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| Capsules of tightly-woven collagen fibers form as an ] around a foreign body (eg. breast implants, pacemakers, orthopedic joint prosthetics), tending to wall it off. ] occurs when the capsule tightens and squeezes the implant. This contracture is a complication that can be very painful and distort the appearance of the implanted breast. The exact cause of contracture is not known. However, some factors include bacterial contamination, silicone rupture or leakage, and hematoma.] may happen again after this additional surgery.<p> | |||
| '''Capsular contracture''' is a common complication of ] surgery. Capsular contracture happens when the ] or capsule that normally forms around the implant tightens and squeezes the implant. It can happen to one or both of the implanted breasts. | |||
| Methods which have been successful for reducing capsular contracture rates include submuscular implant placement, using textured <!-- --><ref name="Barnsley2006">{{cite journal | author=Barnsley GP| title= Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials. | journal=Plast Reconstr Surg. | year=2006 | pages=2182-90| volume=117 | issue=7 | id=PMID 16772915}}</ref>or polyurethane-coated implants <!-- --><ref name="Handel2006">{{cite journal | author=Handel N, et al| title= Long-term safety and efficacy of polyurethane foam-covered breast implants. | journal=Aesth. Surg Journal | year=2006 | month=may | pages=265-74| volume=26 | issue=3 |}}</ref> , limiting handling of the implants and skin contact prior to insertion <!-- --><ref name="Mladick1993">{{cite journal | author=Mladick RA| title= "No-touch" submuscular saline breast augmentation technique. | journal=Aesth. Surg Journal | year=1993 | pages=183-92| volume=17 | issue=3 | id= PMID 8213311 }}</ref> , and irrigation with triple-antibiotic solutions as described by Adams, et al.<!-- --><ref name="Adams2006">{{cite journal | author=Adams WP jr., et al| title= Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. | journal=Plast Reconstr Surg. | year=2006 | pages=30-36 | volume=117 | issue=1 | id=PMID 16404244}}</ref> <p> <br> | |||
| Correction of ] may require surgical removal or release of the capsule or removal (and possible replacement) of the implant itself. Closed capsulotomy (disrupting the capsule via external manipulation), a once common maneuver for treating hard capsules, has been discouraged as it can facilitate implant rupture. Nonsurgical methods of treating capsules include external ultrasound <!-- --><ref name="Planas2001">{{cite journal | author=Planas J| title= Five-year experience on ultrasonic treatment of breast contractures. | journal=Aesthetic Plast Surg. | year=2001| pages=89-93 | volume=25 | issue=2 | id=PMID 11349308}}</ref>,treatment with leukotriene pathway inhibitors (Accolate, Singulair) <!-- --><ref name="Schlesinger2002">{{cite journal | author=Schlesinger SL, wt al| title= Zafirlukast (Accolate): A new treatment for capsular contracture. | journal=Aesthetic Plast Surg. | year=2002| pages=329-336| volume=22 | issue=4}}</ref>, and pulsed electromagnetic field therapy. <!-- --><ref name="Silver1982">{{cite journal | author=Silver H| title= Reduction of capsular contracture with two-stage augmentation mammaplasty and pulsed electromagnetic energy (Diapulse therapy). | journal=Plast Reconstr Surg. | year=1982| pages=802-8 | volume=69 | issue=5 | id=PMID 7071225}}</ref> <P> | |||
| There are four grades of capsular contracture - Baker grades I through IV. The Baker grading is as follows: | There are four grades of capsular contracture - Baker grades I through IV. The Baker grading is as follows: | ||
| * Grade I the breast is normally soft and looks natural | * Grade I the breast is normally soft and looks natural | ||
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| * Grade IV the breast is hard, painful, and looks abnormal. | * Grade IV the breast is hard, painful, and looks abnormal. | ||
| Capsular contracture may be more common following ], ], and ]. However, it is not known for sure why capsular contracture happens. The literature also discusses other factors, such as a textured implant surface and submuscular placement of the implant, which may decrease the capsular contracture rate. | |||
| A reoperation may be needed to correct capsular contracture, usually for grade III or IV capsular contracture. The surgical procedures range from removal of the implant capsule tissue with or without replacement of the implant itself. Capsular contracture may happen again after this reoperation. | |||
| An ] report stated in 2000 that the capsular contracture rates were 36-81% for silicone-gel filled breast implants and 8-41% for saline-filled breast implants. | |||
| Prospective studies of saline-filled breast implants approved by FDA in May 2000 showed rates of grade III or IV capsular contracture of 9% at 3 years and 10-11% at 5 years for augmentation patients. The same studies showed rates of grade III or IV capsular contracture of 25-30% at 3 years and 29-36% at 5 years for reconstruction patients. | |||
| == Sources == | == Sources == | ||
Revision as of 04:47, 19 October 2006
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Capsules of tightly-woven collagen fibers form as an immune response around a foreign body (eg. breast implants, pacemakers, orthopedic joint prosthetics), tending to wall it off. Capsular contracture occurs when the capsule tightens and squeezes the implant. This contracture is a complication that can be very painful and distort the appearance of the implanted breast. The exact cause of contracture is not known. However, some factors include bacterial contamination, silicone rupture or leakage, and hematoma.Capsular contracture may happen again after this additional surgery.
Methods which have been successful for reducing capsular contracture rates include submuscular implant placement, using textured or polyurethane-coated implants , limiting handling of the implants and skin contact prior to insertion , and irrigation with triple-antibiotic solutions as described by Adams, et al.
Correction of capsular contracture may require surgical removal or release of the capsule or removal (and possible replacement) of the implant itself. Closed capsulotomy (disrupting the capsule via external manipulation), a once common maneuver for treating hard capsules, has been discouraged as it can facilitate implant rupture. Nonsurgical methods of treating capsules include external ultrasound ,treatment with leukotriene pathway inhibitors (Accolate, Singulair) , and pulsed electromagnetic field therapy.
There are four grades of capsular contracture - Baker grades I through IV. The Baker grading is as follows:
- Grade I the breast is normally soft and looks natural
- Grade II the breast is a little firm but looks normal
- Grade III the breast is firm and looks abnormal
- Grade IV the breast is hard, painful, and looks abnormal.
Sources
- Section on Complications from the FDA Breast Implant Consumer Handbook - 2004. Most of the above text was copied verbatim from this public domain source.
- Safety of Silicone Breast Implants. Institute of Medicine National Academy Press, Washington, D.C. 2000.
External links
- Barnsley GP (2006). "Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials". Plast Reconstr Surg. 117 (7): 2182–90. PMID 16772915.
- Handel N; et al. (2006). "Long-term safety and efficacy of polyurethane foam-covered breast implants". Aesth. Surg Journal. 26 (3): 265–74.
{{cite journal}}: Cite has empty unknown parameter:|1=(help); Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help) - Mladick RA (1993). ""No-touch" submuscular saline breast augmentation technique". Aesth. Surg Journal. 17 (3): 183–92. PMID 8213311.
- Adams WP jr.; et al. (2006). "Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study". Plast Reconstr Surg. 117 (1): 30–36. PMID 16404244.
{{cite journal}}: Explicit use of et al. in:|author=(help) - Planas J (2001). "Five-year experience on ultrasonic treatment of breast contractures". Aesthetic Plast Surg. 25 (2): 89–93. PMID 11349308.
- Schlesinger SL, wt al (2002). "Zafirlukast (Accolate): A new treatment for capsular contracture". Aesthetic Plast Surg. 22 (4): 329–336.
- Silver H (1982). "Reduction of capsular contracture with two-stage augmentation mammaplasty and pulsed electromagnetic energy (Diapulse therapy)". Plast Reconstr Surg. 69 (5): 802–8. PMID 7071225.