The Fasciocapsular Flap in Capsular Herniation

After augmentation mammaplasty, either subglandular or submuscular, the most typical complication to occur is capsule formation or its advanced form, capsular contracture. Even the less severe capsule formation can cause a feeling of discomfort because the breast starts to be fixed to the rear chest wall, thus resulting in a feeling of slight tightening. In extreme cases, a painful, distorted knot appears, which can immobilize the implant, resulting in the development of the so-called tennis ball phenomenon. Currently, because of high-quality mammary prostheses, the occurrence of the aforementioned extreme capsulation is rare (2–3%). The development of a soft, thin, but strong capsule, which neither distorts the shape of the breast nor fixes the breast to the rear chest wall, is much more frequent. However, the capsule does exist, and even if barely noticeable, it puts the implant under considerable pressure. It does not harm the prosthesis, but it is possible that the capsule itself is weakened, leading to the development of a hernia in which the implant may become visible. In the early phase, the hernia cannot be seen at rest, but when the implant is pressed, a small tumescence occurs on the breast. When the pressure is released, the herniated part of the implant withdraws, and the bulge disappears. At later stages, however, the bulge becomes permanent, and the implant protrudes along the weakened capsule. Thus, the overall image of the breast has lost its smooth continuity. The new tissue has developed around the implant, and the fascia of the pectoral muscle should be used to strengthen the weak point of the breast because the blood supply of both the capsule and the fascia is sufficient to allow their use as flaps.