I am scheduled to have revision surgery in two weeks. I have baker II contracture. I had 350 silicone implants placed through armpit in October 2010. They look good in clothes & ok but not natural in swimsuit due to stiffness. My breasts are fairly tight/hard to the touch and are sitting a bit high. PS plans to open the lower part of the pockets back up & perform capsulotomy. What is recommended for best results of such a procedure? Also, how should recovery be compared to initial surgery?
What Can I Do to Avoid Recurrence of my Baker II Capsular Contracture Following Capsulotomy (Scoring Capsule) & Pocket Revision?
Doctor Answers 14
Preventing capsule contractures around breast implants
There is more information about bacterial colonies forming biofilms around implants causing capsule thickening and contractures around implants. So, in addition to the traditional capsulotomies and antibiotics, your surgeon should consider using an acellular dermal matrix to buildout the lower pole of the new implant pocket. There are current clinical trials looking at the use of cold lasers to prevent and treat capsule thickening, and finally the use of Accolate (Zafirlukast) a synthetic, selective peptide leukotriene receptor antagonist, is recommended by some surgeons in the plastic surgery literature. Ask your surgeon about these techniques for potentially better results after your revision.
Revision for capsular contracture?
Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. At a 3rd recurrence, it may continue to occur despite all of these modalities and consideration for explantation or living with the contracture are options. Hope that this helps! Best wishes!
Capsulotomy (Scoring Capsule) & Pocket Revision?
Sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons. In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants, and the use of acellular dermal matrix. Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source ( human, porcine, or bovine in origin). I hope this, and the attached link ( demonstrating a case utilizing acellular dermal matrix) helps.
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Treatment of Breast Capsular Contracture
As you can see, this is a "grey area" and many different answers to your question have been posted. Reviewing the recent literature on capsular contracture, the consensus points towards removing (capsulectomy) versus scoring (capsulotomy) of the capsule. This may be due to the bio-film theory described in other answers. Perhaps removal of the capsule allow removal of the biofilm as well. Your surgeon may also consider placing the implant in another location (above the muscle if originally placed below the muscle). However, each approach has it's own risks and it is best to ask your surgeon about these.
Capsular contracture, axillary incisiion, breast augment
It would be helpful to see pre and postop photos, but based opn your description, this problem may be somewhat different than a pure capsular contracture. I see this fairly often when a patient with a slight breast droop has an axillary placement of the implants and it is usually quite easy to correct using another incision than the axillary one. If the problem is what I think it might be, it has more to do with the lower edge of the muscle needing to be released from the overlying breast tissue for 2-3 centimeters so the implant can fall down and the muscle ride up. This corrects the problem of the lower edge of the muscle hodling up the implant.
Contracture after augmentation
This is a difficult problem in the best of circumstances. Recurrence rates for correction of capsular contracture range from 35 to 50% of cases .
Best results after capsulotomy
There is some evidence that asthma medications can minimize and even reduce capsular contracture. I have had very good results in my patients with these inhibitors. Ask your surgeon about Accolate or Singulair. These drugs are safe and have few side effects. I usually prescribe a one month supply and evaluate the results. If there is a favorable response then I have my patients continue for a total of 3 months.
What can I do to avoid recurrence of capsular contracture?
It is generally accepted that the risk of recurrence after simple capsulotomy (splitting the capsule but not removing it) and using the same implant is quite high. Most cases of capsular contracture are caused by bacteria in a biofilm on the implant that cannot be removed by antibiotics or washing the implant. Most plastic surgeons would suggest a complete capsulectomy and implant replacement so that the new implant resides in a fresh pocket. Other technical factors would include dissecting the pocket under direct vision to minimize bleeding stimulating fibrosis and scar contracture (which would mean an inframammary or periareolar incision and using a drain after surgery), and many of us feel that cutting through the breast tissue via a periareolar incision may expose the implant to bacteria in the ductal system of the breast, so we prefer the inframammary incision. No touch technique, triple antibiotic irrigations, etc. may also decrease the risk of bacterial contamination. Some of us do use Accolate for a period of time following surgery, and I have found it helpful, though not all surgeons believe that it works. Ultimately the use of Strattice (derived from pig skin) is a newer technique that is very promising, but the material is so expensive ($3,000 plus) that I do not always use it in a first time treatment of a capsular contracture, and our use of this material is still evolving. Discuss these issues with your surgeon, and consider getting more than one opinion if you are unsure of which plan is best
How to Avoid Recurrence of my Baker II Capsular Contracture Following Capsulotomy (Scoring Capsule) & Pocket Revision?
The best way to avoid caosular contracture is not to have a breast augmentation since contracture is seen in as many as 15% of women having a breast augmentation. Once you develop a contracture, the odds of it happening again are much higher despite the surgical treatment.
Attempts at breaking up the scar tissue from the outside (Closed capsaulotomy) from the inside (Open capsulotomy), generally do NOT work long term. The best promise appears to be with subtotal removal of the acr with the old implant and placement of a new implant in as NEW pocket (preferably under the muscle) with the use of a biological sling (Strattice) to add cover to the implant and break up the scar.
Each case has to be individualized. If possible, it is best to remove the entire capsule, although is many cases this can be quite difficult especially in very thin patients if it is subglandular and also in subpectoral pockets when attempts are made to remove the posterior wall over the rib cage.