In terms of the actual surgical process itself, one common problem that people have is capsular contracture. We think that that's related to biofilm which is bacterial contamination.

A lot of studies have shown now that if we go through the nipple or the axilla, it increases the risk of capsular contracture. We do a lot during surgery to try to decrease the risk of bacteria in the implant. People ask me what's a biofilm. A biofilm is like the tartar in your teeth. Bacteria can [inaudible 00:00:34] off, so that it can create a coating so the body can't fight it. When you go to the dentist to have your teeth cleaned, the tartar that the dentist is taking off is a biofilm. If bacteria gets on an implant, the body might keep trying to fight that and it's not really a true infection. What happens now is the body starts to get tighter and tighter on that implant, and that's when we get a capsular contracture.

I don't know that I'd do anything that's not standard for many surgeons, but you certainly want to check with your surgeon are they doing things to mitigate capsular contracture.

One of the things that we'll do is try to pick an inframammary approach most of the time if we can, because it's been shown to have a lower risk for capsular contracture. We'll put a piece of plastic over the nipple during surgery throughout the procedure because even though we've prepared the skin with an antiseptic solution, it can't lower the bacteria count to zero. The bacteria that comes out of the nipple, we'll shield that area by keeping a plastic patch over it during the surgery that comes off at the end.

With the surgery itself, I like to use a disposable implant called a sizer to check the space where the implant is going to go after we made that, so we're not taking the final implant and moving it in and out of the pocket. When I do go put the implant in, I'm the only one that touches it in the operating room and we'll rinse the space out with a mixture of antibiotics that's been suggested to decrease risk for capsular contracture in studies that have been performed in the plastic surgery society. I'll also use a piece of plastic over the breast with a hole on it, so that the implant doesn't touch the skin while it's going in. Some surgeons call it a no-touch technique. There are funnels or flasks that have been designed to do a similar thing, but someway to try to decrease contimination in that implant is going to be important. I found that those measures have led to a very, very low incidence of capsular contracture in my practice.

A couple of interesting things that I would urge a woman if they had a vaginal piercing, not to put those back in, or nipple piercing, and to leave those out afterwards, because I've had two cases in my practice that were my own patients in the last eight years that had serious capsular contracture. We had to take the implant out and replace it. One at a time, the person wanted a vaginal piercing. It makes sense because both those parts of the body have bacteria and a little bit of trauma can let a bacteria get into your bloodstream.

The other controversy, I think, is whether to take antibiotics before dental procedures. Not all plastic surgeons even agree with that. I think people have to weigh the risk of taking a single dose of antibiotics an hour before a procedure versus the risk of a capsular contracture. We really don't know. I [inaudible 00:02:58] amount of patients do that. [Inaudible 00:03:00] to discuss that as well. Similar to if someone had a hip replacement or a heart valve, the dentist might give an antibiotic as a prophylaxis. We'll consider having people do that afterwards, but we don't know how long to do that for. Do you do that for a year or longer? There's a lot of things that we don't know, but we do know some things we'll try to use those to decrease the risk of problems.

Breast Implant Procedure: What Can Be Done During Surgery to Decrease the Risk of Capsular Contracture?

Dr. Jonathan Hall explains one theory of why capsular contracture occurs and what he does in the OR to try to prevent this issue.