Aesthetic breast surgery has made many advances to provide plastic surgeons and their patients more control over the results. Capsular contracture is a classic problem with breast implants where the healing membrane around the implant distorts shape and symmetry and degrades softness. This was once largely the result of silicone gel that leached out of intact implants. Modern implants are low-bleed and factors like blood and biofilms (colonies of bacteria) on the surface of the implants are now thought to be the leading causes. A number of developments help prevent capsular contracture including no-touch technique, bloodless dissection, use of antibiotic and antibacterial irrigation, among others. The controversial role of incision selection is discussed by Dr. Bass and his guest expert, Dr. Jason Pozner from Boca Raton, Florida. Mild capsular contracture can often be treated with ultrasound, non-invasively. Moderate or severe capsular contracture requires surgical correction including capsulotomy (cutting the capsule), partial or total capsulectomy, implant exchange and sometimes change of plane from subglandular to submuscular implant placement. Acellular dermal matrix materials like Alloderm or Stratice can also help reliably expand and maintain the implant pocket after capsular contracture.
Techniques have advanced to help mastopexy or breast lift improve in degree and durability of correction. One example is the use of artificial mesh to help support the breast tissue, minimizing weight and strain on the skin. This is particularly useful in augmentation mastopexy where the breast is being lifted and increased in size using a breast implant. This is often viewed as one of the most difficult procedures in aesthetic plastic surgery. Find out why by streaming the podcast. Mastopexy incisions can be minimized in some cases but the larger and droopier the breast the more incisions will be needed.
Breast reduction is sometimes performed with the addition of a breast implant. This seems paradoxical given the desire to reduce breast size but the implant can help in various ways to maintain breast shape. Finally, fat grafting is being used in all breast surgery for correction of small features of breast shape that are not readily addressed in any other way.
Dr. Lawrence Bass is a board certified plastic surgeon offering a full range of plastic surgery and non-surgical aesthetic services, with two New York area locations in Manhattan on Park Avenue between E 62nd and E 63rd and on Long Island in Great Neck.
To learn more, visit the Bass Plastic Surgery website at https://www.drbass.net/ or follow the team on Instagram @drbassnyc https://www.instagram.com/drbassnyc/
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Contents of this video:
00:00 - What are the biggest issues in aesthetic breast surgery?
00:55 - What causes capsular contracture?
02:52 - How can capsular contracture be prevented?
16:09 - What is the process of breast lifting like?
19:12 - What are the indications for breast procedures with limited incisions?
20:35 - Can breast lifting be combined with other procedures?
22:11 - Why is a breast lift with augmentation so difficult?
25:51 - How can fat grafting be used to modify breast shape or size?
