When cleaning up a capsular contracture, is Strattice Mesh recommended so capsular contracture doesn't return?

Capsular
Contracture is relatively uncommon after breast augmentation. However when a patient does have capsular
contracture (hardening of the breast) it needs to be treated appropriately to
prevent recurrence.

Treatment of
capsular contracture involves multiple steps to decrease the chance of
recurrence. First the current implant is
removed and replaced with a new implant.
Second a complete capsulectomy (removal of all the scar tissue around
the implant) is performed. This removes
any irritant that might have caused the capsular contracture in the first
place.

Lastly, if
patients have had capsular contracture more then once then I will put a dermal
mesh sling (Alloderm or Strattice) around the implant. This material has been shown to decrease the
risk of capsular contracture. It prevents the scar tissue from forming
completely around the implant.

This
combination helps decrease the chance that the scar tissue will return after
the implant exchange.

For patients with recurrent capsular contracture, it is important to attempt to minimize as many risk factors as possible. Acellular dermal matrices (like Strattice and Alloderm) have been associated with a reduced risk of capsular contracture; they are expensive, Alloderm being significantly more so than Strattice. Other things that you (and your surgeon) may want to consider to minimize your risk of occurrence include the following: select a conservative to moderate sized implant volume (not the biggest implant you can fit), place the implant in a submuscular pocket, approach the implant pocket via a breast crease (inframammary fold) incision as opposed to an areolar or axillary incision, be a non-smoker, consider use of a leukotriene antagonist (e.g. singulair), minimize contamination from skin/ductal bacteria with irrigations/glove changes/minimal touch techniques, and consider the use of textured implants. If you develop capsular contracture again despite optimizing all the things that you can, you may want to consider removal of your implants with a fat transfer. It may take more than one fat transfer to get your desired volume. However, if you don't have implants, you can't get capsular contracture. Best of luck. 

Since you have had four prior breast procedures, I would suggest complete capsulectomy, insertion of two brand-new silicone implants, changing the position of the breast pocket and insertion of Strattice mesh. I think you would be an ideal candidate for insertion of Strattice mesh since you have had so many problems. Strattice mesh has been shown to significantly decrease the recurrence of breast capture contracture after breast augmentation. Personally, I use Strattice mesh whenever there is a recurrence of a breast implant capsular contracture. Good luck.Sincerely,J. Timothy Katzen, MD, FACS, FICSChief of Reconstructive Plastic Surgery

hi and thanks for your question. Treating capsular contracture is not so simple. would advise implant removal with total capsulectomy to create a fresh pocket and apolyurethane textured Silicone breast implant. At Elite Surgical in the UK, prefer these implants as they have the lowest capsular contracture rates at around 1% after 15years! compared t over 20% CC rates with textured silicone implants! do your research and consult an accredited PS. Acellular dermal may help support the lower pole of your breast, but there is no definitive data to my knowledge that shows it will prevent CC. good luck!

Thanks for your question. Data shows that capsular contracture is increased in those with previous contracture, history of bleeding or infection, large implant sizes and subglandular pockets. Newer implants that are textured have the lowest incidence of contracture. I would propose changing the approach to an IMF incision and use the Strattice if the other things above have already been done. I do agree that consideration also has to be given to taking the implants out indefinitely to let things cool off and then consider other options (implants vs. fat). Best of Luck!

Good question- there are multiple factors that different plastic surgeons use when treating a capsular contracture. Each patient's experience is different. An experienced board certified plastic surgeon who does a significant amount of breast surgery is the right person to see in consultation. Mesh products often have very good results as many plastic surgeons who also have significant breast reconstruction experience use this technique routinely. Good luck

This sounds like a difficult problem.  My personal algorithm is complete capsulectomy as a first treatment, if the contracture returns then stratus, if it returns again consider strongly implant removal and fat grafting as an alternative.  Hope that helps.

Recurrent capsules are not infrequent but they can be a vexing problem and has been for years for those of us that do these kinds of surgery.  You are the perfect candidate for the use of an ADM or acellular dermal matrix.  There are two kinds Aloderm ( Human skin) and Strattice ( procine skin) but the human skin is very expensive and Stattice is much less and it works just as well. Using Strattice will reduce your risk of a recurrent capsule from around 30% down to less than 2%.  The style of implant is not as important as to the placement of the implant.  I would recommend that you go under the muscle with new implants.  Strattice and new implants are expensive but it is far more expensive to have another surgery.  Find a PS who has done a lot of these surgeries if you want to get the best result.  There are several of us around the country that have done this type of surgery and can help you.

Lucy, a more important question is WHY are you having recurrent contractures. You don't give any details about the types of implants you've had or have, or where they are (under or over the muscle). The silicone gel implants of the 1980's had a very high rate of capsular contracture, nearing 100%. However, the rates for current gel implants or saline implants are quite low, let's just say hovering around 5% or less (depending on a lot of variables). So while the most common cause of contracture from a long time ago would most likely be related to the implant, that is not the case today-- which means you should try to figure out with your surgeon what the deal is. Without knowing anything else about your situation, one of the things I would be most concerned about would be bacterial contamination of the implant. This does not cause a standard type infection as you would expect, and is usually a skin organism (S. Epidermidis) which stays in the biofilm around the implant and really can't be eliminated short of removing the implant. The reason why this is important to at least suspect, is because if that is the real culprit, simply changing out implants (with or without mesh) will just re-colonize the new materials with the old bugs-- and you will have the same problem. If that is the situation, the only way for your body to clear this is to remove the implants, and go without for 6-12 months. After that, hopefully new implants could be placed and you would not have issues with colonization. It may be tough to hear, but discuss this possibility with your plastic surgeon."Insanity: doing the same thing over and over again and expecting different results." - Albert Einstein

is challenging and it just depends on how aggressive you wish to be in trying to resolve your issue.  Is it absolutely needed?  No it is not as the new implant and texturing may be enough.  But if you've done everything you possibly can, then using Strattice is a good idea.