Is capsulectomy, along with strattice matrix best correct capsular contracture?

The Plastic Surgery Channel Surgeon Answers: (2)

1. Answer from PSC Doctor:

   

   Bruce W. Van Natta, MD

   bvannatta responded:

   It’s always difficult to make suggestions without seeing the patient or at least photos. That being said, there is anecdotal evidence that the use of acellular dermal matrices such as Strattice, can significantly reduce the recurrence of capsular contracture. It sometimes may even make sense to take the implant out for a couple of months and then start over since many believe bacterial contamination is the culprit in recurrent capsular contracture. Another anecdotal idea is the use of fat grafting to reduce the incidence of contracture. Again, I want to emphasize that is not any good data yet to support the Strattice or fat grafting effect. Also, I believe strongly that if Strattice is used a drain is a must. You should definitely make sure that your surgeon is not only board certified by the American Board of Plastic Surgery, but also has significant experience at revisional breast surgery.

   Bruce Van Natta, MD

   Posted on February 15th, 2012

2. Answer from PSC Doctor:

   

   Caroline Glicksman, MD

   cglicksman responded:

   Capsular contracture is the most common complication in breast implant surgery. It affects about 15% of first time breast augmentation patients and up to 20 % of revision augmentation patients, affecting almost 50,000 American women each year.

   The potential causes include infection, hematoma, seroma (fluid collection), gel rupture, the implant location, implant surface texture, and finally biologic factors such as smoking, age, and scarring. The most widely accepted theories involve bacteria and Biofilms as a cause for capsular contracture. Antibiotic used at the time of the procedure to wash out the pocket, and limiting potential implant contamination, have been shown to reduce capsular contracture rates.

   The use of Acellular Dermal Matrixes (ADM), such as Alloderm and Strattice has gained wide-spread popularity in breast reconstruction and breast revision surgery. The data suggests that there is less adherence of implants under the material, and it may possibly reduce capsular contracture. The addition of ADM however, is not a substitute for good surgical technique, nor does it come cheap (may run over $2500/breast). Drains are routinely recommended in revision breast augmentation and especially when using ADM. In addition a complete capsulectomy (removal of the old capsule) may reduce the risk of recurrent capsular contracture due to Biofilm. Finally, explant alone should be considered when multiple implant procedures have all resulted in the same outcome.

   Caroline Glicksman, MD FACS

   Posted on February 15th, 2012

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