Capsulectomy breast implant exchange is the best solution for capsular contracture, a complication in which a thick scar capsule forms around a prosthetics, as explained by leading Beverly Hills plastic surgeon Dr. Tarick Smiley on his recent Snapchat posts.
In a series of Snapchat videos, Dr. Smiley presented a patient whose right breast had capsular contracture, leading to the implant to ride higher; it also resulted in hardness of the breast tissue. The left breast, meanwhile, had no such problem although it appears pendulous.
To achieve good results from capsulectomy breast implant exchange, Dr. Smiley also performed areola reduction and wise breast lift technique.
After and before photos of a patient who have had revision breast augmentation to correct her capsular contracture
In the videos, the celebrity plastic surgeon is seen removing the entire scar capsule, which has encapsulated the implant.
“It is important to remove the entire capsule to prevent the problem from recurring. In primary breast augmentation, the capsular contracture rate is 4 percent, but in revision it goes up to 15 percent,” he said.
“However, removing the entire capsule and with the use of meticulous techniques, we can lower the capsular contracture rate to 4 percent,” he added.
Aside from lowering the risk of recurrence, Dr. Smiley said that removing the entire scar capsule also allows for smoother, more natural results from revision breast augmentation.
“The thick scar capsule squeezes the implant inside sometimes to the point that it becomes deformed, with some of its edges showing through the skin as bumps,” he said.
To further reduce the risk of capsular contracture recurrence, Dr. Smiley always irrigates the implant pocket with antibiotic solution, and only performs his surgeries in accredited surgical facilities.
“One of the main causes of capsular contracture is implant contamination at the time of surgery. However, this can be minimized since our accredited surgical facilities have air ventilation system designed to curb contamination. Also, they are fully equipped with sterilization devices,” he further explained.
Moreover, Dr. Smiley requires all his patients with smooth round implants to perform breast implant massage everyday to maintain the “thinness” and softness of the scar capsule, which naturally forms around any implanted device.
“Capsular contracture is made up of excess collagen fiber. We could prevent this from happening with daily breast implant massage in which the idea is to push the prosthesis into the outermost corners of its pocket,” he added.
Meanwhile, Dr. Smiley finished off the surgery by performing a breast lift, which corrected the patient’s pendulous breasts.
There is a lot of misconception surrounding breast implant longevity, with some patients thinking that it should be replaced every ten years. However, implant removal, with or without replacement, must only be done when there is some type of implant- or breast-related problem.
Perhaps the “10-year replacement” misconception stems from longitudinal studies suggesting that one out of five breast augmentation patients with silicone implants would need revision surgery.
However, revisions are only warranted when there are implant-related problems such as leak and malposition, or breast-related issues such as sagging appearance and capsular contracture.
Simply put, there is no point of replacing a “functioning,” stable breast implant.
Capsular contracture, according to studies, is one of the most common reasons for revision surgery. This happens when the scar capsule around the implant, which is the body’s natural response when it comes into contact with a syntethic material, becomes too copious and stiff.
Most cases of capsular contracture happen immediately after surgery or a few months afterward, which may affect one or both breasts. Many surgeons suggest that implant contamination at the time of surgery or low-grade infection during the healing stage are the most likely cause of the complication.
Nonetheless, capsular contracture may happen years after surgery, although with daily breast massage, or more aptly called implant displacement exercise, this could be prevented or at least minimized, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
The goal of breast massage is to maintain the malleability and “thinness” of the scar capsule, ultimately preventing capsular contracture, says Dr. Smiley who has performed thousands of breast augmentation surgeries (primary, revision, and reconstructive type).
While 20 percent of patients with silicone breast implants would need removal/revision surgery within a 10-year period, it is important to note that the studies involving their longevity were conducted before the introduction of the latest silicone implants.
In 2013, the fifth generation silicone implants, also referred to as gummy bear implants, were approved by the US Food and Drugs.
Gummy bear implants are notable for their durability thanks to their highly cohesive filler material that even after cutting their shell in half, no leak will occur. Hence, it is perceived that they have longer lifespan compared to saline and fourth generation silicone implants.
The no touch breast augmentation is a surgical technique in which the implantation process is done with a Keller Funnel, a device closely resembling that of a baker’s bag. With its tip inserted into a small incision, it is squeezed successively to propel the implant toward its pocket.
While the surgeon holds the Keller Funnel, the nurse pours the implant from the sterile packaging directly into its wide opening. Once the implant is properly loaded, the surgeon squeezes and propels it into place. Simply put, no one actually touches the prosthesis.
Photo Credit: Kellerfunnel.com
One of the benefits of the no touch breast augmentation technique is the perceived reduction of capsular contracture rate.
Capsular contracture is a copious formation of scar tissue around the implants. While a thin flexible capsule-shaped scar is a normal part of recovery, implant contamination at the time of surgery is believed to trigger the over production of collagen bundles (scar tissue).
Low-grade infection during the initial healing stage may also cause capsular contracture.
In its late stage, capsular contracture causes breast deformity and pain and thus it requires surgery in which the copious scar tissue is removed together with the implants. Replacement might be done simultaneously, while some doctors recommend waiting for a few months to ensure complete healing of the breast pocket.
Aside from minimizing the risk of capsular contracture, the no touch breast augmentation offers other benefits; hence, it has become a favorite technique of celebrity plastic surgeon Dr. Tarick Smiley who has posted Snapchat videos to demonstrate the method.
The use of Keller Funnel can reduce the length of incision by almost half, making it easier to hide scars at the areola’s border, parallel to the submammary fold, and inside the armpit skin crease, says Dr. Smiley.
Furthermore, the implantation process via Keller Funnel reduces the force by up to 95 percent (the finger insertion method uses about 27 lbs. of force, while the no touch just requires 0.64). This results in less trauma around the skin incision and thus promotes favorable scars, he adds.
And with reduced force, Dr. Smiley says implant stability is preserved as well.
The shorter surgical time is another key benefit of Keller Funnel. According to surveys, more than half of surgeon-respondents reported 10-20 minutes reduction in their procedure time.
The Keller funnel breast augmentation is a technique that uses a pouch-like disposable device that makes the insertion of silicone breast implants quicker and less “traumatic.” Studies have also suggested it can lower the risk of contamination at the time of surgery, which in turn reduces the capsular contracture rate.
Capsular contracture happens when the usually thin scar capsule around the implants becomes thicker. This complication is closely linked to implant contamination at the time of surgery and low-grade infection during the initial healing phase.
Photo Credit: kellerfunnel.com
With this technique, the implantation process is entirely done without touching the implants (their sterile packaging is opened before they are “poured” into the funnel). The tip of the funnel is placed into a small incision and is then squeezed to propel the implant into its pocket.
The implantation process will only take about 20 seconds, significantly shorter compared to the finger-push technique.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated on his Snapchat account how Keller funnel breast augmentation is performed.
The patient shown in the video received 500 cc high profile implants via peri-areolar incision, also referred to as “through the nipple.” One of the challenges of larger breast implants is the need for longer incisions, which of course result in longer scars. But with the use of Keller funnel, this problem has been easily resolved.
With a short incision (about 3.5 cm) that ran precisely within the areola’s lower border, the scar is expected to blend in with the surrounding skin after 6-12 months, said Dr. Smiley.
In addition, the celebrity plastic surgeon has noted the drastic reduction in the amount of surgical trauma around the skin, which could further promote favorable scars.
With the gamut of benefits provided by Keller funnel breast augmentation, he now uses it in most of his surgeries involving silicone implants, which are always prefilled.
It is important to note that the Keller funnel technique does not apply to saline implants, which are always positioned inside their pockets “empty” before they are gradually inflated by a predetermined amount of saline or sterile saltwater.
In breast augmentation surgery, it is possible to eliminate some risk factors in order to achieve predictably good results and avoid short- and long-term complications. For this reason, any prudent plastic surgeon will always require his patients to quit smoking at least three weeks prior to surgery.
But for extra conservative doctors, patients are even advised to avoid tobacco products for several months. The idea is to wait for the body to flush out the toxins known to impede healing and increase risk of complications.
Upland plastic surgery expert Dr. Tarick Smaili explains the four main reasons to quit smoking before breast augmentation, or better yet, to kick the nicotine habit for good.
1. Accelerated aging of the breast. Several studies have already proven the detrimental effects of smoking to skin, particularly how it breaks down collagen and leads to dry, sagging skin. For this reason, heavy smokers are more prone to breast ptosis or drooping even after factoring in other variables.
If sagging occurs after augmentation, the breast will look pendulous and unattractive. While breast lift can give some improvement, the poor skin quality of smokers could impede them to achieve optimal results.
The leading breast augmentation surgeon believes that there is no point of improving one’s appearance through surgery if she is unwilling to kick the nicotine habit or poor lifestyle known to accelerate aging.
2. Increased risk of infection and capsular contracture. Smoking can significantly increase the risk of general complications and less than optimal results.
Infection is particularly detrimental because it could trigger capsular contracture in which a thin, transparent scar tissue that normally forms around an implanted device becomes too thick. Eventually, the affected breast becomes painful and distorted, thus warranting a revision surgery.
Smokers are also prone to internal bleeding, coughing episodes (which is rather inconvenient during breast augmentation recovery), anesthetic-related complications such as pneumonia, and blood clots.
3. High incidence of reoperation. Of course, with increased risk of complications comes another problem—i.e., high incidence of reoperation which means additional expenses, emotional distress, and possibly less than optimal results.
4. Longer recovery. Cigarettes and other tobacco products are considered vasoconstrictors, meaning they cause blood vessels to tighten up, affecting the way the body recovers from surgical trauma.
Usually, quitting smoking just three weeks is enough to reverse most of its detrimental effects, although some patients who are heavy smokers are required to wait a little longer “to be on a safer side.”