Many plastic surgeons will postpone or reschedule the surgery of their patients who are sick—e.g., common colds, flu, urinary tract infection, and even minor cough. This “guideline” is particularly true if symptoms such as fever, productive cough, and breathing difficulty are present.
Because plastic surgery procedures are commonly performed under general anesthesia, any sign of breathing difficulty is a reason enough to delay surgery until the patient is better.
However, some surgeons feel that patients with just a minor cough or cold can safely proceed with an elective surgery.
But when it comes to breast augmentation in which artificial prosthetics are used, it is not uncommon for surgeons to be extra conservative, meaning that even a minor cough might be enough to postpone the surgery because of the perceived increased risk of implant infection and capsular contracture.
The theory is that a “suppressed” immune system could predispose the patient to higher risk of implant contamination or infection, which could lead to capsular contracture, or a thick scar tissue that forms around an artificial prosthetic, causing the breasts to look and feel different.
In late stages of capsular contracture, the breast is painful and has a distorted appearance—symptoms that can be only treated by a revision surgery in which the thickened scar tissue and implants are removed. If there is plan to use new prostheses, most experts suggest waiting for a couple of months so the infection will clear up, thus minimizing the risk of recurrence.
Plastic surgeons are also extra conservative when the surgery involves the mid section—e.g., tummy tuck and extensive abdominal liposuction—since any amount of coughing could put tension on the incisions and lead to wound healing problems and “unnecessary” discomfort.
Because it is ideal to be in one’s optimal health prior to an elective surgery, LA plastic surgeons typically recommend frequent washing of hands to prevent cold and flu, sticking to superb nutrition, and avoiding strenuous exercise that could lead to injuries at least a week prior to surgery.
Capsular contracture occurs when the scar tissue around the implant pocket becomes too thick, eventually leading to misshapen, painful breasts. Studies have suggested that a low-grade infection is one of the triggers leading to this complication, which requires a revision that always requires replacement of implants.
Los Angeles plastic surgery expert Dr. Tarick Smaili explains the five potential ways to minimize breast implant capsular contracture rate.
1. Breast implants. Some studies have suggested that gummy bear implants (fifth generation silicone implants) and textured implants could reduce capsular contracture rate.
Gummy bear implants, because their filler material is extremely cohesive, have been known to drastically reduce the risk of rupture, which is tied to capsular contracture believed to be an over-reaction of the body to fight off minute leak and low-grade infection.
2. Breast implant massage. Dr. Smaili typically advises his patients to begin implant displacement exercise a week after surgery to maintain the natural softness of the tissue and pocket, thereby potentially preventing capsular contracture. This postop care is also known to accelerate the settling of implants into their proper place, leading to a more teardrop appearance.
3. Submuscular. Placing the implants under the muscle, as suggested by several studies, can reduce the complication rate by as much as 20 percent. The idea is to position the prostheses in a way that there is no contact with the breast tissue known to harbor staph bacteria, which can trigger capsular contracture.
4. Asthma medications (Accolate). A small study involving patients with first stages of capsular contracture who were asked to take these drugs has shown that such treatments can soften the breasts in three to six months.
The theory is that these medications prevent the body to overreact from the presence of breast implants, the same way it works to relieve asthma.
5. Sterilize everything. Contamination around the implant shell is believed to be a common trigger of capsular contracture and a wide range of complications. For this reason, it is crucial to sterilize the surgical facility, equipment, implants, and even the pockets where they will be positioned at the time of surgery.
To further minimize the risk of infection and capsular contracture, many reputable plastic surgeons, including Dr. Smaili, uses the no-touch technique in which the implants are opened only at the moment of implantation, and positioned into the pocket with the use of a cone-shaped device called Keller Funnel that is squeezed rapidly.
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.
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.
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.
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.
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.
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.