An Unusual Complication following the Replacement of Breast Implants

The replacement of breast implants is a procedure which is easily performed with satisfactory results according to both surgeons and patients.

In general, complications do not occur, except for the rare possibility of infection, hematoma, or dislocation of the prosthetics.

However, we wish to address a complication that we encountered following a prosthetic replacement surgery in a patient of 64 years of age.

The patient had a previous procedure in 1989 to remove breast tissue with nodules and a subsequent reconstruction surgery involving breast implants.

After >13 years, the patient underwent a new procedure of the removal of recurrent fibroadenomatous breast nodules and the replacement of breast implants, always in a subglandular position.

In 2016, an ultrasound showed a possible breakage of 1 of the 2 prostheses. Due to this result, the patient decided to replace the breast implants and requested that they be of a smaller volume.

Considering that the patient already had a periareolar scar, it was suggested to keep the same scar.

The procedure took place without any complications using general anesthesia and infiltration of lidocaine and epinephrine in a percentage of 1:200,000, proceeding with capsulotomy.

The next morning, however, the areolas were extremely congested, and, therefore, the sutures were removed, converting the scar in a “T” mastopexy technique to close the surgical wound without tension.^1,2

The following morning, there was a noticeable improvement with regard to the congestion, but the problem was not resolved.

In the days following (Fig. 1), there was a partial necrosis of the areola that was treated with local medications and oral aspirin until healed.

Fig. 1.

Right areola, 5 days postoperative.

Partial or full necrosis of the nipple–areola complex results from either arterial insufficiency or, more commonly, venous congestion. Superficially coursing venous network can be disrupted during breast reduction procedures. Venous congestion can occur because of inadequate preservation of the venous drainage, constriction of the pedicle because of an inset that is too tight, or hematoma.^3,4 In our patient, neither breast resection nor transposition of the nipple–areola complex was performed, so we can suppose that the cause of the congestion and consequent partial necrosis could be attributed to a reorganization of the tissues over time which led to a deficit in vascular surplus.

Therefore, in repeated surgeries to replace prosthesis, take care to consider the possible risk of areola necrosis.

DISCLOSURE:

The author has no financial interest to declare in relation to the content of this article.