Post-surgical breast hardness as a sign of pseudocapsule

Distinguishing between pseudocapsule and capsular contracture

Pseudocapsule occurs when the breast becomes hard right after surgery and does not soften over time. While pseudocapsule shares some similarities with capsular contracture, which causes stiffness in both standing and lying positions compared to implants outside the body on palpation, they differ in their underlying causes.

Both pseudocapsule and capsular contracture, if left untreated over time, can lead to premature implant rupture and aging at breast fold sites due to pressure in the pocket.

Pseudocapsule after breast augmentation from an expert's perspective

Master of Medicine, Dr. Ho Cao Vu, who graduated with a master's degree from the University of Medicine and Pharmacy in HCMC and currently works at Cho Ray Hospital, specializes in benign and malignant pathology surgery. Dr. Vu has over 15 years of experience and has performed more than 2,000 aesthetic and reconstructive surgeries using the new-generation ultrasonic surgical scalpel technology. He has also corrected numerous cases of defective, asymmetrical, exposed, or ruptured implants, pseudocapsule, severe grade III and IV capsular contracture, and more.

Below are insights from MMed, Dr. Ho Cao Vu on the signs, causes, prevention, and management of pseudocapsule before and during breast augmentation surgery.

Causes of pseudocapsule

● Selection of inappropriate implants

Women should choose implant sizes that are compatible with their anatomical structure. Many surgeons fail to assess three common abnormalities in chest structure: protruding, concave, and irregularly shaped chests.

This leads to the selection of implants that are not suitable in terms of diameter, projection, gel consistency, softness, and pressure within the pocket, which then creates pressure on the implants. Consequently, this results in the implant being compressed, leading to a sensation of breast hardness immediately after surgery that does not soften over time.

Choosing implants that do not align with the anatomical structure of the body is a primary cause of pseudocapsule following breast augmentation.

Some breast implants on the market lack the softness of certain well-known brands. Implants that do not feel as soft as or softer than natural breast tissue may be unsuitable for individuals with abnormal anatomical structures, thin skin, or limited glandular tissue. This can result in implant exposure, hard implants, and palpable rippling at certain border areas of the pocket where tissue coverage is minimal or too thin.

● Inaccurate creation of the implant pocket

Creating an implant pocket that is too small or not appropriately shaped for the size and contour of the implant can lead to complications, especially in individuals with unusual anatomical structures.

If the pocket diameter is smaller than the implant diameter or if the pocket is incorrectly positioned, the implant will not be evenly distributed in the upper, lower, inner, and outer poles. This creates pressure on the implant, leading to pseudocapsule shortly after surgery.

Furthermore, prolonged external pressure can cause the implant pocket to expand forward, leading to deformation. This can also result in the implant sitting predominantly above the nipple (a condition known as "high-riding breast"), below the nipple ("bottoming out"), primarily in the inner area (creating a "symmastia" effect), or mainly in the outer area ("lateral displacement"). Another noticeable sign is when the nipple is not centered within the breast mound.

The second major cause of pseudocapsule is the incorrect creation of the implant pocket.

If the pocket size is larger than the implant, the implant can move within the pocket, leading to an uneven appearance and altered sensation.

Some surgeons may not anticipate the risks associated with patients having abnormal anatomical structures such as chest bones, spine alignment, or the distribution of breast tissue, leading to complications and aesthetic issues over time. Therefore, the precise creation of the implant pocket is crucial.

Recognizable signs of pseudocapsule

● Immediate post-surgical breast hardness

Many patients experience breast hardness immediately after surgery and assume it is normal. However, this is a sign that should be monitored closely for the first six months post-surgery.

Typically, the implant's softness and breast shape change during this period. If the breasts do not soften after six months, a consultation with a specialist in breast pathology and aesthetics is necessary.