What is the best option to reduce the risk of capsular contracture?

Question

I am having a MM with a lift and sub-muscular implants. I have read that there is a decreased risk of CC when textured implants are used. Unfortunately textured implants have an increased risk of lymphoma and while rare, I am wondering if it is worth it to further decrease the risk of CC. This will effect which implant line I choose as the Mentor Boost is only available in smooth. The Mentor Xtra however does come in textured. I was wondering what the best option is?

Gerald Minniti, MD, FACS · Answer

Textured implants do not reduce your risk of cc in the subpectoral position. What will reduce your risk of CC is what your surgeon does in the operating room. The use of an inframammary incision, all electrocautery dissection to create a subpectoral pocket, irrigation with Betadine solution, implant delivery through a dedicated funnel, and watertight closure of the implant pocket prior to beginning of the breast lift will minimize the risk of cc.

Martin Jugenburg, MD · Answer

Hello, thank you for your question. Textured implants have been  removed from the market in most parts of north America. It is unclear whether or not the texture decreases the risk of capsular contracture. Theoretically they always thought it should however statistically is a marginal difference. Speak to your plastic surgeon about your concerns.

James M. Economides, MD, FACS · Answer

It is true that textured implants may reduce the risk of capsular contracture, and, yes, the risk of ALCL with textured implants is exceedingly low (as low as 1 in 30,000). However, this is still a developing area of investigation. Remember that implant texture is not the only variable that can impact CC rates, and you can optimize your risk by optimizing all other factors and still choose a smooth implant. Other factors such as incision location, implant plane (under the muscle vs on top), use of an implant funnel, surgical technique, aseptic use, etc. all factor into capsular contracture rates. When choosing an implant, discuss with your plastic surgeon your goals and which type of implant would best achieve those goals.

Daniel Barrett, MD · Answer

Dear Warmhearted902777,
capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Bryan Curtis, MD · Answer

Capsular contracture is a potential complication that can occur after breast augmentation surgery. It happens when the tissue capsule that naturally forms around the breast implant tightens and contracts, leading to firmness, distortion of the breast shape, and sometimes pain. While there is no guaranteed way to prevent capsular contracture entirely, there are several strategies that may help reduce the risk:1. Choose the Right Surgeon: Select a board-certified and experienced plastic surgeon who is skilled in breast augmentation procedures. A surgeon's expertise and technique can influence the outcome.2. Implant Placement: The placement of the breast implants can affect the risk of capsular contracture. Placing the implants under the muscle (submuscular) rather than over the muscle (subglandular) may have a lower incidence of capsular contracture.3. Implant Surface: There are two main types of implant surfaces: smooth and textured. Some studies suggest that textured implants may have a lower risk of capsular contracture compared to smooth implants, although this is still a debated topic among surgeons.4. Prophylactic Antibiotics: Some surgeons recommend a short course of antibiotics around the time of surgery to minimize the risk of infection, as infections can contribute to the development of capsular contracture.5. Breast Massage: Gentle breast massage, as instructed by your surgeon, may help prevent the formation of a tight capsule around the implant.6. Regular Follow-Up: Attend regular follow-up appointments with your surgeon to monitor your breast health and address any concerns promptly.7. Consider Implant Type: The type of implant material may also play a role. Silicone implants may have a lower incidence of capsular contracture compared to saline implants.It's important to note that individual responses to surgery can vary, and there is no foolproof method to eliminate the risk of capsular contracture. Discuss your concerns, preferences, and medical history with your surgeon to develop a personalized plan that considers your unique situation. Regular monitoring and communication with your healthcare provider are crucial for early detection and management of any potential issues.

Connie Hiers, MD, FACS · Answer

The risk of capsule formation is still fairly low even with smooth implants. The textured implants carry other risks, including late seroma, and higher breakage rates than smooth. I only use smooth implants.

Kalila Steen, MD · Answer

Thank you for your question! It would be best to have this conversation with your board-certified plastic surgeon who can guide you based on your personal needs. Traditionally the risk of capsular contracture is thought to be lower with textured implants. However, a recent study on the risk of capsular contracture for smooth vs textured implants have suggested there is no significant difference in capsular contracture between the two groups (Lista 2020).
In addition, textured implants have fallen out of favor due to its association with anaplastic large cell lymphoma (ALCL). Studies estimate the risk of ALCL from a textured implant to be between about 1 in 3,000 to 1 in 30,000, although some studies quote the risk to be even higher (Cordeiro 2020).
In my practice, I would recommend patients avoid textured devices to help limit their risk to ALCL. I provided the references below, which can be found on PubMed. Good luck with your journey!
References:1. Lista F, Austin RE, Saheb-Al-Zamani M, Ahmad J. Does Implant Surface Texture Affect the Risk of Capsular Contracture in Subglandular Breast Augmentation and Breast Augmentation-Mastopexy? Aesthet Surg J. 2020 Apr 14;40(5):499-512.2. Cordeiro PG, Ghione P, Ni A, Hu Q, Ganesan N, Galasso N, Dogan A, Horwitz SM. Risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL) in a cohort of 3546 women prospectively followed long term after reconstruction with textured breast implants. J Plast Reconstr Aesthet Surg. 2020 May;73(5):841-846.

What is the best option to reduce the risk of capsular contracture?

Answers (7)

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