Influence of Some Operative and Postoperative Factors on Capsular Contracture Around Breast Prostheses

Hipps, C J; Raju, D. Raghava; Straith, Richard E.

doi:10.1097/00006534-197803000-00012

Cited by 87 publications

(29 citation statements)

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“…Little and Baker 12 reported 6 recurrences among 18 open capsulotomies (33%). Hipps et al 11 reported a 34% capsular contracture rate, and 46% of contractures were bilateral. In all 3 studies, second-generation devices had been implanted between 1973 and 1978 and many of the women had undergone closed capsulotomies.…”

Section: Discussionmentioning

confidence: 98%

Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

Swanson

2016

Plastic and Reconstructive Surgery - Global Open

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Background:The prevailing theory for capsular contracture after breast augmentation is a subclinical capsular infection. A capsulectomy, site change, and implant replacement are recommended. An open capsulotomy leaves the capsule in the patient. Theoretically, such a procedure would be ineffective because it does not remove the infected tissue. Recurrences occurred frequently in women treated in the 1970s when leaky silicone gel implants were in use. Open capsulotomy has not been studied in women implanted with third-generation devices.Methods:Seventy-five consecutive women with Baker III/IV capsular contractures after breast augmentation treated with open capsulotomies between 1996 and 2016 were retrospectively evaluated. The original implants were usually saline-filled (72.2%). Replacements were all smooth and round, and 92.6% were also saline-filled.Results:Seventeen women (22.7%) developed a recurrent capsular contracture. Two patients (2.7%) experienced a second recurrence. Patients with ruptured silicone gel implants (n = 13) had a significantly greater risk of recurrence (P = 0.01). There was no significant difference in recurrence rates comparing patients whose intact implants were reinserted (12.5%) with women whose intact implants were replaced (18.2%). Povidone–iodine irrigation did not affect the recurrence rate. Capsular contracture was corrected with 1 procedure in 77.3% of patients and 2 procedures in 97.3% of patients.Conclusions:Open capsulotomy is a safe and effective treatment that avoids the additional morbidity and cost of a capsulectomy. The findings challenge the infected biofilm theory of capsular contracture. Open capsulotomy deserves reconsideration by plastic surgeons.

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Section: Discussionmentioning

confidence: 98%

Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

Swanson

2016

Plastic and Reconstructive Surgery - Global Open

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“…They found that contracture occurred in 29% of cases complicated by hematoma compared with 13% of cases without hematoma. Previously published studies (41)(42)(43)(44) suggest that hematoma may be a predisposing factor to the development of capsular contracture. Goldberg (45) routinely used a 7 mm to 10 mm Jackson-Pratt drain for 24 h to 48 h. The drain usually drained between 30 mL and 150 mL of serosanguinous fluid.…”

Section: Discussionmentioning

confidence: 99%

Absence of Capsular Contracture in 319 Consecutive Augmentation Mammaplasties: Dependent Drains As A-Possible-Factor

Fanous¹,

Salem

Tawilé

et al. 2004

Canadian Journal of Plastic Surgery

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N Fanous, I Salem, C Tawilé, AE Bassas. Absence of capsular contracture in 319 consecutive augmentation mammaplasties: Dependent drains as a possible factor. Can J Plast Surg 2004;12(4):193-197. Capsular contracture is one of the major complications of augmentation mammaplasty. A review of 638 augmented breasts in 319 consecutive patients who underwent primary augmentation, with an average follow-up of 17.2 months and without a single case of capsular contracture of any degree to date, is presented, along with a discussion of the surgical technique and complications, and an analysis of measures used to prevent capsular contraction. Each patient received a pair of smooth saline-filled implants (Mentor, USA) placed in the submuscular space through an inframammary incision. In all operated breasts, many of the known measures commonly used for capsular contracture prevention were implemented. As well, a dependent drain was used as the final hemostatic step to prevent blood accumulation in the pocket. Leaving a dependent drain in the dissected pocket overnight, as one of the sequence of measures aimed at eliminating blood accumulation, is believed to be a contributing factor in capsular contracture prevention.Key Words: Augmentation mammaplasty; Drains; Prevention of capsular contractionAbsence de contracture capsulaire dans 319 augmentations mammaires consécutives : Rôle possible des drains chirurgicaux La contracture capsulaire est l'une des importantes complications de l'augmentation mammaire. On présente ici une revue de 638 augmentations mammaires chez 319 patientes consécutives ayant subi une première augmentation, avec suivi moyen de 17,2 mois, sans un seul cas de contracture capsulaire quel qu'il soit à ce jour; la présentation s'accompagne d'une description de la technique chirurgicale, de ses complications et d'une analyse des mesures utilisées pour prévenir la contracture capsulaire. Chaque patiente a reçu une paire d'implants lisses de sérum physiologique (Mentor, U.S.A.), placés dans l'espace sous-musculaire au moyen d'une incision inframammaire. Dans tous les seins opérés, les mesures connues et couramment utilisées pour prévenir la contracture capsulaire ont été appliquées. De même, un drain chirurgical a été installé comme étape hémostatique finale pour prévenir l'accumulation de sang dans la poche. Parmi les mesures visant à éliminer l'accumulation de sang dans la poche disséquée, l'installation d'un drain chirurgical jusqu'au lendemain serait un facteur propice à la prévention de la contracture capsulaire. C apsular contracture is a particularly frustrating problem for everyone concerned with breast augmentation: the surgeon, the patient and the manufacturer. It is virtually the single major complication of prosthetic use, yet has stubbornly resisted solutions despite more than 25 years of persistent clinical and laboratory investigation (1,2).Because sound etiological evidence has been lacking, many different theories have been advanced to explain capsular contracture: blood accumulation in the...

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“…29 However, when suction drains were used to treat postoperative hematomas, the rate of capsular contracture was less than when no drains were used. 8 Foreign particles may have been removed with the aspirated fluid in a similar manner to irrigation.…”

Section: Discussionmentioning

confidence: 99%

“…1 Studies over the years show development of capsular contracture by as many as 70% of gel-filled breast-implanted patients, with frequent recurrence following secondary procedures. [2][3][4][5][6][7][8][9] With such a common complication following breast implantation, causation analyses were conducted but with no definite conclusion. 10 And so, 30 years after its initial documentation, capsular contracture still remains of unknown etiology.…”

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confidence: 99%

Talc and Capsular Contracture

Chandler¹

2004

Annals of Plastic Surgery

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Capsular contracture, constrictive tightening of scar tissue around implants, was historically the primary reason for reoperating breast-implanted women. Yet, capsular contracture remains of unknown etiology. Contamination with foreign material is one of several suspected causes. Talc, a known fibrogenic agent, was recently found in peri-implant scars. A comparison of 192 explanted women was designed to investigate the role of talc in the induction of capsular contracture. This study included women implanted with silicone gel-filled implants for whom tissue samples were available. Patients were evaluated for the occurrence of capsular contracture and the presence of intracellular talc particles in peri-implant tissues. There was a significant association between talc and capsular contracture (odds ratio = 18.0, 95% confidence interval = 5.9-55, P < 1 x 10(-9)). This study indicates that talc was a major risk factor for capsular contracture in women augmented before 1992.

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Influence of Some Operative and Postoperative Factors on Capsular Contracture Around Breast Prostheses

Cited by 87 publications

References 0 publications

Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation

Absence of Capsular Contracture in 319 Consecutive Augmentation Mammaplasties: Dependent Drains As A-Possible-Factor

Talc and Capsular Contracture

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