Post breast Cancer Mastectomy I have developed capsular contracture. Do you recommend capsulotomy or capsulectomy?

Question

I have developed capsular contracture post bilateral prophylactic mastectomy eight months ago with reconstruction and saline implant (under pectoral muscle) . The hardening occurred soon after surgery. I am concerned that the contracture will occur again. I am doing massage and taking Singular.

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  I am sorry to hear of the issues that you are having with your breast reconstruction.  Capsular contracture is a known complication that can occur following implant placement, especially in breast reconstruction.  It is more common following radiation as well as other issues such as previous infection, hematoma, etc.  Your options include: do nothing, implant removal, conservative measures (like those you are doing), capsulectomy/otomy, placement of a dermal matrix, or flap reconstruction.It appears that your plastic surgeon has recommend several proven things that can ameliorate capsular contracture.  At eight months, postoperatively, it may not improve much more.  Indications for having another procedure to hopefully correct the issue would be pain or significant deformity/asymmetry of your breasts.  I typically perform capsulectomy to remove the entire area and start again with a fresh palette, and ultimately remove all of the capsule.  Either way, the contracture can in fact return.  If so, your options would be the same again.  Hope that this helps!  Best wishes!

Curtis Wong, MD · Answer

When it comes to contractures and the theories behind it, its always better to remove the capsule if you can.  If you can't, 'neopockets' help isolate the capsule wall from the new implant.  Capsulotomies do work but I personally prefer to remove it if possible.  Textured implants should be used as much as possible.

Robert Whitfield, MD · Answer

Provided you stick with a device capsulotomy and capsulectomy may both be necessary as well as the use of other materials to help prevent another contracture depending on the device used and whether or not biologic mesh was used.Three
basic forms of breast reconstruction exist. You can use your own tissue,
implants or a combination of the previous two techniques. Your own tissue can
be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting.
Implants can be done in one stage or two stage. Two stage reconstructions are
started by placing expanders at the time of mastectomy. Once they expanders are
placed they are able to be inflated as determined by wound healing. The final
time consists of combining any of the above techniques.

If
you are interested in being seen in Austin please give us a call.  I know
this is a difficult time for you.  The majority of my practice is devoted
to reconstruction for women with breast cancer or who are BRCA+

Edward S. Gronka, MD · Answer

If you are having pain or if there is breast distortion from the contracture then either of the procedures you described are possible. It often depends on what is found at the time of surgery. I haven't seen any benefit with Singuair and the data for any true benefit is lacking. If it is bothering you, its worth fixing.

Megan Jack, MD · Answer

It sounds like you are taking some of the right steps to help with your capsular contracture so well done!  The intervention needed completely depends on the severity.  It may take several months before the singular is effective. You may also want to consider looking to see if anyone in your area performs Aspen protocol which is a special protocol using massage, ultrasound, and bandaging to help with asymmetry and contracture.  They have a website you can look up.  Finally, if surgery is needed if it is a mild contracture you may be able to get away with capsulotomy but if it is significant you may require capsulectomy. As mentioned by some of my colleagues, consideration should be given to use of an acellular dermal matrix product which seems to decrease the recurrence of contracture.

Steven Wallach, MD · Answer

More details are needed as well as performing a physical exam.  Was alloderm placed?  Are they fill muscle coverage?  How firm are the implants?  These are just a few things to know.  Good luck.

Ash Mosahebi, MBBS, FRCS FRCS(Plast) · Answer

It depends how badly affected you are. It is better to wait if you can at this early stage. But should you decide to have a procedure capsulotomy would be better.

Hilton Becker, MD · Answer

If your capsular contracture is mild, capsulotomy may be sufficient. Post operative massage and ultrasound  is also recommended.Capsulectomy is usually not necessary.If the capsule recurs there are several other options including adjustable saline implants with temporary overexpansion, or insertion of acellular dermal grafts

Samir Shureih, MD · Answer

For Breast reconstruction after mastectomy, and developing capsular contracture, consider the use of acellular matrix. There is some evidence it does decrease CC. But it is very expensive..Samir Shureih MD. FACSsshureih@msn.com

Post breast Cancer Mastectomy I have developed capsular contracture. Do you recommend capsulotomy or capsulectomy?

Answers (9)

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