Capsular Contracture Treatment in Manchester and Liverpool

 

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What does capsular contracture means?

Capsular contracture (CC) is the name used to describe scar tissue that always form around any breast implants which may become very thick and cause the breasts to harden leading to breast deformity and even discomfort.

Nobody knows how or when Capsular contracture could or would occur. It is known to be an unpredictable complication.

Most importantly you should be aware that capsular contracture is the most common complication after breast augmentation.

What is the treatment of the capsular contracture?

The best treatment for capsular contracture is its prevention. Actually, there are some techniques that can help to reduce CC to happen. Plastic surgeons do not know all of the causes of capsular contracture. Dr. Mounir will offer you the latest methods to try to prevent the occurrence of capsular contracture. He is constantly seeking to apply the latest techniques in breast enhancement and also in the treatment of capsular contracture.

How can the risk of capsular contracture be reduced?

The choice of the implant:

It has been reported a lower rate and risk of capsular contracture when textured implants are used and placed over the chest muscle. However, this is less evident when the implant is placed under the pectoralis muscle. Since most breast implants are usually placed at least partially behind the chest wall muscle (submuscular or dual plane), the benefits of textured implants are reduced. Dr Mounir will explain to you that the disadvantages of textured implants is that the texturing shell makes the implant more likely to become more palpable or visible.

Over or under the pectoralis Muscle (chest Muscle):

Statically the risk of capsular contracture is 8-12% when the implant is placed under the muscle over 20 years. Over the muscle or the so-called sub-glandular placement the risk of CC is about 12 to 18 %.

Dr Mounir usually uses the dual plane technique or the so-called partial placement to also reduce the risk of rippling.

Massage

Often postoperatively Dr Mounir will advise you to massage your breasts by performing the rolling exercise, which is basically another way to massage actively your breasts to stop them getting harder. Although there are no scientific data to prove the effectiveness of the rolling exercise but Dr. Mounir believes in this massage technique on an individual basis. He is not convinced that massage can prevent capsular contracture to happen, but he does believe that massage can help the breasts soften post-operatively.

The "no-touch" technique

Dr. Mounir uses strictly the no-touch technique. This means, the implant package containing the implants is opened only at the last moment when they are ready to be inserted into the breast pocket. The plastic surgeon should re-sterilise the skin of the breasts all over again with betadine and even re-drape the surgical site field with new sterile towels, and always replace his own gloves. No one else touches the implants except Dr. Mounir. During the implants insertion into the breast pocket, he makes sure not to allow the implants to touch any instruments, the skin of the patient, or any sterile drapes surrounding the operative field. In this manner, this will reduce the chance for the bio-film to form and no foreign substances attach themselves to the implant, which could leas to tissue inflammation and then probably to CC.

How is capsular contracture diagnosed?

A capsular contracture is normally diagnosed on clinical examination by a plastic surgeon. Dr Mounir may notice that one or both of your breasts are starting to harden. You may notice that your breast shape has changed and that you have even started feeling some discomfort.

At the Manchester Cosmetic Centre Dr Mounir will examine you to determine if you have a capsular contracture. The examination of each breast is classified in different grades:

Grade I: The breast is firm but not hard.
Grade II: The breast is starting to become hard and the implant can be easily palpated
Grade III: The breast is hard and usually asymmetric due to distortion of shape.
Grade IV: The breast is hard, tender, painful, and the shape distortion is pronounced or severe

Can capsular contracture be seen on a MRI scan or mammogram?

The MRI scan and mammogram can help in the diagnostic of the capsular contracture but these radiological investigations are not necessary.

What treatment methods are available for capsular contracture?

Singulair or Zafirlukast (Accolate)

Zafirlukast (brand name: Accolate) is usually taken twice a day for three months has been shown to improve the symptoms of CC by reducing the hardness in approximately 50% of cases. If you are experiencing a capsular contracture, Dr. Mounir will most probably recommend a trial of Accolate before considering surgical intervention. If you are planning to undergo a surgical treatment such a capsulectomy, then Dr. Mounir will likely recommend a course of Singulair and an oral antibiotic for 3 months to prevent the recurrence of CC. Post operatively rolling exercise massage is also started early

Surgical treatment:

Capsulectomy (complete removal of the scar tissue around the implants) or Capsulotomy?

Closed Capsulotomy:

This is when the breast surgeon squeezes and produces an intense pressure on the implant until hearing a popping noise. This technique is not used anymore because of the risk of rupture of the implant.

Capsulotomy:

This is when the plastic surgeon would perform only scoring and consequently breaking the scar tissue of the so-called capsule. This does technique is associated with higher risk of recurrence of capsulation. This is why the capsulotomy is now rarely performed.

Capsulectomy:

The most efficient surgical treatment for capsular contracture is the capsulectomy, or removal of the entire thickened capsule surrounding the breast implant. This is the most used procedure to prevent capsular contracture to happen again. future recurrent capsular contractures from forming.

For a Grade 3 or 4 capsular contracture that are a matter of concern for the Manchester patients and that are unresponsive to Singular treatment, surgery is the only option available. Dr Mounir will offer you different options such as for patients with subglandular implants (over the muscle)a change to a submuscular placement (under the muscle) and complete removal of the hard capsule which could be the best treatment.

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