Complications from Breast Implant Removal
Unclean implant pocket with residual fibrous tissue, necrotic tissue, blood clots, and fluid accumulation
When patients experience post-surgical abnormalities such as infection, abscesses, excessive bleeding or fluid discharge, or delayed wound healing, high-dose antibiotics are often prescribed for an extended period. While these measures can alleviate pain or discomfort caused by infection within the pocket, improper treatment and care can result in prolonged, silent infections. Over time, this leads to the accumulation of contaminated fluid, blood clots, and mucous-like fibrous tissue within the implant pocket.
In such cases, breast implants cannot be placed. The surgeon must perform a revision surgery to thoroughly clean the implant pocket, conduct antibiotic susceptibility testing, insert drainage for monitoring, and continuously irrigate the pocket until it stabilizes.
Non-adherent implant pocket following breast implant removal
For cases involving abnormalities in the implant pocket due to infection, capsular contracture ranging from grade 1 to grade 4, ruptured implants, textured implants, or smooth implants, different surgical techniques must be employed for implant removal. In many instances, following implant removal, the pocket fails to re-adhere, excessive excision occurs, or residual gel is left within the pocket, resulting in infections that make it impossible to place a new implant in the subsequent surgery.
For abnormal cases such as infection or implant rupture, appropriate implant removal techniques are essential
Infection spreading inward due to improper wound care for non-healing wounds
If internal inflammation is not thoroughly treated, wounds may become difficult to heal and remain unclosed for an extended period. For open wounds, improper wound care practices can lead to cross-infection from external sources, causing delayed healing or failure to heal entirely. Prolonged inflammation not only hampers the wound healing process but also negatively impacts the patient’s overall health and immune resilience.
Case of Abscess Management: Debridement, Clearing Pockets, and Irrigating Soft Tissue Abscesses
Ms. TT, born in 1990, underwent multiple breast augmentation procedures before seeking assistance from Dr. Ho Cao Vu. First Procedure (April 2022): Ms. TT had her initial breast implants placed at another facility but unfortunately developed complications with an abscess, requiring a second surgery to remove the implants. Third Procedure (December 2023): Ms. TT underwent another breast augmentation at a different aesthetic clinic. Post-operatively, she developed fluid accumulation, prompting the surgeon to perform another operation to remove the implants, place drainage tubes, and discharge her. Fourth Procedure (December 17, 2024): After undergoing breast ultrasound and testing negative for infection, Ms. TT sought Dr. Ho Cao Vu to perform the surgery to reinsert breast implants. During the procedure, after dissecting into the breast pocket using an ultrasonic surgical scalpel, abnormalities were identified.
The previously formed pocket had a thin capsule with scattered pseudomembranes and multiple cavities. The left breast pocket contained clusters of white clumped pseudomembranes, while the right breast pocket showed yellow fluid secretion and clumped pseudomembranes. These findings indicated poor pocket hygiene and incomplete cleaning, leading to persistent infection.
Additionally, on the left breast, the lower pectoralis major muscle at ribs 4, 5, and 6 was intact and not excised. Dr. Vu consulted with the patient’s family to gain consent for further management. He proceeded with cavity removal and partial dissection of the pocket on both sides, followed by lavage of the pocket with hydrogen peroxide, betadine, and saline solution. Irrigation drains were placed post-operatively. Pseudomembranes were collected for bacterial culture, antibiotic susceptibility testing, and histopathology to check for tuberculosis bacteria.
Management of Breast Pocket Abscess in Non-Healing Wounds
The following case involves a patient who underwent breast augmentation and areolar reduction surgery via an inframammary fold incision on November 28, 2024. Postoperatively, the patient experienced pain, swelling, and discomfort. Ten days later, after visiting the aesthetic center for suture removal, she developed a fever, a bitter taste in her mouth, and chills. She was prescribed intravenous antibiotics along with oral antipyretics and anti-inflammatory medication. Upon follow-up three days later, the attending doctor identified abnormalities, noting yellow fluid discharge from the breast pocket. The decision was made to remove the breast implants, leave the wound open without drainage, and continue oral medication.
Still concerned about persistent fluid discharge from the open wound, the patient consulted with Dr. Ho Cao Vu. Clinical examination revealed light red fluid seeping from the pocket through the open incision, fully communicating with the implant cavity. Dr. Vu ordered tests to evaluate the infection status and devised a treatment plan, which included continuous wound irrigation for seven days at the center.
Having undergone two surgeries within a short period, the patient presented with weak immunity and deteriorating health. As such, a non-surgical approach was chosen to manage her condition.
Procedure for Breast Implant Removal with Laryngeal Mask Anesthesia
Laryngeal mask anesthesia offers significant advantages, particularly for patients and children. This method is not only easy for surgeons and anesthesiologists to perform but also minimizes the risk of laryngeal trauma during the procedure. Furthermore, laryngeal masks are less likely to irritate the airway, allowing patients to recover from anesthesia more comfortably, with fewer side effects compared to endotracheal anesthesia.
Dr. Ho Cao Vu routinely employs laryngeal mask anesthesia in breast implant removal surgeries, combined with the use of an ultrasonic surgical scalpel. This approach ensures a bloodless procedure, prevents tissue damage, and facilitates a minimally invasive implant removal technique, avoiding trauma to the breast pocket.
Post-operatively, patients experience no pain, require no downtime, and are discharged within six hours without the use of painkillers or antibiotics. For this reason, the anesthesiology team unanimously decided to utilize laryngeal mask anesthesia, ensuring greater safety and comfort for the patient both during and after the breast implant removal procedure.
