For instance:

  • tubular breast (cone-shaped breast, not hemisphere);
  • asymmetry of the breast;
  • reduction and prolapse of the breast after pregnancy or lactation;
  • reduction in breast volume due to weight loss;
  • mammoplasty after removal of the breast (mastectomy) due to cancer.

The operation is performed on girls and women over 18 years of age.

- Can pregnancy and breastfeeding affect the appearance of the breast with implants?

- Certainly. Women who have not given birth should be aware that after pregnancy and breastfeeding, the shape of the breasts will change and a second operation may be necessary.

What are breast implants?

An implant is a silicone capsule, inside which there is often a silicone or other gel, there may be a saline solution (the latter are practically not used by surgeons at the moment). The shell of the implant can be smooth, textured, microtextured or additionally textured, coated with polyurethane. The shell type is determined by the tasks presented to the implant.

The shape of breast implants can be round or anatomical (teardrop-shaped). Round implants can enlarge the breasts, evenly ensuring good filling of the upper pole of the breast.

Anatomical implants copy the shape of the female breast, increasing the volume of the breast in its lower part to a greater extent, leaving the upper pole shallow.

- Plastic surgeons are now talking about the fact that implants are made of extra strong materials that do not break. Is it so?

- Indeed, the shell of the implant is as strong as possible, does not allow gel to flow out, does not collapse upon impact, and withstands large pressure drops. For example, some brands of breast implants can withstand pressures of up to 800 kg per square centimeter.

- Still, are complications possible?

- Surgical intervention is always associated with a certain risk. Complications after mammoplasty are rare, on average in 5% of patients, but, unfortunately, no one is immune from this. The following complications are possible.

General surgical complications

Seroma - accumulation of serous fluid between tissues and the implant, can manifest itself as a change in the shape of the breast, swelling of soft tissues, the appearance of pain, redness of the skin in the area of fluid accumulation.

A hematoma is a collection of blood in a pocket around a breast implant.

Keloid scarring is an overgrowth of connective tissue at the site of surgical incisions.

The development of the infectious process is inflammatory processes in the body, which are characterized by the fact that the pain does not subside, but, on the contrary, intensifies, swelling and redness of the skin increases, and wounds are suppurating. Inflammation can cause seroma, and seroma, in turn, can cause capsular contracture.

Specific complications (associated with the presence of an implant)

Capsular contracture is a complication in which a dense capsule of fibrous tissue forms around the implant, which leads to deformation of the shape of the implant and, accordingly, the shape of the breast.

Rupture of the implant shell.

Implant displacement - deformation of the shape of the breast due to a change in the position of the implant to the wrong one.

- How can you find out about the occurrence of complications? 

The easiest and safest method is ultrasound. But its capabilities are limited and it is not always possible to identify damage to the implant. When imaging, a small field is used, this greatly complicates the diagnosis and prolongs its time. In this case, the subjectivity of the data obtained directly depends on the experience of the doctor, the current position of the device sensor, which can lead to inaccurate results. 

X-ray mammography. The method cannot be called safe, because it carries radiation exposure. In addition, it can be harmful in the early postoperative period, because the breast is compressed (“crushing” it to obtain a more accurate image), it can give an inaccurate picture due to the complexity of the study with implants. Also an important point! Mammoplasty reduces the effectiveness of breast cancer diagnostics with mammography. Therefore, it is imperative to inform the medical professional conducting the examination about the presence of the prosthesis. In such cases, special techniques are used to minimize the risk of complications. In addition, additional scanning in different projections may be required, which increases the radiation dose that a woman receives. 

MRI mammography (MRI of the mammary glands) is the most modern and accurate method for detecting postoperative complications and violations of the integrity of implants. Magnetic resonance imaging has a high sensitivity, best reflects the condition of the breast and is most likely to show damage to the implant, if any. It will also help identify other possible complications. The study is conducted without contrast. As a result of its implementation, a detailed layered image of tissues in different projections is obtained. - What complications can be after mammoplasty that require the use of MRI as an additional diagnostic method? 

Suspected violation of the integrity of the implants. If the integrity of the shell is violated, the implant deforms, it looks like a change in the size or shape of the breast. Damage can occur both in the first months after surgery, and after several years. 

Seroma is an accumulation of serous fluid, which is the water component of the blood. A hematoma is a collection of blood around an implant or incision. Postoperative hematoma and seroma can contribute to infection and / or capsular contracture and be accompanied by swelling, pain, and bruising. Hematoma formation is most likely in the postoperative period. However, it can appear at any other time with a bruised chest. As a rule, small hematomas and seromas resolve on their own. With extensive hematomas or seromas, surgeon intervention may be necessary. Implant displacement. 

Implant rotation - anatomical implants are subject to inversion, such rotation leads to a complete loss of breast shape. One of the complications of mammoplasty is capsular contracture. Capsule - formation of connective tissue around the implant; it is a natural reaction of the body to a foreign body. With capsular contracture, the capsule thickens and thickens. In most cases, capsular contracture is preceded by infection, hematoma, and seroma. 

Typical symptoms are: breast thickening and discomfort, pain, change in the shape of the gland, protruding of the implant and / or its displacement. 

Extracapsular spread of silicone outside the implant when it is damaged into the breast tissue, lymph nodes; complication due to the introduction of free silicone into the mammary gland in the form of silicone granulomas. - How is an MRI scan done? 

- MR mammography is performed using a special coil with holes for the mammary glands in the prone position, face down. This allows the breasts to sag and stretch, making it easier to visualize the internal tissues. Its mobility is minimized for the clearest possible image. A study to assess the integrity of the implants is performed without contrast medium. The duration of the procedure is 20-25 minutes. 

- Do you need any preliminary preparation for the study? 

- No preparation required. All jewelry and metal objects must be removed before the procedure.

- Are there cases when it is necessary to perform MRI of mammary glands with implants using a contrast agent? 

Indeed, there are such cases. 

For instance: 

  • the appearance of a change in the shape or density of the breast;
  • feeling of discomfort, pain; 
  • if there are close relatives with breast cancer; 
  • with discharge from the nipple; 
  • when a seal is found in the mammary glands, inverted nipples; 

MRI is also prescribed as a clarification of the diagnosis after ultrasound. And, of course, this method is irreplaceable if there is a suspicion of a malignant lesion of the breast with an implant. 

- What other MRI examinations of the mammary glands are carried out and for what purpose? 

- In our center, diagnostics are carried out on an ultra-high-field Siemens Magnetom Spectra device with a capacity of 3 Tesla. We conduct 4 types of research related to the diagnosis of the mammary glands: 

MRI without contrast enhancement to assess the condition of breast implants, which we talked about earlier. Here, the condition of the breast tissue is not assessed, the purpose of the study is to assess the condition of the implants. Contrast-enhanced multiparameter breast MRI and implant assessment. The study allows you to fully assess the condition of the mammary glands and the condition of the implants. 

In addition, research is being conducted: 

multiparameter breast MRI with contrast enhancement. 

The study allows you to fully assess the state of the mammary glands, to identify both benign changes and signs of a malignant tumor process; contrast-enhanced breast MRI screening protocol. The study is carried out only with the use of dynamic contrast enhancement, and its purpose is to identify changes with signs of a malignant tumor process. 

- Tell us more about screening? Is it desirable for every woman to pass it? 

- Conducting an MRI of the mammary glands using a screening protocol has become a unique experience for us. This study is carried out in women with a genetic predisposition to diseases of the mammary glands and / or with the presence of a mutation in the BRCA 1-2 genes, potentially healthy (no identified pathology). The peculiarity of this protocol is that it requires less time spent in the MRI machine (about 15 minutes). the program is used only with contrast enhancement to identify formations suspicious of a malignant process.  

- Are there any recommendations on whether and when to replace implants? 

- If the patient is satisfied with the cosmetic effect and there are no complications, the implant replacement is not needed. Currently, most manufacturers provide a lifetime product warranty, replacement under warranty is free of charge. 

The absolute indications of plastic surgeons for implant replacement are: 

  • complications associated with damage to the shell of the implant;
  • complications requiring complete or partial removal of the fibrous capsule in the so-called capsular contracture.

However, the decision on the need for replacement must be made in conjunction with the plastic surgeon. 

I would like to appeal to all women and remind you that it is very important to take care not only of beauty, but also of your health. And among the string of cases, you just need to find time for a preventive trip to the doctor! And don't be afraid to ask for help in case of problems! 

Be healthy!