Capsular Contracture Treatment and Prevention of Recurrence
Hello,For the record, Sientra makes the least 'gummy' of the form stable implants available. Further, most American surgeons do not even use shaped, form stable implants, so you are unlikely getting Sientra's gummy bear implants, only their round and textured ones. Mentor implants are firmer, and Natrelle Style 410's are the most firm or 'gummy'. As for treatment and prevention of recurrent CC, texturized implants play a small role. What's more important is how the surgery is performed. Most women get CC due to implant contamination at the time of surgery, something that is most common with a periareolar incision. Any revision surgery should avoid this and instead enter through an inframammary incision. The surgery itself should be either a total en bloc capsulectomy, or a subtotal capsulectomy with placement of a biologic material called an ADM, like Strattice. This may sound Greek to you, but what you should take home is that these are not easy surgeries to perform well. Make sure the surgeon you choose is a ABPS certified/ASAPS member surgeon that specializes in complex revision breast surgery.Best of luck!
What implants to use in the setting of capsular contracture
Hello and thank you for your question. I am sorry to hear that you have suffered from capsular contracture.There are many strategies shown to help decrease the occurrence of capsular contracture. There are factors that YOU control and others that YOUR SURGEON controls. Here is the breakdown:
FACTORS THAT YOU (THE PATIENT) CONTROL:
1) not using any nicotine products at all
2) choosing a board certified plastic surgeon
3)not having any procedures done within 6 months after your surgery that can
seed bacteria to your implants (like dental work and other procedures)
4) Not having your nipples pierced
FACTORS THAT YOUR SURGEON CONTROLS:
1) Inframammary crease incision to insert implants
2) Using a Keller funnel to insert your implants
3) Using a consistent operating room team
4) Performing surgery at a hospital or highly credentialed surgery center
5) Using triple antibiotics to irrigate your implants and also the breast pocket
6) Placing implants in the submuscular pocket
7) Placing nipple shields to decrease chances for bacterial contamination during your surgery
In your case, switching to textured implants may give you slightly added
benefit. I love the Sientra textured implants as a) they do appear to have the lowest rates of capsular contracture, b) they have the most highly cohesive gel, and c) they have an ideal gel-shell interaction and feel as soft as smooth implants.
Make sure to seek consultation with a board certified plastic surgeon with expertise in revision aesthetic breast surgery. I hope this helps and good luck!
Dr. Sean Kelishadi
Revision Breast Implant Choices are Difficult
It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing revision breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your native breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in
Texturing is known to help diminish risks for contractures
but all companies have them and I personally don't see a place for the textured round implants you are considering... if you go textured, I would always use the shaped ones or highly cohesive, gummy bear implants. Companies make their claims and when the difference is only 1-3%, is it really that significant? I don't think so. But with treating contractures, Dr. Kelishadi summarized some important factors and removing your old capsule is very important (and if you cannot, then creating a neopocket is). Good luck.
Capsule contracture surgery is rather tricky and needs to be done by a qualified and experienced surgeon who does a lot of capsular contracture surgery. With that said I don't necessarily use textured implants but I do use and acellular dermal matrix for every capsular contracture case because the data clearly shows that it decreases the rate of recurrence. I don't believe that the implant type is as important as the technique and the use of a cellular matrix.
Which brand of implant
While a textured implant will fare better for Capsular Contracture, textured implants, especially aggressively textured have been implicated in causing a low-grade lymphoma called ALCL.Sientra Implants are less aggressively textured than are Allergan. There are several other factors that would lead to a less chance of recurrent capture contracture. The creation of a dry pocket with all electrocautery, antibiotics in the pocket, isolation any potential skin contamination, and the use of ADMs are all factors in reducing the rate of capsular contracture.
Sientra textured round implants. Best choice for CC revision?
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 (especially recurrent encapsulation) 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. 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.
Sientra breast implants for capsule contracture?
If there was a general consensus amongst plastic surgeons that one particular implant was clearly the best for resisting recurrent encapsulation I think we would all be using that implant. I personally find Sientra implants to be of high quality and have used them for many years until their recent temporary production shutdown. I do not think there is one right answer however and in my opinion you are best off discussing options with your selected ABPS board-certified plastic surgeon before making a decision. The benefit of textured implants beneath the muscle is relatively small and may be of only minor statistical difference. This does not mean it should not be your choice, but if your plastic surgeon feels more comfortable with a different brand you should consider that as well. I would also point out that the very small risk of ALCL appears to be associated with textured and not smooth breast implants.
I emphasize to my patients in your circumstance the importance of avoidance of blood thinners to reduce postoperative bleeding a known source of recurrent encapsulation, and I recommend preoperative and postoperative use of Singulair to further stack the odds in your favor. I feel it is very important to reduce physical activity with your upper extremities during the formation of the new capsule which is approximately six weeks in my experience.
Good luck and best wishes.
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, California
Sientra Textured Implants: A Great Choice for the Right Patient
Thank you for your question regarding Sientra textured implants. I have found that the incidence of CC is lower for many patients using textured implants compared to smooth. This is also supported by recent studies which you can review at pubmed.com by doing a search of the database there.
The beauty of the Sientra texturing is that it does not form a soft tissue connection or adhesion between the breast pocket and implant. The implants do move to some degree, which is a feature that many patients like. The implants themselves are a more highly-cohesive gel than the smooth, round Allergan or Mentor brands which are available. I would make sure that you have enough breast tissue to conceal these implants, as in my experience, a patient would be best to have a good "B" cup of breast tissue to avoid implant wrinkling.
If your breasts are both encapsulated, it may make sense to switch them out to a textured implant....of course you need enough breast tissue to be a good candidate. On the other hand, if only one of your smooth implants has CC, then it may be best to only treat the encapsulated breast.
If you are switching out both your implants to textured, I would ask your surgeon to remove ALL of the scar tissue and place a drain. This will help you heal faster and not accumulate In my experience, I would ask your surgeon to also consider the off-label use of Singulair to reduce CC recurrence. Good Luck!