I had lumpectomy and radiation 18 months prior to my mastectomy. I currently have tissue expanders w/alloderm and am doing well, but am concerned about capsular contraction since I had rads. I was reading about the "pocket protector" and the Capsule Switch Procedure using e-PTFE. I don't want to get a latissimus flap if this happens. Is CSP an option? Or is that just used in augmentation cases?
Can the "Capsule Switch Procedure" Be Used in Reconstruction for Capsular Contracture?
Doctor Answers 4
Further reconstructive options are always available
There are always further reconstructive options available to you--of which fat grafting and pocket changes may help. But you are doing well and may never need anything further. Your surgeon has done an excellent job. Congratulations.
Alloderm may help reduce your incidence of capsular contracture.
The "capsule switch procedure" sounds like using a graft to replace a portion of the capsule. I would be wary of using a non-biologic mesh to decrease contracture. Alloderm is a dermal matrix which is acellular at the time of placement. In essence, the Alloderm does not form a traditional capsule and it is theorized that the disruption of a circumferential capsule limits contracture effects. This has shown a contracture rate in reconstruction of less than 1%. In radiation, the issues with contraction have a higher rate. However, the radiation will affect more than just the capsule. Tissue thinning, skin healing problems, and higher complications rates are common. A latissimus flap is an excellent option to bring non-radiated tissue to increase bulk, stabilize a reconstruction, reduce contracture, and improve the overall appearance of the breast.
Prevention of capsular contracture after radiation
I am not aware of any published articles on the use of e-PTFE in the treatment of capsular contracture in the plastic surgery literature. There is however mounting favorable experience with the use of dermal grafts(Alloderm) as your surgeon apparently utilized in your case. Using your own tissues (flaps) may become more of a tenable option if you do develop capsular contracture. You sound like your on the right track. Good luck