Have You Found Serrapeptase to be Helpful?

We plastic surgeons feel the pain of women such as yourself who have suffered immensely with capsular contracture, repeated procedures, and no response to medical treatment (e.g. leukotriene inhibitors).  The evidence is becoming stronger that contracture is a response to bacteria native to breast tissue, and the biofilms they establish.  Just this month a report in Aesthetic Surgery Journal documents three staph species, Propionibacterium, and Actinomyces cultured in 37% of random specimens taken from inside the breast.  Apparently, breast ducts, like so many other areas of the body, are home to commensal organisms that affect the implant-tissue interaction.  These organisms are more numerous near the areola.  

Non-surgical treatments have been, in general, not as successful in resolution of contracture as surgery.  Re-operation is not an emergency for you.  If you try serrapeptase and/or montelukast and eventually decide to have the capsule removed surgically, the operative plan must include measures to prevent recurrence of contracture.   Perioperative antibiotics to cover all staph species, Actinomyces, and propionibacterium must be administered.  The breast gland must NOT be entered.  Silicone cannot be left behind (capsulectomy must be complete).  Pocket irrigation with triple antibiotics must be part of the procedure.  Hemostasis must be absolute.  There is also strong evidence that RIP (RNA inhibiting peptide, Balaban et al at Tufts University) prevents implant associated bacteria from establishing biofilms.  You should see if RIP can be incorporated around your new implant.

Serrapeptase is an enzyme with anti-inflammatory properties, and its use to treat infections around implanted materials was proposed some 20 years ago. Unfortunately there is no published study showing effectiveness for treatment of capsular contracture around breast implants. It is theoretically possible that it could help but seems unlikely; if you do get a good result please let me know. In my experience, the most effective treatment for recurrent capsular contracture is implant replacement and the use of an acellular matrix such as Strattice or Alloderm. Unfortunately this is not a trivial or inexpensive surgery.

Treating returning capsular contracture is based on the following principles:

1. Avoid tissue trauma (increases the body response and therefore may lead to thickening of the capsule
2. Avoid infection and decrease bacterial load in the area of the implant
3. Do not make Plan B the same as Plan A:  The surgical plan should be changed and not simply repeated.
4. Some implants (textured) have a decreased capsular contracture rate.  Some implant placements (subpectoral) have also a decreased capsular contracture rate.

Once the breast is highly activated from repeated surgical and other trauma, it will respond with heightened scarring and therefore a more likely capsular contracture.  Proteolitic and omeopathic products like Serrapeptase do not have any scientific track record.  There is some evidence that patients who take Accolate (Zafirluclast)  experience a decreased capsular contracture but this treatment is not endorsed by the ASPS.

  Some groups have had good results with combination treatment with external ultrasound successfully avoiding further surgery and this area seem to be the one with the most promising advances.

If all else fails, the most reliable approach is implant removal and reinsertion after a minimum of 3 months.