I had breast augmentation over 3years ago.I developed capsular contracture and had them replaced in march this year only to find that when I came round from the op the Implant had slipped out of the muscle.I had another op 2wks later.again I developed capsular contracture and had another op last month,I then developed a collection of blood and had another op 2wks ago,in which I then picked up an infection.had a checkup today and it's now been confirmed that I have got capsular contracture again.
Why Does Capsular Contracture Reoccur in Certain People?
Doctor Answers 5
Capsular contracture after breast implants
Capsular contracture is not well understood:
- some women are prone to them
- blood may contribute
- bacteria may contribute
- capule rate is higher if you already had one
- no implant , no capsule
There are several theories as to why capsular contractures occur, but it is difficult to predict. Some peopel do get them more frequently than others.
Why Does Capsular Contracture Reoccur in Certain People?Answer:
We probably don’t know for sure why some people form capsules and others don’t. We know bacteria and blood probably have a role, and it has been rare in my practice to see it on both sides and yet we prep the skin the same and give the same antibiotics…And we see it many times repeat itself on the same side even after treatment…A very perplexing problem for doctors and more for patients!
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Repeated Capsular Contracture
No one knows with absolute certainty the cause of capsular contracture, either as a single event or recurrent contracture, but the leading theory is that a film of bacteria attaches to the surface of the implant. This biofilm incites an inflammatory process which leads to thickening of the implant capsule. There is also a higher rate of capsular contracture after a hematoma (blood collection in the implant pocket). If a contracture recurs more than once, it may be that there is a low level of bacterial contamination in the implant which has not been eliminated. In that cases most would agree that the implants should be removed, not replaced. Whether or not they could, or should, be replaced at a later time is debatable.
Studies have shown that a bacterium called Staph epidermidis can be cultured from as many as 70% of capsule specimens obtained during surgical procedures for capsular contracture. So I employ a number of measure that address the possibility that skin bacteria or nipple duct bacteria may adhere to the implant surface during the augmentation procedure. We prep the skin using potent antiseptic solutions prior to draping the surgical site with sterile drapes, however the microscopic surface of the skin is full of peaks and valleys, and `nooks and crannies' - like sweat glands, hair follicles and sebaceous glands - that may harbor bacteria despite thorough application of an antiseptic prep solutions.
After prepping, we apply a new skin sealant product called InteguSeal to the skin surface where the incision is to be made. This effectively seals off all of the `nooks and crannies' that may harbor bacteria, and the sealant lasts for several days postop. We also apply it over the nipple and areola to seal off the nipple ducts which may also harbor bacteria.
Over the course of the surgery, we irrigate the implant space several times with a large volume of a saline solution containing three antibiotics (which can be modified in patients with an allergy to any of the antibiotics in the solution). Prior to implant placement, we irrigate the implant space with full-strength Betadine, a potent topical antiseptic that has been shown in clinical studies to reduce the incidence of capsular contracture.
I think one of the greatest advances in reducing the possibility of implant contamination by skin bacteria during breast augmentation surgery is the development of a soft, sterile, paper funnel for insertion of silicone gel implants into the implant pocket. This simple yet clever device actually looks much like a pastry chef's bag. It allows me to introduce the implant into the subpectoral pocket without ever touching it with my gloves, and without the implant ever contacting the patient's skin surface. The implant package is opened, the implant is irrigated with antibiotic solution then `poured' into the funnel, the small end of the funnel is inserted in to the skin excision which is held open with retractors, and I gently `squirt' the implant into the pocket. Before this was available, there was a great deal of implant contact with the patient's skin, under great pressure, as a pre-filled gel implant is forced into the pocket through a relatively small incision. The implant insertion funnel completely eliminates what I think has been the most concerning aspect of breast augmentation surgery in regards to the potential contamination of the implant with bacteria during the procedure.
There is no breast augmentation practice with a capsular contracture rate of zero. Yet there are obviously a number of measures that can be taken to make the rate of contracture as low as possible. I think it is important for patients to have confidence that their surgeon is focused not only on providing a breast enhancement that is beautiful and natural-appearing, but also on maximizing the likelihood that their aesthetically pleasing result will remain beautiful and natural-appearing over the long term.