Posts Tagged "Capsular Contracture"


Breast implants are reasonably safe for healthy patients, although for some known and unknown reasons some women develop capsular contracture, which is a thickened scar that results in a hard, misshapen breast.

The normal response of body after implant placement (breast implants, pacemaker, etc.) is to encapsulate the “foreign” material in a thin, transparent collagen. But in some instances, the scar tissue becomes too thick that it results in capsular contracture, which in late stages always requires a revision breast surgery.

accolate-breast-implant-capsular-contracture

Most Los Angeles plastic surgeons agree that contracture primarily occurs because of increased inflammatory response often triggered by infection, silicone gel leak, trauma, and edema (accumulation of excess fluids).

Asthma medications, particularly those containing Zafirlukast (Accolate), are known to block natural substances in the body responsible for swelling and tightening of the airways. This prompted some plastic surgeons to use them “off-label” in an attempt to prevent and treat early stages of capsular contracture.

(Note: Off-label means prescribing medications for a certain condition other than that for which it has been officially approved.)

The idea is that Zafirlukast can also prevent and stop excessive inflammatory response that triggers the formation of contracture. According to several studies, the treatment provides good results for the majority of patients who reported dramatic softening of their breast within one to three months of treatment.

Meanwhile, the drug is also used off-label to prevent capsular contracture in patients believed to be at particular risk such as those already with a history of contracture and are seeking a revision surgery, and women who require breast reconstruction via implant-based technique.

Some Los Angeles plastic surgeons who are proponents of this asthma medication in treating and preventing contracture also recommend it to patients who have experienced hematoma or accumulation of excess blood within the surgical site, infection, trauma, and other “factors” that could increase their risk.

Aside from off-label use of asthma medications, some doctors also recommend vitamin E, breast massage, and/or ultrasound to treat early stages of capsular contracture.

Breast implant massage, or more accurately referred to as implant displacement exercise, is believed to be particularly helpful in preventing and treating contracture by maintaining the scar capsule thin and flexible. In fact, some doctors even instruct their patients to perform it daily for the rest of the implant’s life.

Some experts suggest that breast massage combined with Zafirlukast is particularly effective in treating capsular contracture in patients who do not want to undergo a revision surgery.

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Studies have suggested that on average the lifespan of breast implants is between 10 and 15 years, although the recently introduced fifth generation silicone implant, or gummy bear implant, is believed to last longer than its predecessors because of its form-stable, highly cohesive filler material.

US breast implant manufacturers Allergan, Mentor, and Sientra offer some kind of warranty on their products, with some even free lifetime replacement should their implants fail.

breast-implant-warranty

But Sientra, which is the newest breast implant manufacturer, specifically offers product guaranty against capsular contracture, a complication in which a copious scar tissue forms around the implant shell, eventually leading to hard, painful, and misshapen breasts.

The Capcon Care or C3 program, which has been introduced since November 2013, covers all women with Sientra textured breast implants who will develop capsular contracture within two years after their breast augmentation surgery. Despite the “limited” coverage, most plastic surgeons agree that this is a good deal for patients since in most cases the complication occurs during this period.

But it is important to note that the product warranty only covers patients with Baker III and Baker IV, which are the late stages of capsular contracture wherein the breasts already have visible manifestations such as deformed appearance and tissue hardening .

A revision surgery is needed to correct capsular contracture in its late stages. Ideally, the implants, together with the thick contracture or scar tissue, are removed to reduce the risk of recurrence. It is believed that a low-grade infection or contamination around the implant shell is one of the most causes of the said complication.

While all US breast implant manufacturers offer some kind of product warranty, or to be more specific, product replacement, it is important to note that the other costs of revision breast surgery such as anesthesia fee, surgical facility fee, surgeon fee are not included in the “standard” program.

However, Mentor and Allergan are now offering “extended” product warranty that includes $2,400 financial assistance. To be enrolled in this program, the patient has to pay $100.

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Some LA plastic surgeons feel that prior to any dental work, women with breast implants need to take prophylactic oral antibiotics at least an hour before the procedure and another one afterward. Others only recommend such practice before periodontal treatment, dental surgery, and deep cleaning and not in superficial cleaning, fillings, and other routine dental procedures.

The idea behind the use of prophylactic oral antibiotics in patients with breast implants is that dental surgeries and deep cleaning could cause transient bacteria, which theoretically could increase the risk of capsular contracture.

breast-implants-antibiotics-before-dental-works

Capsular contracture is a thick scar tissue that forms around the implant, causing the breasts to harden and appear constricted. In its late stages, the “capsule” becomes excessively tight to the point that it results in pain and discomfort.

While it is normal for the body to produce a scar capsule around any implanted device (to prevent it from migrating and growing), the theory is that the presence of bacteria around the breast implant shell could trigger the production of excess collagen or scar tissue, which in turn results in capsular contracture.

However, not every plastic surgeon supports the idea of giving oral antibiotics before and immediately after dental works. First and foremost, there is no medical evidence or study suggesting that such treatments could predispose the patient to higher risk of capsular contracture and its related complications.

And because there is no “hard” evidence, as of this writing there is no standard recommendation.

Some La plastic surgeons who feel that prophylactic antibiotic treatments are unnecessary when having dental works argue that the risk of capsular contracture is related to the circumstances around the actual surgery. According to some studies, if it would occur the most “crucial stage” is between the third and 12th month after the procedure.

These doctors argue that capsular contracture is primarily caused by implant contamination at the time of surgery, thus oral antibiotic treatments years after the procedure may not be of use.

Because of different views on the use of antibiotic pre-medication, the best course of action of women with augmented breasts is to follow their plastic surgeon’s specific advice, and inform their dentists (and even their general physicians and specialists) that they have breast implants.

Breast implant surgery has been the most commonly performed surgical enhancement over the past several years. In fact, last year alone more than 290,000 US women had the procedure, a 37 percent increase from 2000, according to the American Society of Plastic Surgeons website.

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In 2006, the US Food and Drug Administration lifted the ban on silicone breast implants after comprehensive studies have found no link between cancer and systemic diseases and their use.  And from then on, they have become more popular than saline implants because of their more natural results.

Currently available silicone breast implants are filled with a medical-grade silicone gel.  To further make them safer, their shell is made of biocompatible silicone that significantly reduces the risk of allergic reaction.

silicone-breast-implants

In terms of shell implant stability, the new silicone breast implants can withstand about three times the weight of an average woman, so the rigors of daily life activities will not have any effect.  Simply put, it would take an extraordinary amount of force (e.g., car collision and gunshot) before the prostheses rupture.

But despite the strength of the outer shell, the natural wear and tear will eventually affect its stability.  According to studies conducted by the two largest implant manufacturers in the US, Allergan and Mentor, breast implants have an average lifespan of 10 to 15 years.

In theory, silicone breast implants have a slightly longer lifespan than saline implants because they are less likely to “wrinkle,” which over time could affect the outer shell and possibly lead to rupture.

Wrinkling is more common in saline breast implants because they have a natural deflation rate, which some studies have suggested to be around 1 percent annually.  This is attributed to their filler material, which is simply a sterile saltwater.

Meanwhile, silicone implants sold after the mid 1980s have a slightly thicker shell and gel (compared to their predecessors), but they are still soft to simulate the natural feel of breast tissue and fat.

This “model” is still used today and is deemed reasonably safe as long as used by physically healthy women who have realistic goals and expectations.

But recently, manufacturers have released the latest version of silicone breast implants (fifth generation to be exact), which are more commonly referred to as gummy bear implants because just like the popular fruit candy, it is also soft but “shape stable.”  But as with any new technology, they come with a higher price tag.

Proponents of gummy bear implants believe that in terms of safety, they are superior over the “standard” silicone implants in which the filler silicone gel is cohesive but still liquid.  According to studies, the new technology can significantly reduce the rate of leak and capsular contracture because of its form-stable filler material.

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Surgical drains are commonly used after tummy tuck, breast reduction, and body lift in which skin excision is quite extensive.  They are primarily needed to prevent seroma or excess accumulation of fluids underneath the skin, which could lead to risk of infection, persistent swelling, and healing problem.

However, LA plastic surgeons rarely used drains after primary breast augmentation surgery because the vast majority of women do not develop seroma.  Nevertheless, there are some doctors who always use them on their patients.

breast-augmentation-drains

But using teardrop or anatomical breast implants may necessitate the use of surgical drains to eliminate any potential fluid that could prevent the textured or “rough” implant shell to infuse with the surrounding tissue, leading to risk of rotation.

Anatomical implants must adhere to the surrounding tissue because they cannot afford to rotate inside the “pocket” unlike round implants whose all sides are equal.

Because anatomical implants have more volume in their lower half, leading to the appearance of teardrop, their original position must not change lest they could flip and lead to visible deformity that requires a revision breast surgery.

Another situation that may warrant the use of surgical drains, according to LA plastic surgeons, is revision breast surgeries that commonly involve extensive dissection, which could increase the likelihood of seroma and hematoma or buildup of excess blood.

It is important to avoid or at least immediately treat seroma and hematoma, which if left untreated could lead to breast implant contamination and capsular contracture that is often exhibited by “unusual” firmness, breast distortion (i.e., it appears like a ball or “constricted), and pain.

Infection or implant contamination is believed to be the main cause of capsular contracture, triggering the body to produce a copious amount of scar tissue around the implants that eventually constricts the prostheses.

The use of AlloDerm and Strattice, which are used to “thicken” the tissue of patients prone to rippling and implant displacement (e.g., post-mastectomy patients, older women, female body-builders), may also necessitate the use of surgical drains after breast augmentation surgery.

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