What Is a Grade 4 Capsular Contracture

Capsular contracture: causes, risks, signs, symptoms and treatments. Breastcancer.org. This phenomenon, which often requires additional surgery to correct it, can be avoided by properly massaging the breasts after surgery to move the implants up and down, left and right, and to keep the implant pocket larger than the implants. If you are considering breast augmentation or have already performed the procedure and are concerned about capsular contracture, the best thing to do is to talk to your Omaha plastic surgeon, Dr. Ayoub. Dr. Ayoub has helped several Omaha patients correct capsule contracture during his nearly 15 years of experience as a Board-certified plastic surgeon. In the meantime, read these signs of capsular contracture, especially grades 3 and 4. Of course, complications during plastic surgery are now very rare, both because of advances in surgical techniques and because we have better predicted which patients are likely to have surgical complications. Patients prone to the development of thick scar tissue may be advised to avoid plastic surgery, or their surgeon will use special surgical techniques that allow remote incisions to be placed (for example. B, the insertion of breast implants through an incision in the armpit) to keep scars largely out of sight. Patients with weakened immune systems or autoimmune diseases are often advised to refrain from surgery and choose less invasive forms of aesthetic enhancement.

Similarly, there are a number of procedures that can be used after surgery, such as the Aspen rehabilitation technique, to treat complications and improve the patient`s appearance. One of the most common areas where aspen is used is to treat capsular contracture after breast augmentation. A new surgical management technique has been proposed, in which a neopocket is formed into which the implant must be inserted. This involves the creation of a new deep subpectoral level at the major pectoral muscle, but superficially at the anterior capsule that remains intact to prevent further tissue damage. This allows the use of the existing capsule and is usually done through an inframammary incision.[64] A retrospective review of 198 patients, 69.7% of whom had capsular contracture treated with this technique, found a high success rate in reducing contracture [65]. Another study by Castello et al. [66] concluded that neopocket training was an effective one-step solution to correct augmentation-induced deformities and that complications remained completely resolved after 24.1 months of follow-up. This could be a potential new standard of care for capsular contracture, as it allows the use of the existing capsule, but provides a new vascularized pouch into which a new textured implant can be inserted. Currently, however, this is only possible in submuscular placement, as there is enough tissue to create a new level.

Johnson JD, Oven SD, Skalicky RJ. A new technique for the treatment of recurrent capsular contracture using the acellular dermal matrix in aesthetic-revisional breast surgery. Am J Cosmet Surg. 2019;36(1):7-14. Other surgical methods that have been discussed as strategies for treating capsular contracture include the use of autologous fat transfer. This can take one of two forms: lipofilling to try to treat capsular contracture, or a fat graft placed with a half-size implant during the first procedure. Some studies have looked at autologous double fat transfer and implant surgery in reconstruction cases that have yielded positive results. Salgarello et al. [67] found that when fat grafts were used 6 months after radiation therapy followed by implant placement 3 months later, a reduced incidence of postoperative complications, including capsular contracture, occurred with a 15-month follow-up. These results were reflected in a small study involving 28 patients who underwent lipofilling 6 months after radiotherapy, followed by implant placement 3 months later, there were no cases of grade III/IV capsular contracture at a 17-month follow-up [68]. Although these cases have focused on reconstruction cases, this is a technique that could be adapted for use in primary augmentation. It would be beneficial to conduct prospective cohort studies that examine this procedure in cases of augmentation with long-term follow-up to see if it affects the development of capsular contracture.

Rupture of an implant as well as a genetic predisposition to scarring can also increase the risk of capsular contracture. Although capsular contracture with breast implants may not be ideal, there are treatments available. It is important to take steps before and right after surgery to reduce the risk of capsular contracture, but sometimes it happens anyway. Talk to your doctor about possible risks and ways to reduce the likelihood of this happening. Bachour Y, Verweii S, Gibbs S. Etiopathogenesis of capsular contracture: a systematic review of the literature. Journal of Plastic Reconstructive and Aesthetic Surgery. 2018.

71(3):307-317. Individual studies have published capsular contracture incidence rates between 2.8% and 20.4% [9,10,11,12,13,14]. A recent systematic review found a combined overall rate of 3.6% after augmentation surgery [2]. However, there is a wide range of heterogeneity between studies in terms of follow-up time, which can affect capsular contracture development rates, as well as a lack of standardization of the type of implant and surgical techniques used. The individual variables of the study are presented in Table 1. Despite the wide range of reported incidence rates, it is generally accepted that capsular contracture is the most common complication after implant breast surgery. Nevertheless, the etiology and pathogenesis are not yet clear, although they appear to be multifactorial. To effectively treat or even prevent capsular contractures, it is important to understand the mechanisms that lead to them. Saline implants also offer a number of advantages. The main advantage is that saline implants avoid concerns about the rupture of silicone implants.

When saline implants rupture, fluid is safely absorbed into the body, but exposure to silicone gel is considered more dangerous [36]. There is less variety with saline implants and they have remained relatively unchanged in recent years. In terms of the risk of capsular contracture, a ten-year prospective study of Allergan Natrelle saline-filled implants found a 20.8% incidence of capsular contracture in cases of breast augmentation [42], indicating a much higher risk than silicone implants. This is consistent with a 2008 meta-analysis that revealed more than twice the risk of capsular contracture after treatment with silicone gel implants as opposed to saline. However, these results were limited by the low scientific qualities of the studies involved and a high variability of the different types of implants used in the different studies [43]. Ideally, further research comparing long-term use of saline implants and silicone would be useful, or an updated meta-analysis that includes the results of the above studies to assess a possible difference in the risk of capsular contracture. Capsular contracture can occur regardless of the type of breast implant inserted into your breast. It occurs more frequently around silicone than saline implants and appears to be less common with textured implants when placed subcornular or placed directly under the skin between breast tissue and pectoral muscle.

However, due to the risk of developing atypical large cell lymphoma associated with breast implant, breast surgeons are now refusing textured implants. Capsular contracture can occur at any time after implant surgery. Sometimes it occurs as early as 12 months after surgery, sometimes it can take years for it to develop. Ranking: The rating system helps to classify the severity of capsular contracture: Photo 1 below shows grade IV capsular contracture in the right breast of a 29-year-old woman seven years after subgobolous placement (top of the muscle and under the mammary glands) of breast implants filled with 560cc silicone gel 1. Capsular contracture is the most common complication after implant breast surgery and one of the most common reasons for re-surgery. Therefore, it is important to try to understand why this happens and what can be done to reduce its frequency. A literature review using the MEDLINE database was conducted, including the search terms “capsular contracture breast augmentation”, “capsular contracture pathogenesis”, “capsular contracture incidence” and “capsule contracture management”, which yielded 82 results meeting the inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors identified included the use of smooth (vs. textured) implants, subgillular (vs. submuscular) implants, the use of a silicone-filled implant (vs. saline), and anterior breast radiation therapy.

The standard treatment of capsular contracture is performed surgically via capsultomia or capsulotomy. Medical treatment with the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent the formation of capsular contractures, as well as the use of acellular skin matrices, Botox and neopocket. .