I had a needle biopsy for a lump in my right breast 3 weeks ago which luckily was benign. A week after the precedure the inscision area was hard from scarring.It also creates a dimple in my breast when I raise my arm. Because I scarred to easily, should I be worried about being prone to CC? I am scheduled to have BA in one week. Should I ask my PS to prescribe me Accolate or Singulair for prevention? Thank you for your responses.
Am I Prone to Capsular Contracture if I Scar Easily?
Doctor Answers 10
Skin scarring and capsule contracture are not likely closely related
Thank you for the question. I do not think that there is enough information either in the literature or from your prior healing to raise the concern of capsule contracture after breast augmentation. Its also hard to know if Accolate or Singulair will make much of a difference. If you are concerned and your plastic surgeon prefers to use these medications then there will be little harm in doing so.
All the best,
Dr. Remus Repta
Skin scarring and CC
As far as I know, there are no published studies linking skin scarring and CC. This is, we think, because they are two different processes. One is edge-to-edge healing of the skin. The other is related to a foreign-body reaction caused by the implant or other inflammatory processes.
You can have patients with beautiful scars but hard breasts. Or vice versa.
Scarring and capsular contracture breast implants
The hard scar you experienced after a needle biopsy likely has little to do with whether or not you are prone to the development of CC. All scars are firm and hard a week after needle biopsy. Discuss this with your plastic surgeon for a final recommendation.
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Capsular contraction and scarring
Almost all scars are hard three weeks after a procedure. Poor scar quality does not make someone more prone to a capsular contraction that I know of.
External skin scarring independent of capsular contracture
SH87: You are "fortunate" that your needle biopsy occured prior to your BAM because you gained important information and avoided exposing your implant to a sharp object. The "dimpling" you described is probably related to the "trauma" of the needle biopsy and associated bleeding/bruising. It will undoubtedly resolve with time. I would advocate continuing breast self exam and choosing a dual plane (subpectoral) pocket for your implants.
The etiology of capsular contracture is hotly debated and includes subclinical bleeding and biofilms. Medications like Accolate and Singulair are are used "off label" to diminish the inflammatory response which is thought to contribute to capsular contracture. The efficacy is approximately 50%, so it's not guaranteed to prevent reoperation. If a woman gives a history of unfavorable skin scarring, it's important to evaluate prior scars, their locations, how they were repaired and suggest either deferring surgery or using access incisions, which will allow scars to be less visible (axilla). Hope this helps. Good luck.
Keloids & Capsular Contracture Not Related
There does not seem to be a direct relationship between forming bad cutaneous scars and the development of capsular contractures. I agree that meticulous technique is important in the prevention of capsular contracture. I also feel that there is less capsular contracture when implants are placed under the pectoralis muscle.
Thank you for the question.
The quality of scarring from your previous biopsy does not necessarily make you more prone to capsular contracture. If you wish to use one of the anti-inflammatories that you mentioned, discuss the pros and cons with your selected plastic surgeon to get his/her view.
Best wishes with your upcoming surgery. Hopefully you will enjoy a complication free result for many years.
Causes of Hardening of Breast Implants- Capsular Contracture
There are several known causes of capsular contracture or hardening of the breast implants. Many surgeons feel that excess blood in the breast pocket can lead to increased scarring and thus capsular contracture. Usually, formation of skin scars or even keloids is not associated with formation of capsular contracture. Meticulous surgical technique is the best prevention for developing capsular contracture.
Scarring and Capsular Contracture
You have not demonstrated a propensity to scar abnormally by the description of your breast biopsy incision. To answer your question however, in some individuals there may be a link between abnormal or hypertrophic scars and capsular contracture, but this has not been looked at in a scientific manner yet.
Regardless, Accolate and Singulair have failed to reduce the incidence or effectively treat capsular contracture in well controlled, scientific studies. Despite this, there is a culture of prescribing these medications to patients among plastic surgeons, possibly in a vain attempt to mollify the patient who has developed this unfortunate problem, or to give the appearance of doing something proactively for the patient instead of just standing there and saying 'I am sorry that this happened to you.'
What has been demonstrated time and again is that capsular contracture rates can be reduced to 1-2%, and reoperation rates reduced to 2-3% by special surgical techniques combined with detailed preoperative planning. This was first written about by John Tebbits, MD in 2000. Best described as ultra-precise, atraumatic surgery, this not only leads to minimal risk of capsular contracture, but results in rapid recovery without the need for narcotic pain medication. Paitents go home in a bra (no tight wraps or binders) and begin arm movement exercises above their head that day. Unfortunately, few surgeons have adopted these techniques. Hopefully as the practice of cosmetic plastic surgery becomes more evidence based, surgeons will be performing these techniques as the norm, not the exception.
Best of luck!