Capsular Contracture Surgeon Riverside, Inland Empire
March 2nd, 2010 Dr. Carli“CAPSULE” – A NON-SURGICAL APPROACH:
Capsular contracture, or more simply “capsule”, is the most common complication of breast augmentation. Once a capsule has formed, the treatment is surgical. Little can be done to prevent or predict this complication. The nation-wide incidence is 11%, which is lower than 20 years ago. In my practice, this incidence has continued to go down over the past 18 years, and is now about 2-3%. Like all plastic surgeons, I tried and used different techniques to avoid the problem with more or less success; always looking for some type of new technique or technology. However, by combining several ways I have noticed some definite improvement in prevention and non-surgical treatment of an early capsule.
PREVENTION:
In 1995, Jaime Planas, a well known plastic surgeon from Barcelona, Spain, presented a large series of cases using ultrasound for three to four weeks, twice a week after each capsulectomy (surgical excision of the capsule) to minimize the risk of capsule recurrence.
His result was encouraging. He finished his article saying that he had started doing the same regimen after each breast augmentation, and felt it was promising. He said that he would wait until he had a very large service before publishing his result in regards to the use of ultrasound status post breast augmentation.
Five years later, in 2000, Jorge Planas, the son of Jaime Planas, a plastic surgeon like his father, published an article showing that the routine use of ultrasound after breast augmentation can lower the incidence of capsule formation. I had started in 1995, after his first article, and had the same impression. Our practice does not charge for this service.
The same year, in 2000, Andre Camirand, a renowned plastic surgeon from Montreal Canada, published a series of more than 3000 breast augmentations, all treated with a compression strap for the first two to three months status post surgery. He explained the mechanism of that treatment, based on elementary knowledge of scar tissue formation. Though somewhat bothersome, I use the strap on my patients. Again, I noticed less capsule formation. I also use the strap after a capsulectomy, and notice fewer capsules as well.
In 2003, Schlessinger, from Honolulu, Hawaii, published another large series minimizing capsule formation by giving Accolate to his patients after a breast augmentation for two to three months. His rationale was that one cause of capsule formation is inflammation, which can be partially controlled by Accolate; a medication for the treatment of asthma. The only contraindication is a liver condition since Accolate can be hepatotoxic. Accolate is now used nation-wide, and seems to be effective.
These three modalities combined have resulted in a positive result. At my Riverside Plastic Surgery practiceI rarely see a capsule in patients who follow these instructions. Combined, they do prevent capsule formation; however I cannot determine which helps the most. If a patient seems to form an early capsule, in spite of that combined technique, I prolong the treatment.
In April 2008, a new tool became available. Claude LeLouarn, from Paris, France, published a new approach; again based on the theory against inflammation. Schlessinger uses Accolate, a systemic medication, to fight inflammation. Le Louarn thought of using Flector Tissue Gel, which is an anti-inflammatory patch that delivers the anti-inflammatory agent via a percutaneous bioadhesive impregnation system. These patches measure 10 X 14 cm and contains 180 grams of diclofenac-epolamine, which is the active substance.
The whole breast needs to be covered by one or two patches, depending upon the size of the breast. It is kept on 24 hours per day and changed daily for three weeks. There is no toxicity, and it can be covered by insurance, as Accolate can be. Without insurance, the cost is still minimal. Within the past two years, I used it in three patients with an early capsule that had formed within three months after surgery.
According to LeLouarn, there is no response if Flector is used on a capsule that is already six months old. At this point the inflammation process is complete and the scar tissue has formed.
In conclusion, there are non-surgical ways to prevent and treat an early capsule.
Surgery may still be indicated, but it is a last recourse and much less necessary than in the past.
Feel free to contact us about Capsular Contracture in Riverside, Inland Empire at (951) 688-8660.