BREAST RECONSTRUCTION SURGERY #4 CAPSULECTOMY

Recently I underwent  a surgical procedure called a capsulectomy.

 

What is ‘breast capsulectomy’ surgery?

This is the name given to the surgical procedure to remove capsules which have formed around breast implants. These capsules can thicken and so squeeze the implants which will distort the appearance of the breasts.

When a breast implant is performed on a patient, the body will wall it off and form a capsule that surrounds the implant. This capsule can vary in thickness from patient to patient. Patients with capsules that contain muscle cells have the ability to contract and misshape the breast altogether. This contraction is called a capsule contraction. It may cause pain, break, rupture, and deform the shape of the breast altogether. The removal of this capsule is done through breast capsulectomy surgery.

What is involved in a breast capsulectomy surgery?

A capsulectomy will involve total or partial removal of the capsule and will usually involve the replacement of the implants. The goal in this surgery is to allow the body to form a more favourable capsule and to place a breast implant that will last longer than the previous one.

My breasts were hard, the right breast more so than the left.  They also had a sever rippling effect occuring when I bent over.  My breasts took on a very round ball like shape and were unnatural looking.  This was a result of capsular contracture.

During this surgery, my surgeon removed my right breast implant entirely.  She then surgically removed the capsule surrounding the implant and then  placed the implant back into my chest.  She was able to position the implant better.  My surgeon also adjusted the positioning of my left implant.  She then performed fat grafting once again to give the implants a softer cushioning and a more natural look.

The results are amazing!  I am so pleased.  They are softer, have a more natural slope and most importantly look real.



CAUTION.........................NUDITY AHEAD!!!!   IF YOU DONT WANT TO SEE MY NAKED BREASTS DONT READ ANY FURTHER!!  

HERE COME MY BREASTS.....................

 

I have chosen, hesitantly, not to cover my nipples.  I think it is important for women to see a very realistic photograph of the results!  Plus you can also see the horrible swelling and puffiness all around my abdomen, the water retention from countless IV D5W during surgery.  I always feel so fat after reconstruction surgery.  I want women to know that they are not alone!

You can see the bruising around my hip bone area where fat was removed last week and then deposited around my implants.  

You can see where my areolas were tattooed and my nipples constructed.  The stitches surrounding my nipples and areola have not completely dissolved.  That usually takes about 5 weeks. 

My nipples were actually grafted from some of the excess skin that was left behind from the original mastectomy.

I found out today at my post-op appointment that the nipples will need to be done again.  They have flattened quite a bit.  This could be a result of too much pressure applied to the graft area either by the gauze or my bra.  Thankfully the surgeon left enough excess skin to complete the nipple reconstruction again.....I hope.

This procedure will thankfully be performed under a local anesthetic in the minor OR.  However, it takes a long time to get an appointment for the minor OR.  I may be looking at 4 months!  

Next time, I will take special precautions such as covering the nipples in a very loose, fluffy gauze, and not wearing a bra at all for 2 weeks and dressing in a very loose type of T-shirt taking care not to apply any pressure at all on the nipple area. It is safest to keep them completely dry for 2 weeks.  I really wish this was explained to me after my surgery.  I was quite upset about this today, because the nurses in the recovery room did not fully explain how to care for my nipples at home.  

I will also have to endure a long course of antibiotics.  Since capsular contracture can be caused by an infection of the implant itself, it is very important that I am compliant and take my antibiotics as prescribed and for the complete duration.  I also must apply polysporin ointment to my nipples and cover with a loose gauze pad. 

No matter how much you hate the look of the excess skin, you will be so thankfull that it is there!  Especially after having the capsule cut out, my implant reinserted and fat grafting performed.  If there wasnt enough excess skin remaining we would have been in trouble!

The areolas will be made a little larger in diameter and will be tattooed again.  The colour usually fades after the 1st and even the 2nd tattooing.  

I have done quite a bit of research since coming home from the hospital and I am determined to get my hands on this plastic splint for nipple reconstruction.  It is obvious that any type of dressing will eventually lead to the flattening of my nipples.  It seems that the best results are to wear a Nipple Guard for 3 months following the nipple reconstruction.  

I found this great advice on a breast reconstruction blog.....

As far as caring for nipples-- essential rules...
1. do not remove, play with, or even sneak a peek at the dressing that your surgeon has put on you after surgery.

2. When the bandage comes off, you should have an idea of what to expect-- discoloration, a big nipple that is swollen, scabs, stitches sticking out, etc. Dont panic.

3. The first two to three weeks are the critical ones.  You don't want to compress the nipple. So whether you use the Dr scholl pads, or stack gauze and wear loose tops, its essential not to compress the nipple.

4. If your breast was radiated, you should have a reasonable expectation for the nipple.  Sometimes it is harder to achieve a lot of volume, and projection, depending on the skin on the breast mound.

5. Nipples take a long time to totally heal and look normal, and even at that- the tattoos can further enhance the look of the nipple and areola, and can make a perfect circle for the areola as well.

6. At about 6 weeks the nipple is usually at the desired size.  It will flatten.  This is a fact.  But, many women will tell you, that even if the nipple flattens over time, it still makes the breast look very real.  

There are a lot of options to give projection to a flattened nipple.  The most common are a dermal filler injection-- but now, surgeons that work with AlloDerm and Strattice are using them to give nipples lasting projection.

The care that goes into nipples and tattoos can be frustrating.  It's technically the easy part surgically, but it takes a lot of after care.

Again, why am I finding this out now and why am I discovering this on my own?  Another example of how women must take matters into their own hands some times and be prepared to advocate strongly for what you believe in!

For the sake of cost, I think I will purchase Medela nipple shields that are used during breast feeding.  They seem to get positive reviews when used for nipple reconstruction.

http://link.springer.com/article/10.1007%2Fs00266-009-9426-9

The surgery took about 2.5 hours with a 2 hour recovery.  The pain was about 6/10 on a scale of 1-10.  I had quite a lot of nausea and vomiting as usual.  I was recommended to take 2 weeks off work, but that was not possible.  I returned to work the next day.  Thankfully I have the support of an amazing co-worker and friend! 

My breasts are now measuring a 34 DD, and are healing nicely.