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.
One of the main complications that can occur as a result of extremely large breast implants, is stretching of the skin and excessive sagging or falling to the side of the implants. Plastic Surgeons have used various materials such as Alloderm® and Stratice® over the years to help reinforce the tissues when trying to correct these problems. These materials are expensive however, and also have a high complication rate such as infection and seroma formation (excess fluid). Dr. Hochstein highly recommends Belladerm, which is a mesh material that can be used as a tissue reinforcement material for breast reconstruction and to help correct breast implant complications. Belladerm is the first commercial product from this technology that provides a strong biodegradable mesh which can be used to strengthen weakened tissue and provide support.Belladerm can be used to reinforce the breast in breast lift procedures and help provide support when the tissues have been excessively stretched due to very large implants.
Most notably Belladerm can be used as a support material for a breast revision surgery and to correct rippling in previous breast augmentations. This material has the potential to resolve breast capsular contracture, which occurs in some breast implant patients, and will likely become a key material in correcting implant bottoming out.
Belladerm actually becomes part of the body as collagen grows into it and the material itself is slowly re-absorbed over a 1-2 year period. Studies show, that once the collagen grows into the Belladerm, the resulting tissue is twice as strong and thick as the original Belladerm mesh itself.
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.