[:en]WHAT IS CAPSULAR CONTRACTURE?[:]

[:en]Capsular contracture of the breast refers to the formation of thick scar tissue surrounding a breast implant. It affects 2.8 to 15.9 percent of breast implant patients, and it is the most common cause of reoperation following both cosmetic and reconstructive implant surgery of the breast.1,2 It is, in fact, the most unpredictable and challenging complication following breast implant surgery. We don’t know the exact cause, but there are likely a number of causative factors, including infection, hematoma (bleeding), prior radiation therapy, and biofilm formation, which describes the ability of microorganisms to stick to each other on a surface.3-7

When a patient develops a capsular contracture, she may first notice that one or both breasts feel firm, and they may be painful or distorted. At this stage, I recommend seeing your original surgeon for an evaluation of your breasts. If your original surgeon is not available, seek out a board-certified plastic surgeon in your area. When you are examined, your surgeon may refer to the “Baker Grade” of your breast. This is how we assign these levels:

Baker Grade I Breast is soft; implant is not palpable

Baker Grade II Breast is solid; implant is palpable but not visible

Baker Grade III Breast is hardened; implant is palpable and visible

Baker Grade IV Breast is hard, deformed, and painful; implant is palpable and clearly

Visible

At this time, the main treatment for capsular contracture of Baker Grades III and IV is surgical, and generally involves removing the implants, partially or completely removing the scar tissue, and placing new implants. Other non-surgical methods include closed capsulotomy (the breast is squeezed very firmly to break up the scar tissue), and oral medication. However, all of these methods have been used with varying degrees of initial success and high recurrence rates.8

Recently, the possibility of using ultrasound to treat this difficult problem has come under evaluation. The use of ultrasound for the treatment of capsular contracture of the breast was first suggested in 1984 when Dr. Silversmith published a brief report of a patient in whom implant firmness of the breast softened following application of ultrasound in an adjacent region for inflammation in her shoulder joint.9 This was followed by another report by Dr. Herhahn, who studied 36 patients who had been treated for capsular contracture with the use of ultrasound. He noted that 55% of patients reported a relief of firmness with the use of ultrasound alone.10

An ultrasound instrument named the Capsuloblast™ has been tested in three clinical trials by Dr. Planas in Barcelona, Spain. Dr. Planas conducted his first study in 1997. He applied the device to 24 patients with 34 contractures following closed capsulotomy, and 82% of patients improved their capsular contracture grade.11 In a follow-up study in 2001, he reported on his five-year experience with use of the same device. He had treated an additional 52 patients and noted an improvement in 82.6% of patients.12 Dr. Planas finally evaluated the device in 2002 for the prevention of capsular contracture, and found that when the device was used in four sessions (24 hours after surgery, 3 days after surgery, 7 days after surgery, and one month after surgery), there was a more rapid reduction of swelling, bruising, and pain. None of the patients he treated had developed a capsular contracture at 18 months out from surgery.13 Finally, Dr. del Yerro reported the use of an external ultrasound device three times per week over the course of 30 days, with partial or complete reduction of capsular contracture in all patients.14

Although ultrasound is not being performed in the United States for the treatment of capsular contracture, it is an exciting new treatment which may potentially help many women in the non-surgical treatment of an extraordinarily challenging problem.

1. Cunningham B. The Mentor Core Study on silicone breast implants. Plast Recon Surg 2007; 120: 19S-29S; discussion 30S-32S.

2. Spear SL, Murphy DK, Slicton A, Walker PS. Inamed Silicone Breast Implant Core Study results at 6 years. Plast Reconstr Surg 2007; 120(suppl 1): 8S-16S; discussion 17S.

3. Spear SL, Murphy DK. Natrelle Round Silicone Breast Implants: Core Study Results at 10 Years. Plast Recon Surg 2014; 133: 1354-1361.

4. Pajkos A, Deva AK, Vickery K, Cope C, Chang L, Cossart YE. Detection of subclinical infection in significant breast implant capsules. Plast Recon Surg 2003; 111: 1605-1611.

5. Embrey M, Adams EE, Cunningham B, Peters W, Young VL, Carlo GL. A review of the literature on the etiology of capsular contracture and a pilot study to determine the outcome of capsular contracture interventions. Aesthetic Plast Surg 1999; 23: 197-206.

6. Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: a critical review of the literature. Plast Recon Surg 2009; 124: 395-408.

7. Tamboto H, Vickery K, Deva AK. Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty. Plast Recon Surg 2010; 126(3): 835-842.

8. Mendes FH, Viterbo F, DeLucca L. The influence of external ultrasound on the histologic architecture of the organic capsule around smooth silicone implants: experimental study in rats. Aesthetic Plast Surg 2008; 32: 442-450.

9. Silversmith PE. Ultrasound for capsular contracture of the breast. Plast Recon Surg 1984 73(3): 500.

10. Herhahn FT. Ultrasound and capsular contracture. Plast Recon Surg 1984 74(4): 574.

11. Planas J, Migliano E, Wagenfuhr J, Castillo S. External ultrasonic treatment of capsular contractures in breast implants. Aesthetic Plast Surg 1997; 21: 395-397.

12. Planas J, Cervelli V, Planas G. Five-year experience on ultrasonic treatment of breast contractures. Aesthetic Plast Surg 2001; 25: 89-93.

13. Planas J. Prophylactic use of external ultrasound for breast implant capsular contracture. Aesthetic Surg J 2002; 22: 205-207.

14. del Yerro. Discussion: The influence of external ultrasound on the histologic architecture of the organic capsule around smooth silicone implants: experimental study in rats. Aesth Plast Surg 2008; 32: 451-452.[:]