In order to have a charming curvy figure quickly and enhance self-confidence, breast augmentation with prosthesis has become the first choice for many women. When they reappear in front of people with beautiful fashion, their lovely posture will make people admire. However, the pain may only be clearer to them. Many female friends complain that they have a beautiful figure after breast augmentation with prosthesis. Time is short, or two or three years, or four or five years, the breast becomes tough and hard, and even with the passage of time, there will be symptoms of breast deformation and pain. Why is this? Beauty comes at a price! A song once sang: "Just like a butterfly, it has to go through the struggle of the pupa, and its wings can be as solid as a painting." The above situation is a common complication after augmentation mammoplasty: capsular contracture of prosthesis. Its incidence rate is generally about 14%, and even as high as 25% ~ 40% reported abroad. According to its development, it can be roughly divided into four levels: level I (completely natural): it is the same as normal breast and does not need surgery; Grade ⅱ (mild): the breast is slightly hardened, and the prosthesis can be felt, but the appearance can not be seen; Grade ⅲ (moderate): breast is moderately hardened, and the prosthesis is easy to see; IV (severe): the breast is severely hardened, painful and even distorted. So can it prevent and avoid this complication? The so-called complications in medicine are all foreseeable problems, but they can't be completely avoided. It's just a matter of chance. Let's first look at the causes of capsular contracture of prosthesis. The formation process of fibrous capsule is similar to scar tissue formed by wound repair. Although breast prosthesis has good histocompatibility, it is still not completely compatible with human body. When the breast prosthesis is implanted in the body, the body will have a physiological protective response to it, forming a fiber capsule to wrap it. In other words, the formation of fibrous capsule is a normal defense response of the body, which will happen to everyone, but the degree varies with individual differences. Investigation and analysis show that capsular contracture is related to people's age, skin color, scar hyperplasia tendency and hormone level. Of course, this is also related to the treatment before, during and after breast augmentation surgery. We can formulate corresponding preventive measures for each factor that will cause capsular contracture. First, choose high-quality breast prosthesis before operation. Breast prostheses are mainly divided into two types according to the content of silicone membrane: silicone prosthesis and physiological saline prosthesis. Although the saline prosthesis is soft, it has strong penetrating power. Some people even hear the sound of saline flowing in the chest water sac during exercise, so it has basically been eliminated. Silicone prosthesis will also have infiltration, but its infiltration degree is much lighter than that of normal saline prosthesis, and the sound of liquid flow will not be heard, so silicone prosthesis is mainly used now. The molecular weight of silica gel determines its softness and permeability. The smaller the molecular weight, the better the softness, but the greater the penetration; Conversely, the greater the molecular weight, the worse the flexibility, but the smaller the permeability. The degree of infiltration is directly proportional to the postoperative capsular contracture. Therefore, we need to find the best combination point, which is both soft and less penetrating. At the same time, the silicone membrane on the outermost layer of the prosthesis is also related to capsular contracture. Basic experiments and clinical practice have proved that the incidence of capsular contracture of rough surface prosthesis is lower than that of smooth surface prosthesis. Generally speaking, a rough prosthesis is better than a smooth prosthesis. Therefore, we suggest to choose a silicone prosthesis with low permeability and rough surface. Second, choose the appropriate implantation plane during the operation. Prosthesis implantation mainly has two levels: posterior pectoralis major and posterior mammary gland. Some scholars believe that it is better to put the prosthesis behind the pectoralis major. Because pectoralis major exerts continuous pressure on the prosthesis to resist capsular contracture, the scars around the prosthesis extend outward. Moreover, the natural layer behind pectoralis major is obvious, and the blunt separation is relatively easy, with less bleeding. Because pectoralis major is covered on the prosthesis, its shape is relatively more natural and it is not easy to be touched. Moreover, because there is no direct contact with the breast, it will not have adverse effects on the breast, nor will it affect the normal breastfeeding after operation. However, when the breast is separated, the damage is relatively large, it is easy to bleed, the foreign body reaction is relatively heavy, and the prosthesis is relatively shallow and easy to be touched out. Therefore, we generally recommend that the prosthesis be placed in the pectoralis major. Of course, this is not absolute. Some people are not suitable for putting it behind the pectoralis major, but only behind the breast. Need to analyze the specific situation. Third, a large enough cavity was isolated during the operation. Only when the prosthesis is placed in a large enough cavity and fully stretched can the postoperative appearance be beautiful and natural, and the capsular contracture can be restrained to the greatest extent. In the process of separation, it is necessary to fully, especially when separating the pectoralis major muscle, and even to separate part of the pectoralis major muscle, so that the prosthesis has a broad extension space. Therefore, we generally use general anesthesia surgery, the patient is in a state of complete relaxation, and there will be no antagonistic effect when separating. Doctors can operate calmly and easily separate a cavity large enough. At the same time, the patient has no pain and will not be nervous. Some people think that psychological stress is also related to capsular contracture. Fourth, complete drainage after operation. Because there is a space at the potential level of the body during the operation, it is inevitable that there will be some bleeding and tissue leakage. When the body removes these things by itself, it will produce inflammatory reaction, then fibrosis, formation of capsule, and then capsule contracture. Therefore, it is necessary to clear the bleeding and exudates in the body in time. Postoperative hematoma is an important factor causing capsular contracture. We suggest that a drainage tube be placed after operation to completely drain. The length of drainage time depends on the drainage fluid. This requires hospitalization and timely replacement of drainage devices. In the absence of any drainage measures, it is not advisable to go home after outpatient surgery. 5. Take anti-inflammatory measures during and after operation. Local inflammatory stimulation is also one of the main causes of capsular contracture. Mainly divided into bacterial inflammation and aseptic inflammation. The former is mainly that aseptic operation is not strict, and the prosthesis is polluted by long-term exposure to air during operation; The latter is mainly caused by the prosthesis itself and talcum powder on the gloves during the operation. In view of the above two points, we suggest strict aseptic operation during operation; Soak the prosthesis with a specific disinfectant before putting it into the prosthesis, and then rinse the glove surface with sterile saline again; Routine systemic antibiotic anti-inflammatory therapy after operation can minimize local inflammatory reaction and reduce the occurrence of capsular contracture. Sixth, postoperative drugs and physical therapy When the incision is removed after surgery and the body is fully recovered, you already have a proud posture. But don't worry, don't be complacent too early. For patients themselves, the process of preventing capsular contracture has just begun. As we have already introduced, the formation process of fibrous capsule is similar to that of scar tissue in wound repair. Therefore, we suggest that patients take Fukang tablets for a long time within six months to one year after operation. It is a drug that inhibits the formation of fibroblasts and scar growth, so it can reduce the thickness of fiber capsule and reduce the incidence of capsule contracture. At the same time, the maximum chest massage is carried out within the acceptable range, mainly to massage the prosthesis. After the prosthesis is placed in the body, the separated cavity will definitely shrink, so it is necessary to carry out external massage at an early stage to obtain continuous, effective and sufficient space. In this way, the breasts can be soft and moderate, realistic and natural. Beautiful breasts are an important part of a woman's beauty. Be kind to your breasts. While gaining beauty, we should also use science to maintain it. May every woman have confidence and beauty of her own. Song Kexin Plastic Surgery, Peking Union Medical College Hospital