Breast Implant Revision: Q&A
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What is the Best Way to Approach Capsular Contracture Revision?
I had my first augmentation July 2011 with silicone smooth unders through the areola. Developed contacture at week 4 in my left beast that is now grade III to IV. I want revision with Strattice, since it is likely due to bacterial film around the implant. My question: would it help to decrease the chance for recurrence if I take the implants and capsule out for a few months before I put in the new set? Thank you in advance!
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8 Doctor Answers |
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Margarita6062
in Tampa FL
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Correction of capsular contracture with Strattice
Hi Margarita 6062,
As previously mentioned there is no study that specifically addresses this question. In my opinion, unless there is an obvious infection, as opposed to what may be a biofilm, there is no reason to remove the implants for a few months. Most cases of capsular contracture, if treated appropriately with at least partial capsulectomy, will be corrected. One does not always need to use Strattice, although it may have some benefit. For my patients I do not...
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Capsular Contracture Revision can be assisted with ADMs
Margarita6062: sorry to hear about your predicament. Prior to the advent of ADMs (acellular cadaveric dermal matrices like Alloderm and Strattice), I would counsel women who had experienced early & symptomatic (Baker III-IV) capsular contracture that the surgical approach would include a) anterior dome capsulectomy (removal of the anterior surface of the scar capsule; b) change of the surgical approach (in your case, periareolar to inframammary fold); c) placement of a drain; d)...
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Capsular contracture
Certainly the appraoch you mentioned to remove the implants and the capsule and wait 3-4 months before putting new implants in would be the ideal best chance to minimize recurrence. However, with a first go round with a CC often changing the pocket to under the muscle, changing the implants, and removing as much of the capsule as possible is a reasonable first attempt. Some suggest using Strattice as well.
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What is the Best Way to Approach Capsular Contracture Revision?Answer:
So far there is early evidence that contracture can be successfully treated with Strattice and I think the timing can be anytime you and your surgeon feel that you have given it enough time and are sure that it is not going to change..I would not do a full capsulectomy at that time, but instead would suture Strattice as an interposition material into the capsule....It really seems to work!!!
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Capsular contracture and staging the correction.
The reason for your contracture is most likely unknown at this point. Assuming you did not have a clinical infection of the breast, the contraction could just have easily been from a small hematoma. The bottom line is that most capsular contracture is idiopathic (meaning we don't know why it happened). Strattice is an excellent choice to help prevent recurrence of contracture and in most cases it is not necessary to stage the capsulectomy and the Strattice. However, if you did have a...
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Breast implant contracture revision with Strattice
Most of the time it is not necessary to remove the implants and wait before using Strattice, though sometimes that is recommended for capsular contracture when not using it. Unfortunately there are no specific studies to answer your question definitively. What I can sayis that every case where I have used Strattice along with implant replacement for capsular contracture it has been successful.
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Revision for contracture
These are difficult questions.. unless you had an extreme infection.. this is probably not necessary. the implant should be changed. the entire capsule removed and acellular dermis added.. you still will have a 25-40% chance of some problems.
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Capsular contracture following breast augmentation
The incidence of capsular contracture following breast augmentation approaches 8%. The etiology is unclear and may relate to a low grade infection which does not become clinically apparent or a small amount of blood left in the pocket at the time of surgery. In most cases it is a Grade II capsule with firmness and minimal displacement. Recent evidence suggests asthma medications which are strongly anti-inflammatory such as Accolate may slow or stop a recently...
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Springfield Plastic Surgeon
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