Aggressively textured breast implants are associated with double capsules and late seromas, according to a retrospective study of several hundred primary bilateral breast augmentations and primary bilateral mastopexy augmentations.
The study, which was performed and published recently by Canadian plastic surgeon Elizabeth J. Hall-Findlay, M.D., is a look back at her own patients treated at Banff Plastic Surgery, in Banff, Alberta, over almost two decades.
"I have always followed my results in all of my breast surgery patients, because I think it is important to review outcomes. I have been performing careful measurements to be able to add some 'science' to the 'art' of plastic surgery," Dr. Hall-Findlay says.Dr. Hall-Findlay says she had not seen significant numbers of late seromas or double capsules in the early years of her practice, which she started in 1983. She began to notice them in 2006.
"Given that it is difficult to assess capsular contracture when comparing different surgeons' outcomes, I decided to compare my own outcomes to each other. I tried not to change any of the other variables such as prep solution, pocket irrigation and so on, and I noticed that late seromas and double capsules were a new finding that I had not seen in the first 25 years of my practice. The study was my way of figuring out what was happening," she says.
Dr. Hall-Findlay says she noticed double-capsule formations on some Biocell (Allergan) textured-surface implants when revisions were being performed for various reasons, such as size change and capsular contracture. She did not really take notice, however, until a patient with Style 410 implants presented with an expanding seroma 19 months after her original surgery.
Dr. Hall-Findlay says she recalls that the left breast of this patient kept enlarging, and it was assumed that the problem might have been some form of infection, but detailed questioning and eventual cultures ruled that out. When the patient was taken into surgery, there was a large amount of serosanguineous fluid and a double capsule, Dr. Hall-Findlay reports, adding that this is just one example of several that eventually prompted her study.
Three patients developed late seromas — more than a year after their original surgery — with two patients requiring urgent drainage of an expanding seroma/hematoma. Seven patients were found to have double capsules as an incidental finding for procedures, such as asymmetry and bottoming out, and five patients were found to have double capsules when surgery was performed for capsular contracture.