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 Dr. Brown |
"I believe that capsular contracture (formation), or hardening of scar tissue around the breast implant, in the absence of a clear reason why it occurred like a hematoma or trauma to the breast, is a result of subclinical infection or biofilm formation on the breast implant," said Dr. Brown at the 12th annual Toronto Breast Surgery Symposium.
Because of the concern about biofilm, it is important to remove the implant from the local environment where it is sitting, he says.
Just as if a patient had a hip replacement and it became infected and would have to be replaced by an orthopedic surgeon, a new implant should be placed if infection is suspected, according to Dr. Brown."Reusing the same implant may not be an effective treatment if in fact biofilm formation is the underlying problem," says Dr. Brown, noting that biofilm can't be seen but attaches itself to the implant. "Consideration should be made for taking the implant out of the local environment and replacing it with a new device."
QUANTIFYING COMPLICATIONS The rate of capsular contracture in implant surgeries has been placed at 10 to 15 percent, and the complication occurs with varying severity. It is the complication that most frequently results in the need for additional surgery (Kjøller K, Hölmich LR, Jacobsen PH, et al. Ann Plast Surg. 2002;48(3):229-237). Furthermore, Dr. Brown says, it's a challenge to predict which patients will develop capsular contracture.
Recently, there has been an effort to use artificial "dermis" to reduce the ability of the capsule to contract. In the end, however, the best way to manage contracture is to do everything possible to prevent it, he explains.
IMPLANT MALPOSITION Implant malposition is another significant cause for revision surgery, Dr. Brown says.
"The implant can be either superior, inferior, medial or lateral," he says. "You need to identify the direction of the malposition and develop a surgical plan to get it back to a normal position."
Malposition is not a problem of the implant, but of the implant pocket. To resolve the problem of malposition, the pocket can either be repaired or the implant should be removed from the pocket, and a new pocket should be surgically prepared to insert the new implant. "You either fix the pocket or change the pocket," Dr. Brown says.
