CAPSULAR CONTRACTURE / BREAST AUGMENTATION REVISION
Dr. Hochstein has been awarded for being one of the Top Breast Implant Doctors in the Country with Allergan implants (Performing more Breast Augmentations/Breast Revisions/Breast Lifts than any other single doctor). Dr. Hochstein’s office is nestled 15 minutes just north of Miami and 15 minutes south of Fort Lauderdale in Aventura.
Capsular contracture is the most common complication of breast implant surgery and can occur within 6 weeks after the original surgery. Any time an implant, of any type, is placed within the human body a capsule forms. This is a normal “walling off” process and one of our defense mechanisms dealing with something that is not biologicically recognized. A capsule has been found to be formed from three components including blood vessels, collagen, and my fibroblasts.
In a small percentage of people this capsule begins to squeeze or contract upon itself thus forming a contracture. There are several reasons as to why this might occur such as a subclinical infection or a hematoma (blood) around the implant but by far the most common cause is unknown.
Capsular contractures can be identified as to a scaling from mild to very severe. The classification scale used by Board Certified Plastic Surgeons is the Baker classification.
- Baker I capsule is a soft breast without significant scar tissue.
- Baker II capsular contracture is a palpable scar tissue around the bag; however, not visible.
- Baker III capsular contracture is associated with visible and palpable hardening, leading to a deformed shape to the breast.
- Baker IV capsular contracture, most severe, is associated with hardening, palpable, visible and often a cold, hard breast that is very painful to even mild palpation.
When evaluating a patient who presents to our office with capsular contraction, it is very important to determine the specifics of the original surgery to obtain clues as to why this might have occurred. I would ask if there were any immediate complications after the original surgery. Most importantly if the implants were placed above the muscle (subglandular) or below the muscle (submuscular). In my experience subglandular placement of the implants are the most common cause of contracture and the treatment here is very simple. By placing implants in the submuscular location the contracture is effectively treated. I have performed this procedure now over 800 times and have experienced only a single case of recurrent contracture. Interestingly it happened on the contralaeral side as the original contracture.
If the implants were placed in the submuscular position, the treatment becomes a little less predictable and I take time to discuss the options with my patients as there are two forms of treatment. The first form of treatment is the traditional complete removal of the capsule (capsulectomy) with replacement of the implant. This is an effective method when there is adequate coverage of the implant with the pectoralis muscle. Unfortunately, I have performed surgeries when I have found the muscle to be severely damaged and cut too high to offer adequate implant coverage. This is when I recommend the use of Strattice.
I believe Strattice is the gold standard for the long term correction of contracture. This is a new product made or bovine dermis which I have used successfully to cover the lower pole of the implant in cases of recurrence or when adequate muscle cannot be found. Biologically this works because the capsule will go to the edge of the Strattice but no further. Since it cannot join itself there are no possibilities of a contracture. Think of a tug-of-war situation where there is a segment of rope in the center missing. It just can’t happen. The problem with Strattice is that it is expensive but the people I have used it on tell my it has been a life changing experience. Not only does the contracture disappear but the breasts become very soft. Softer than any typical augmentation and the added coverage at the lower pole of the breast also decreases the risk of rippling. It is truly a tremendous product and for a breast implant surgeon like myself the greatest thing that I could ever have hoped for.
I mention these only to condemn them. I have never seen ultrasound therapy or drugs such as accolade be effective long term. Ultimately this is a correction that will require surgery in my experience.