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Capsular Contracture & Breast Implant IllnessTwo Very Different Problems, Each of Which Can Be Treated with En Bloc CapsulectomyThis page clarifies capsular contractures and breast implant illness, which are very different problems. It also explains why and how each can be treated with en bloc capsulectomyCapsular ContracturesCapsular contractures are hardening of the breast implant due to tightening of the scar which forma around the implant. Before going any further, it is important to understand that scar tissue forms around all implants as a natural part of healing, so the scar itself is not a problem. It only becomes a problem if it tightens. An abnormally tight scar is known as a capsular contracture. It may cause the breast to feel firm, unnatural, or even painful. When you see a breast that looks round and hard, it is probably due to capsular contracture. The most severe cases are sometimes called "coconut breasts." Capsular contractures may occur at any time, but tend to occur in two waves referred to as early capsular contracture and late capsular contracture, which are explained below. Capsular contractures may be treated by a surgeon in one of three ways. A capsulectomy is the surgical removal of the scar tissue around the implant and the placement of a new breast implant. A closed capsulotomy is the use of force to disrupt the surrounding scar tissue, in turn softening the breast (this is an old method and is no longer considered safe or effective). Lastly, Dr. Loftus may suggest an incontinuity or en bloc capsulectomy removal to achieve the greatest likelihood that the capsular contracture does not return. Each of these is explained below. Classification of Capsular ContracturesGrade I = None: Oddly enough, plastic surgeons refer to breasts with no capsular contracture as being Grade I. There is no such thing as Grade 0 Grade II = Mild: The breast feels slightly firm, and the implant edges can be felt through the skin. Plastic surgeons call this a Grade II capsular contracture. Grade III = Moderate: The breast feels firm, and the implant can be both felt and perceived visually through the skin. The breast may appear unnaturally round or spherical. Plastic surgeons call this a Grade III capsular contracture. Grade IV = Severe: The breast is hard, distorted, and painful due to the hardening scar tissue. Plastic surgeons call this a Grade IV capsular contracture. Timing of Capsular Contracture Corresponds to Cause:Early Capsular Contracture: Capsular contractures that occur within the first year of surgery are known as "early". Most of these are thought to be due to a bacteria called staph epidermidis, which is present on everyone’s skin and which usually causes no problems. Staph epi, as it is called, is generally benign unless it is in association with a prosthetic implant, such as an artificial joint, heart valve, pacemaker, or … you guessed it…breast implants. Because staph Epi is so benign, it does not cause the classic signs of infection: redness, swelling, and fevers. Instead, it remains dormant around the implant until it incites the surrounding scar tissue to tighten and contract….thus resulting in a capsular contracture. If you get a capsular contracure during the first year following breast implant placement, then the your capsular contracture may very well be related to staph Epi. Dr. Loftus sees many women from across the country who have early capsular contractures and whom she is able to treat with en bloc capsulectomy. Late Capsular Contractures: Capsular contractures that occur years after surgery are known as "late." These are frequently related to silicone gel implant ruptures, and they occur when the scar tissue around the breast implants becomes irritated or inflamed in response to silicone gel which has extruded from the implant. Saline breast implants are unlikely to cause a late capsular contracture because when saline implants leak, the saline does not cause a reaction and instead gets absorbed by the body rapidly, causing the implant to deflate completely. Late capsular contractures, like early capsular contractures, are most effectively treated by en bloc capsulectomy, according to Dr. Loftus, who has been performing en bloc capsulectomies since 2005, long before the plastic surgery literature even suggested this procedure. Risk and Prevention of Capsular ContractureNumerous studies have been published with capsular contracture rates varying between 10% and 50%. Perhaps the most meaningful way to interpret these apparently discrepant values is to consider that the risk of severe capsular contracture is close to 10% and the risk of mild capsular contracture may be as high as 50%. Implant surface, implant type, implant position, and site of incision may affect your risk of capsular contracture. Generally speaking, smooth saline implants placed under the muscle through an inframammary incision have the lowest rate of capsular contracture, and textured silicone breast implants placed over the muscle through an areolar incision have the highest rate of capsular contracture. Combinations of these placements and implant types will have capsular contracture rates somewhere in between. Dr. Loftus takes extra precautions during placement of imparts to reduce the rate of capsular contracture, and as a result, the rate of capsular contracture among her patients is less than 1 % per implant per year. Efforts to prevent capsular contracture include the implant decisions noted above as well as repeated sterilization of the skin during surgery. Following surgery, implant displacement exercises are very important. Displacement exercises are thought to stretch surrounding scar tissue, thereby reducing the rate of capsular contracture. Displacement exercised are so important that Dr. Loftus teaches patients how to do these herself, about 2 weeks after surgery Treatment of Capsular ContracturesIf you have a mild capsular contracture, you may choose to do nothing. And there is no reason that you should feel compelled to do anything, as a capsular contracture is not an emergency. Nor is it even an urgent problem. However, if you have a moderate or severe capsular contracture, you will most likely want to have it treated. Closed Capsulotomy: Capsular contractures were once treated by a procedure known as closed capsulotomy. Closed capsulotomy was a non-surgical procedure in which the surgeon manually squeezed the implanted breast, sometimes with tremendous force. This disrupted the surrounding scar, thereby softening the breast. Plastic surgeons now condemn this procedure because of its propensity to cause implant rupture, implant displacement, hematoma, unnatural appearance, and redevelopment of capsular contracture. Closed capsulotomy is mentioned here to make you aware of it: if your surgeon suggests closed capsulotomy, you should wisely decline and seek another plastic surgeon. Standard Capsulectomy: Capsulectomy basically means "removal of the capsule." Because the capsule surrounds the breast implant, this operation cannot be performed without removing the breast implant. The way that a standard capsulectomy is typically performed is as follows:
En Bloc Capsulectomy (In-continuity Capsulectomy): An "En Bloc" capsulectomy differs from a standard capsulectomy in that the capsule and implant are removed together as a single unit and without opening the capsule or exposing the capsule contents to the open wound. So, in order for a plastic surgeon to accomplish this, the following must be done:
Breast Implant illnessBreast Implant Illness is a term that has been assigned for women who have part of all of the constellation of problems (and it is not associated with capsular contracture):
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About Dr. LoftusDr. Loftus is a female plastic surgeon who is considered a national authority on plastic surgery, having appeared on numerous talk shows as an expert. Her book has become a best-selling book on plastic surgery and has earned her the reputation as a vocal advocate of patient safety, satisfaction, and education in plastic surgery. No wonder her patients have such great things to say about her… | |||||
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