What is the best way surgically to correct a capsular contracture and what is the success rate?

Question

I've had two breast implant surgeries- and I developed capsular contracture only on the right breast both time! I have been told that wrapping a piece of skin on the implant can be effective but I want to know what is the success rate and pros and cons of this procedure.

Gerald Minniti, MD, FACS · Answer

Biologic materials have become popular, but its use necessitates the use of drains, which are a source of bacterial contamination of the implants, possibly the reason for recurrence of cc. Further, the material doesn't 'incorporate' into your forming capsule as advertised, and frequently leaves palpable lumps where it has lifted and folded on itself. The key to low recurrence is total capsulectomy via gentle all-electrocautery dissection, antibiotic or hypochlorous acid irrigation, delivery of the new implant using a funnel, and use of an inframammary incision, not periareolar.

Richard G. Schwartz, MD · Answer

Although incompletely understood, capsule contracture, the tightening of scar tissue around a breast implant, is thought to be related to chronic bacterial contamination in the implant pocket.  Keep in mind that bacteria normally live in the breast glands and ducts.  Surgeons take precautions and follow sterility protocols to minimize contamination at surgery.  Also, a new type of bacterial growth called biofilm may play a role in contracture.  Many options have been shown to lower the risk of contracture, such as placing the implant behind the muscle, using a Keller funnel for insertion, using textured implants, rigorous antibiotic irrigation of the wound, and most recently placing acellular dermal matrix sheets (so-called xenografts) to surround the implant.  All of these have shown some success in preventing and correcting capsule contracture.  However, no one can guarantee 100% success for this problem.

Farbod Esmailian, MD · Answer

Sorry to read about the issues you are having with capsular contracture.  It can be a difficult problem to fix and the recurrence rates are on the higher side. There are things that can be done during the procedure to help reduce the rates of capsular contracture such as placement of the implant behind the muscle, the use of an implant funnel, triple antibiotic irrigation, use of betadine irrigation, use of Acellular Dermal Matrix (ADM).What you are referring to as skin is just that, it is referred to as an ADM.  There are different companies that offer this product.  The most studied product is Strattice or Alloderm.  Strattice is mainly used for cosmetic cases and is porcine dermis.  There have very good results reported with the use of Strattice and helping prevent recurrent capsular contracture.  Its downside is that there is some learning curve in its placement and use and also the cost.Make certain you see a board certified plastic surgeon that has experience in breast revision surgery.Hope that helps.

Dallas Buchanan, MD · Answer

Thank you for your questions. It would be most helpful to have photos or a physical exam to properly evaluate your problem. Recurrent capsular contracture is a tough problem to fix and recurrence rates can be very high. It is known that capsular contracture can be decreased by meticulous surgical technique, submuscular implant placement, and the use of adjunct techniques and medications. This is why the first thing you want to do it make sure you are seeing a plastic surgeon who is board certified by the American Board of Plastic Surgery. If your implant is in front of the muscle, that would be the first step to correcting your problem. Any recurrent patients that I treat go on post-op medication protocol of both steroids and Singulair. The "skin" you are referring to is acellular dermal matrix and this can be very effective at preventing cap con. It is a re-processed human dermal tissue from cadaveric donors and while its clinical benefits are many, the big downside is cost. The product usually costs several thousand dollars in addition to the other procedural costs. You need to discuss with your surgeon whether this is the right option for you.Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

David P. Rapaport, MD, FACS · Answer

Hello!Recurrent capsular contracture is a difficult problem to fix and recurrence rates can sometimes be very high for particular individuals. From the collective experience of numerous surgeons, we have found that the best method right now to solve a capsular contracture is by inserting a new implant wrapped in a membrane. The membrane most frequently used is Alloderm (made from cadaver human skin), but recently we have been finding more success in Galaflex, a synthetic membrane. In general, the success rates are in the upper 50%. Special medication and massage given after should help as well. Hope this information helps!

Jason Pozner, MD · Answer

An in person consultation would be best and I would like further surgical history and info on any infections you might have had - ie mastitis, sinus, tooth etc etcMy regimen for capsular contracture is complete capsulectomy, wash with hypochlorous acid then antibiotic irrigation, new implant, submuscular placement, drain and Strattice. This has reduced my capsule rate for capsular contracture down to about 5%. I also send specimens for bacterial DNA analysis and if the results show bacteria we use the sensitivities to prescribe an extended period of antibiotics. We are finding about 50% of the capsule cases show positive for bacteria (publication in press). Aspen treatment with external ultrasound is also used in many cases. I have a series of over 250 patients with Strattice at this point. there is a bit of a learning curve to it and a small risk of infection

Richard P. Rand, MD, FACS (retired) · Answer

The gold standard it total scar capsule removal and a new implant, going under the muscle if you aren't there already. Additional materials ie Strattice have been promoted by many but I have seen several folks come to me with that who still made CC again so I am not a fan of that.

What is the best way surgically to correct a capsular contracture and what is the success rate?

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