About a Capsulotomy Breast Revision
One of the most common problems is breast capsule contracture or the development of thickening, and #contracture of the capsule that exists around the breast implants. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and #uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer implant. A #capsulotomy or opening of the breast capsule may be required for the removal of a scarred capsule. Capsulotomy or the opening up of the #capsule may be required or frequently #capsulectomy, which is removal of the scarred capsule, is recommended to ensure adequate pocket dimensions. New implants may then be placed in the same existing position or may undergo a change of placement frequently from submammary to subpectoral position and, on occasion, the other way around.
How do I correct capsular contracture.
In my practice capsular contracture is not that common. If it does occur I start by making a whole new space for the breast implants and use a newer model of breast implants. You could also use the acellular dermal matrix but not necessary and much more expensive. No guarantees with either.
You are definitely right that an acellular dermal matrix would help you with these hard, painful capsules. I always use a human type rather than porcine.
Dermal matrix for contracture
The word is out, folks, ADM works for contracture. I always use human (flexHD or belladerm or Alloderm). Strattice is porcine (pig) so is not as good. Silk, like seriscaffold, is absolutely not to be used. Surgimend is ovine (cow) so also may be more reactive and cause contracture again. Ideally implants are also submuscular and smaller as well. Make sure your doctor also checks for biofilms, I'm finding a lot of my patients (40%) who have contracture surgery are positive, and this must be treated as well to prevent recurrence.
Strattice for Capsular Contracture
Strattice is the only one of the products that you have listed that I use. The reason for this is that there are studies and data that support its use and result. I don't know of any good data for capsular contracture with the other mentioned products.There are many studies that have looked at the use of Alloderm which is the human product whereas Strattice is the porcine product, but same company, Life Cell. As of now, I know of one study that has looked at capsular contracture and breast revision surgery (aside from breast reconstruction in patients post mastectomy) that has showed promise for the use of alloderm and strattice in helping prevent recurrent capsular contracture.Hope that helps.Good luck.
What is the best solution for encapsulated breast?
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 (I am not convinced that there is a difference with smooth versus textured implants as long as the breast implants are in the sub muscular position), and the use of acellular dermal matrix (especially for recurrent encapsulation).
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). I hope this, and the attached link ( demonstrating a case utilizing acellular dermal matrix) helps.
Best wishes for an outcome that you will be pleased with.
Strattice for recurrent capsular contracture
Strattice has been used longer than other products for treatment of capsular contracture. When you have a capsulectomy (removal of the scar capsule) the Strattice also adds back the coverage and support that is lost. Surgimend is another ADM product but there is little published on it for this purpose. SERI silk might be helpful but again nothing published to back it up.
Thank you for the question and the best ADM or Silk is the hands of the surgeon placing it so chose an expert in the field for the most reliable results. That said in my practice both the ADMs and Seri have had a zero recurrence rate
Treatment of encapsulation after breast implants.
The use of ADM's is being popularized but is probably not a first-line treatment for most patients who have suffered capsule contracture. My recommendation would be to undergo capsulectomy with pre-and post treatment using Singulair. If you are encapsulation recurs at that point I think it be a candidate for placement of Strattice. Discuss your options with your ABPS board-certified plastic surgeon of choice and recognize that there is no one right answer. There are additional details that may help to reduce the risk of recurrent encapsulation that you should discuss with your plastic surgeon.
Best wishes and good luck,
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, California
The usual first-line treatment for capsular contracture is removal of the scar tissue (capsule) and replacement of the implant along with the placement of temporary drains. This works in most cases and is the most cost effective. Jumping right away into using Strattice or Surgimend or Seri Silk adds thousands of dollars to the surgery that you might not need to spend. Get opinions from experienced breast surgeons in person so you can better understand your options. Hope this helps, good luck!