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Boyd CJ, Chiodo MV, Lisiecki JL, Wagner RD, Rohrich RJ. Systematic Review of Capsular Contracture Management following Breast Augmentation: An Update. Plast Reconstr Surg 2024; 153:303e-321e. [PMID: 36877620 DOI: 10.1097/prs.0000000000010358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Capsular contracture is one of the most frequent indications for revision following breast augmentation. Management goals focus on restoring breast aesthetics and minimizing subsequent recurrence of capsular contracture. As new data emerge, close review of the data are merited to build evidence-based clinical guidelines to inform surgical practice and management of capsular contracture. METHODS A systematic review of the MEDLINE, Embase, and Cochrane Database of Systematic Reviews databases was conducted to characterize the surgical management of capsular contracture in revision breast augmentations. The primary endpoint was capsular contracture recurrence rate. RESULTS The review was conducted in November of 2021. Primary search revealed 14,163 results. Initial screening by title left 1223 articles. Abstract review left 90 articles for full-text review, of which 34 were ultimately included and were all observational in nature. CONCLUSIONS Capsular contracture management remains an important topic, with limited high-level evidence for establishing clear evidence-based treatment guidelines. Although more evidence is required to assess the effects of capsulectomy, implant exchange, and plane change, these appear to be useful mechanisms for reducing recurrent capsular contracture. There is more evidence regarding the use of acellular dermal matrix, although this still requires long-term follow-up studies. New developments regarding textured implants limit the revision breast augmentation surgeon to smooth devices.
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Affiliation(s)
- Carter J Boyd
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone
| | | | | | - Ryan D Wagner
- Division of Plastic Surgery, Baylor College of Medicine
| | - Rod J Rohrich
- Dallas Plastic Surgery Institute
- Division of Plastic Surgery, Baylor College of Medicine
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Coatings of Cyclodextrin/Citric-Acid Biopolymer as Drug Delivery Systems: A Review. Pharmaceutics 2023; 15:pharmaceutics15010296. [PMID: 36678924 PMCID: PMC9865107 DOI: 10.3390/pharmaceutics15010296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/23/2022] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
In the early 2000s, a method for cross-linking cyclodextrins (CDs) with citric acid (CTR) was developed. This method was nontoxic, environmentally friendly, and inexpensive compared to the others previously proposed in the literature. Since then, the CD/CTR biopolymers have been widely used as a coating on implants and other materials for biomedical applications. The present review aims to cover the chemical properties of CDs, the synthesis routes of CD/CTR, and their applications as drug-delivery systems when coated on different substrates. Likewise, the molecules released and other pharmaceutical aspects involved are addressed. Moreover, the different methods of pretreatment applied on the substrates before the in situ polymerization of CD/CTR are also reviewed as a key element in the final functionality. This process is not trivial because it depends on the surface chemistry, geometry, and physical properties of the material to be coated. The biocompatibility of the polymer was also highlighted. Finally, the mechanisms of release generated in the CD/CTR coatings were analyzed, including the mathematical model of Korsmeyer-Peppas, which has been dominantly used to explain the release kinetics of drug-delivery systems based on these biopolymers. The flexibility of CD/CTR to host a wide variety of drugs, of the in situ polymerization to integrate with diverse implantable materials, and the controllable release kinetics provide a set of advantages, thereby ensuring a wide range of future uses.
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Abi-Rafeh J, Safran T, Winocour S, Dionisopoulos T, Davison P, Vorstenbosch J. Complications of Capsulectomies: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database. AESTHETIC SURGERY JOURNAL OPEN FORUM 2022; 4:ojac025. [PMID: 35747463 PMCID: PMC9212085 DOI: 10.1093/asjof/ojac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Although plastic surgeons commonly perform capsulectomies for a variety of peri-prosthetic capsular conditions, the safety of capsulectomy remains unknown, and the literature lacks evidence describing its morbidity and complication rates for patients inquiring about its associated risks. Objectives The present study aims to identify and define the complication rates associated with capsulectomies. Methods An analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was performed between the years 2015 and 2018. All information pertaining to demographics, patient-related information, surgical indications, procedure-related information, outcomes, and complications were assessed. Results The study identified 2231 cases of surgeon-reported capsulectomies; indications most commonly reported included capsular contracture (n = 638, 28.6%) and breast implant rupture (n = 403, 18.1%). In total, 141 patients (6.32%) were hospitalized for longer than 1 postoperative day (range, 2-28 days), while the overall complication rate was 3.0% (n = 67/2231 patients). Incidence of minor complications, representing superficial surgical site infections, was 0.8%, while the major complication rate was 2.24%. These included 7 cases of deep surgical site infections (0.3%), 19 organ space infections (0.9%), and 8 cases of wound dehiscence (0.4%). Eight patients developed sepsis (0.4%); 6 patients required transfusions (0.3%); 1 case of postoperative pneumonia and 1 myocardial infarction were also identified (n = 1 each, 0.0%). The overall reoperation and readmission rates were 2.0%, representing a readmission rate of 66% among patients with complications. Conclusions The present study provides the first estimate of the incidence of complications associated with capsulectomies. Although the NSQIP database contains significant limitations, the data presented herein describe a complication profile that plastic surgeons can share with their patients during informed consent. Level of Evidence: 4
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Affiliation(s)
- Jad Abi-Rafeh
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Tyler Safran
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Sebastian Winocour
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Tassos Dionisopoulos
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Peter Davison
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Joshua Vorstenbosch
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
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Zingaretti N, Vittorini P, Savino V, Vittorini JC, De Francesco F, Riccio M, Parodi PC. Surgical Treatment of Capsular Contracture (CC): Literature Review and Outcomes Utilizing Implants in Revisionary Surgery. Aesthetic Plast Surg 2021; 45:2036-2047. [PMID: 33543344 DOI: 10.1007/s00266-021-02148-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this clinical review is to provide an overview of the use of breast implants after capsular contracture (CC) surgical treatment, with a focus on type of implants used. Furthermore, our experience in this field is also reviewed. METHODS MEDLINE, EMBASE, Web of Science, Scopus, the Cochrane Central, and Google Scholar databases were reviewed to identify literature related to surgical treatment of capsular contracture and implant replacement. Each article was reviewed by two independent reviewers to ensure all relevant publications were identified. The literature search identified 54 applicable articles. Of these, 26 were found to have a therapeutic level of evidence. The reference lists in each relevant paper were screened manually to include relevant papers not found through the initial search. RESULTS Only four articles report the replacement of implants after surgical treatment of capsular contracture. Six articles reported an implant exchange with only smooth silicone gel filled implants. Two reviews advice to use smooth implants in implant replacement. CONCLUSION With our expertise in the field and the results of this up-to-date literature review, it can be concluded that implant exchange is recommended in case of breast revision for capsular contracture, and the use of subpectoral smooth silicone gel breast implants is a good option after surgical treatment in patients with primary or recurrence Baker III-IV. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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5
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Restifo RJ. A Case Report of Capsular Contracture Immediately Following COVID-19 Vaccination. Aesthet Surg J Open Forum 2021; 3:ojab021. [PMID: 34373851 PMCID: PMC8241424 DOI: 10.1093/asjof/ojab021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/24/2022] Open
Abstract
Capsular contracture is fundamentally an immunological/inflammatory response to the implant, treating it as a foreign body in need of exclusion from the immune system. The capsule surrounding the implant is populated by a rich variety of immunologically active cells such as macrophages, T lymphocytes, and myofibroblasts. Vaccination in general and the COVID-19 vaccine in particular result in specific and nonspecific activation of the immune system, including those immune cells in proximity to the implant. This phenomenon has been previously demonstrated in delayed inflammatory reactions to previously implanted hyaluronic acid fillers following COVID-19 vaccination. This report is what is believed to be the first case of the rapid development of severe ipsilateral capsular contracture in the immediate aftermath of the second dose of the BNT162b2 (Pfizer) vaccine.
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Affiliation(s)
- Richard J Restifo
- Corresponding Author: Dr Richard J. Restifo, 620 Racebrook Road, Orange, CT 06477, USA. Email address: ; Twitter: @DrRestifo
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Atiyeh BS, Costagliola M, Rampillon F, Chahine F. Comment on Plane Change Versus Capsulotomy: A Comparison of Treatments for Capsular Contraction in Breast Augmentation Using the Subfascial Plane. Aesthetic Plast Surg 2021; 45:1360-1362. [PMID: 33399952 DOI: 10.1007/s00266-020-02072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Bishara S Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Michel Costagliola
- Faculté de Médecine Toulouse-Rangueil, Pr Emérite-Chirurgie Réparatrice et Esthétique, Toulouse, France
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Evaluating the Necessity of Capsulectomy in Cases of Textured Breast Implant Replacement. Ann Plast Surg 2021; 85:691-698. [PMID: 32102001 DOI: 10.1097/sap.0000000000002301] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Capsulectomy has traditionally been recommended as a treatment for capsular contracture after breast augmentation. With the advent of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), and the Food and Drug Administration's decision to ban Biocell textured devices, this operation has taken on new importance. This review was undertaken to better inform clinical recommendations for women with textured devices. METHODS An electronic search was performed using PubMed to identify all the available literature on the subject of capsulectomy and open capsulotomy (the alternative treatment). RESULTS Fifty-seven articles on this topic were identified. Capsulectomy was widely recommended for treatment of capsular contracture, although many authors recommended leaving thin capsular tissue behind in the absence of symptoms. En bloc resection was recommended only for women with a diagnosis of BIA-ALCL. No information supported a prophylactic role for capsulectomy in asymptomatic women with textured breast implants who are concerned regarding their future risk of BIA-ALCL. Routine pathologic examination in asymptomatic patients was not supported. DISCUSSION Capsulectomy adds substantially to the surgical risk, discomfort, recovery time, and expense. Implant removal or replacement without a simultaneous capsulectomy is atraumatic and poses negligible risk. CONCLUSIONS Capsulectomy introduces additional morbidity and is not mandatory for asymptomatic patients. Implant removal or exchange for smooth implants without a capsulectomy may be an acceptable choice for many women who do not demonstrate capsular pathology. However, any symptoms or surgical findings suggesting pathology warrant a capsulectomy. En bloc resections are reserved for patients diagnosed with BIA-ALCL.
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8
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Letter to the Editor: Epidemiology and Prevention of Breast Prosthesis Capsular Contracture Recurrence. Aesthetic Plast Surg 2021; 45:819-821. [PMID: 33206212 DOI: 10.1007/s00266-020-02006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
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9
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Complications et chirurgie secondaire de l’augmentation mammaire à visée esthétique par implants. ANN CHIR PLAST ESTH 2019; 64:583-593. [DOI: 10.1016/j.anplas.2019.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 01/06/2023]
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10
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What Happened after the Poly Implant Prothèse Recall? A Prospective Cohort Study of 808 Implants into the Predictive Value of Implant Rupture on Postexchange Complications. Plast Reconstr Surg 2019; 144:35e-42e. [DOI: 10.1097/prs.0000000000005706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Jeon BS, Shin BH, Huh BK, Kim BH, Kim SN, Ji HB, Lee SH, Kang SI, Shim JH, Kang SM, Lee JC, Lee KS, Heo CY, Choy YB. Silicone implants capable of the local, controlled delivery of triamcinolone for the prevention of fibrosis with minimized drug side effects. J IND ENG CHEM 2018. [DOI: 10.1016/j.jiec.2018.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Endoscopic transaxillary prepectoral conversion for submuscular breast implants. Arch Plast Surg 2018; 45:158-164. [PMID: 29506328 PMCID: PMC5869434 DOI: 10.5999/aps.2017.01263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022] Open
Abstract
Background During breast augmentation, the transaxillary approach provides the advantage of allowing the mammary prosthesis to be placed through incisions that are remote from the breast itself, thereby reducing the visibility of postoperative scars. For patients experiencing capsular contracture who do not want additional scars, the previous transaxillary scar can be used for site change and implant exchange. Methods This study analyzed 17 patients (34 breasts) with submuscular breast implants with grade III-IV capsular contracture who received treatment from 2010 to 2015. The mean age of the patients was 29 years (range, 20–38 years). The inclusion criterion was a pinch test of more than 3 cm at the upper pole of the breast. Previous axillary scars were used to expose the pectoralis fascia, and submuscular breast implants were removed carefully. The dissection underneath the pectoralis fascia was performed with endoscopic assistance, using electrocautery under direct visualization. Results The mean follow-up period was 14 months (range, 6–24 months). The entire dissection plane was changed from the submuscular plane to the subfascial plane. Round textured gel implants were used, with a mean implant size of 220 mL (range, 160–300 mL). Two patients developed grade II capsular contracture. There were no cases of malposition or asymmetry. Three patients complained of minor implant palpability. None of the patients required additional surgery. Conclusions Endoscopic subfascial conversion may be an effective technique for treating capsular contracture and avoiding scarring of the breast in selected patients.
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The aetiopathogenesis of capsular contracture: A systematic review of the literature. J Plast Reconstr Aesthet Surg 2017; 71:307-317. [PMID: 29301730 DOI: 10.1016/j.bjps.2017.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 10/05/2017] [Accepted: 12/05/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Capsular contracture is the most frequent complication after breast augmentation or reconstruction with breast implants. The immune system plays a prominent role in capsular contracture formation, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for capsular contracture. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of capsular contracture. MATERIALS AND METHODS We undertook a systematic literature review focused on immunological factors and microbiota in relation to capsular contraction around implants. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE, and the Cochrane databases were searched from inception up to October 2016. Included studies were assessed for the following variables: subject characteristics, number of capsules, primary indication for surgery, surgical procedure, follow-up or implant duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors. RESULTS Data on immunological factors and bacterial contamination were retrieved from 64 included studies. Notably the presence of macrophages and Staphylococcus epidermidis within capsules was often associated with capsular contracture. CONCLUSION This review provides a clear overview of the immunological factors associated with capsular contracture and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with capsular contracture has been provided. Follow-up research may result in clinical recommendations to prevent capsular contracture.
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Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1096. [PMID: 27826488 PMCID: PMC5096543 DOI: 10.1097/gox.0000000000001096] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/31/2016] [Indexed: 12/15/2022]
Abstract
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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The Use of "Precapsular Space" in Secondary Breast Reconstruction. Aesthetic Plast Surg 2016; 40:716-23. [PMID: 27443324 DOI: 10.1007/s00266-016-0683-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Periprosthetic capsule formation is a physiological phenomenon occurring around breast implants. In case of capsular contracture, several surgical techniques are described; among them, total capsulectomy is considered the gold standard, but it is not free of complications. A more conservative procedure is the use of "precapsular space", leaving intact the preexisting capsule. The method presents minor complications and further advantages over total capsulectomy. METHOD From November 2010 to June 2014, we treated 92 postmastecttomy patients who previously underwent implant-based reconstruction. They presented implant malposition (bottoming-out, double bubble deformity, upward migration) and different degrees of capsular contracture. The implant was repositioned in a neoprecapsular pocket. Sixty-eight out of 92 patients presented a follow-up longer than 24 months, and they are included in the present study. They were evaluated with a questionnaire 1 month before surgery, at 6 months and 2 years postoperatively. Moreover, two independent plastic surgeons completed the same questionnaire at 6 months and 2 years after surgery. RESULTS Mean follow-up is 29 months. Baker III-IV capsular contracture occurred in 9.5 % of the patients, implant malposition in 2.9 % of the cases and no implant displacement rotation was observed. Patient self-assessment preoperatively and postoperatively (at 2 years) revealed improved cosmetic outcomes (p < 0.01). Surgeon assessment correlated with patient self-assessment. CONCLUSION The use of precapsular space, first described for aesthetic augmentation, is a valid alternative to total capsulectomy for the treatment of capsular contracture or implant malposition, even in the reconstructive field. LEVEL OF EVIDENCE IV This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Flugstad NA, Pozner JN, Baxter RA, Creasman C, Egrari S, Martin S, Messa CA, Oliva A, Schlesinger SL, Kortesis BG. Does Implant Insertion with a Funnel Decrease Capsular Contracture? A Preliminary Report. Aesthet Surg J 2016; 36:550-6. [PMID: 26672104 DOI: 10.1093/asj/sjv237] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Capsular contracture remains a common and dreaded complication of breast augmentation. The etiology of capsular contracture is believed to be multi-factorial, and its causes may include biofilm formation due to implant/pocket contamination with skin flora. It has been shown that insertion funnel use reduces skin contact and potential contamination by 27-fold in a cadaver model. After incorporating the funnel into our surgical protocols, we anecdotally believed we were experiencing fewer capsular contractures in our augmentation practices. OBJECTIVES The purpose of this study was to test the hypothesis that capsular contracture related reoperation rates decreased after insertion funnel adoption using data from multiple practices. METHODS At seven participating centers, we retrospectively reviewed the surgical records from March 2006 to December 2012 for female patients who had undergone primary breast augmentation with silicone gel implants. Group 1 consisted of consecutive augmentations done without the insertion funnel, and Group 2 consisted of consecutive augmentations done with the insertion funnel. The primary outcome variable was development of grade III or IV capsular contracture that led to reoperation within 12 months. RESULTS A total of 1177 breast augmentations met inclusion criteria for Group 1 and 1620 breast augmentations for Group 2. The rate of reoperation due to capsular contracture was higher without use of the insertion funnel (1.49%), compared to Group 2 with funnel use (0.68%), a 54% reduction (P = 0.004). CONCLUSIONS The insertion funnel group experienced a statistically significant reduction in the incidence of reoperations performed due to capsular contracture within 12 months of primary breast augmentation.
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Affiliation(s)
- Nicholas A Flugstad
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Jason N Pozner
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Richard A Baxter
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Craig Creasman
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Sepehr Egrari
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Scot Martin
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Charles A Messa
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Alfonso Oliva
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - S Larry Schlesinger
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
| | - Bill G Kortesis
- Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC
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17
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Ajdic D, Zoghbi Y, Gerth D, Panthaki ZJ, Thaller S. The Relationship of Bacterial Biofilms and Capsular Contracture in Breast Implants. Aesthet Surg J 2016; 36:297-309. [PMID: 26843099 DOI: 10.1093/asj/sjv177] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 01/06/2023] Open
Abstract
Capsular contracture is a common sequelae of implant-based breast augmentation. Despite its prevalence, the etiology of capsular contracture remains controversial. Numerous studies have identified microbial biofilms on various implantable materials, including breast implants. Furthermore, biofilms have been implicated in subclinical infections associated with other surgical implants. In this review, we discuss microbial biofilms as a potential etiology of capsular contracture. The review also outlines the key diagnostic modalities available to identify the possible infectious agents found in biofilm, as well as available preventative and treatment measures.
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Affiliation(s)
- Dragana Ajdic
- Dr Ajdic is an Assistant Professor, Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL. Ms Zoghbi is a Medical Student, Dr Gerth is a Volunteer Assistant Professor, Dr Panthaki is a Professor, and Dr Thaller is Chief and a Professor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Yasmina Zoghbi
- Dr Ajdic is an Assistant Professor, Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL. Ms Zoghbi is a Medical Student, Dr Gerth is a Volunteer Assistant Professor, Dr Panthaki is a Professor, and Dr Thaller is Chief and a Professor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - David Gerth
- Dr Ajdic is an Assistant Professor, Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL. Ms Zoghbi is a Medical Student, Dr Gerth is a Volunteer Assistant Professor, Dr Panthaki is a Professor, and Dr Thaller is Chief and a Professor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Zubin J Panthaki
- Dr Ajdic is an Assistant Professor, Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL. Ms Zoghbi is a Medical Student, Dr Gerth is a Volunteer Assistant Professor, Dr Panthaki is a Professor, and Dr Thaller is Chief and a Professor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Seth Thaller
- Dr Ajdic is an Assistant Professor, Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL. Ms Zoghbi is a Medical Student, Dr Gerth is a Volunteer Assistant Professor, Dr Panthaki is a Professor, and Dr Thaller is Chief and a Professor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
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19
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Shestak KC, Davidson EH. Commentary on: An innovative procedure for the treatment of primary and recurrent capsular contracture (CC) following breast augmentation. Aesthet Surg J 2013; 33:1018-20. [PMID: 24081695 DOI: 10.1177/1090820x13502036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kenneth C Shestak
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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