Is it common practice to reuse the same implant for a 2nd capsulectomy?

Question

I have saline implants sub muscular. I've already had one Capsulectomy in May '17 due to CC with the existing implant cleaned and reused. I've developed CC yet again and am due for another Capsulectomy the end of Aug '17. The plan is to resuse the same implant again. I'm wondering if this is common practice? Also, I don't believe we'll be using any type of mesh or transplant material, just lots of antibiotics injected and taken orally.

Austin Hayes, MD · Answer

No, this is not standard practice. One of the causes of capsular contracture is bacterial contamination of the implant. Bacteria can set up a biofilm on the implant and no amount of antibiotics can remove them from the implant surface once this has occurred. Appropriate treatment of a capsular contracture includes removal of the capsule, replacement with brand-new implants +/- placement of an allograft (Strattice or similar) to help prevent the contracture from forming again. The silicone implants that I use in my office carry a 10 year capsular contracture warranty that provides new implants, and up to $3500 towards the cost of a revision surgery (Baker III/IV contractures). If you don't feel that your capsular contracture is being handled appropriately, that I would recommend 1-2 additional consultations with board-certified plastic surgeons.

Gerald Minniti, MD, FACS · Answer

Hello,No, re-use of implants is not the state of the art or even the norm in 2017. We know that bacterial biofilm is the cause cc and it cannot be cleaned.  Similarly, inframammary incisions should be used for access, and total en bloc capsulectomies should be performed, with or without biologics like ADMs. My recommendation is to cut your losses and go to an ABPS certified/ASAPS member surgeon who specializes in revision breast surgery. Best of luck!

John J. Corey, MD · Answer

I think when a patient has a contracture severe enough to warrant capsulectomy that a new implant should be used and in fact the implant companies nowadays agree. Most of them will provide a free implant in the case of severe grade 3 or great 4 capsular contraction....

Payman Danielpour, MD, FACS · Answer

It is an absolute containdication to use the same implant due to the fact that there may be a biofilm on the implant that is leading to the capsular contracture.  Perhaps the reason you have a recurrence is the fact that the wrong operation is being done to correct the contracture.  I highly recommend that you see a surgeon that performs this type of surgery regularly and is board certified.

Afshin Parhiscar, MD · Answer

Dear Flies home
In general, it is not customary to reuse same implant, however, it will depend on you and your surgeon and the reason for the surgery. In the context of capsular contracture, I would not reuse the same implant. The risk of recurrence of contracture might be higher.

Mathew A. Plant, MD, FRCSC · Answer

Breast implants are considered one time use devices. Reusing a breast implant does happen from time to time however in the setting of capsular contracture it's absolutely necessary to replace the implant. The thought is that there is a potential biofilm of bacteria that cannot be cleaned off of it that will continue to cause capsular contracture once the implant is put back. Most companies provide replacement implants in the setting of capsular contracture so I'm not entirely sure as to why your surgeon wouldn't want to replace it. Perhaps it's a good idea to get a second opinion at this point.

Curtis Wong, MD · Answer

should be decided by the patient after having been provided the pros and cons of doing so.  But most would recommend new implants in new pockets as the standard of care.  In the old days, reuse of implants was common and many did go on to heal without recurrences.  But if trying to do everything possible for not having a recurrence, new implants and new pockets is what is recommended.

David S. Motoki, MD · Answer

Thank you for your question. There is a large body of research evidence supporting bacterial contamination as the cause for capsular contracture around breast implants. It is not the standard of care to re-use a breast implant after capsulectomy. Please get a second opinion from an experienced board certified plastic surgeon.

Tom J. Pousti, MD · Answer

I am 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 (his human, porcine, or bovine in origin). Best wishes.

Khashayar Mohebali, MD, FACS · Answer

The short answer is NO.  It is not common practice to re-use the same implant, especially multiple times.  There may be biofilm or bacteria on the implant surface itself that is leading to the repeat capsular contracture. In my practice, I always exchange out the implant.  The only benefit of keeping the same implant is a cost saving.

Is it common practice to reuse the same implant for a 2nd capsulectomy?

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