Capsular contracture
4412120
224833298
2008-07-10T16:53:53Z
LWallsMPH
7454637
Added a paragraph which summarized Mentor's findings on the frequency of c.contracture in implant patients within the first 3 years of surgery.
[[Image:Capsular fibrosis.jpg|thumb|Grade IV capsular contracture in the right breast of a 29-year-old woman seven years after subglandular placement of 560cc silicone gel-filled breast implants]]
Capsular contracture is an abnormal response of the immune system to foreign biomaterials and alloplastic materials. It is most discussed in the context of complications from breast implants and artificial joint prosthetics.
Capsules of tightly-woven collagen fibers normally form as an [[immune response]] around a foreign body (eg. breast implants, pacemakers, orthopedic joint prosthetics), tending to wall it off. [[Capsular contracture]] occurs when the capsule tightens and squeezes the implant. This contracture is a complication that can be very painful and distort the appearance of the implanted breast or limit the range of motion of an artificial joint. The exact cause of contracture is not known. However, some factors include bacterial contamination, silicone breast implant rupture or leakage, and [[hematoma]]. Capsular contracture may happen again after additional surgery.
Methods which have reduced capsular contracture include submuscular breast implant placement, using textured<ref name="Barnsley2006">{{cite journal | author=Barnsley GP| title= Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials. | journal=Plast Reconstr Surg. | year=2006 | pages=2182–90| volume=117 | issue=7 | pmid=16772915| doi= 10.1097/01.prs.0000218184.47372.d5}}</ref><ref name="Wong2006">{{cite journal | author=Wong CH, Samuel M, Tan BK, Song C.| title= Capsular contracture in subglandular breast augmentation with textured versus smooth breast implants: a systematic review| journal=Plast Reconstr Surg. | year=2006 | pages=1224–36| volume=118 | issue=5 | pmid=17016195| doi= 10.1097/01.prs.0000237013.50283.d2}}</ref> or polyurethane-coated implants,<ref name="Handel2006">{{cite journal | author=Handel N, et al| title= Long-term safety and efficacy of polyurethane foam-covered breast implants. | journal=Aesth. Surg Journal | year=2006 | month=may | pages=265–74| volume=26 | issue=3 || doi= 10.1016/j.asj.2006.04.001}}</ref> limiting handling of the implants and skin contact prior to insertion<ref name="Mladick1993">{{cite journal | author=Mladick RA| title= "No-touch" submuscular saline breast augmentation technique. | journal=Aesth. Surg Journal | year=1993 | pages=183–92| volume=17 | issue=3 | pmid= 8213311| doi= 10.1007/BF00636260 }}</ref> and irrigation with triple-antibiotic solutions.<ref name="Adams2006">{{cite journal | author=Adams WP jr., et al| title= Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. | journal=Plast Reconstr Surg. | year=2006 | pages=30–36 | volume=117 | issue=1 | pmid=16404244}}</ref>
Correction of capsular contracture may require surgical removal or release of the capsule, or removal and possible replacement of the implant itself. Closed capsulotomy (disrupting the capsule via external manipulation), a once common maneuver for treating hard capsules, has been discouraged as it can cause implant rupture. Nonsurgical methods of treating capsules include massage, external ultrasound,<ref name="Planas2001">{{cite journal | author=Planas J| title= Five-year experience on ultrasonic treatment of breast contractures. | journal=Aesthetic Plast Surg. | year=2001| pages=89–93 | volume=25 | issue=2 | pmid=11349308| doi= 10.1007/s002660010102}}</ref> treatment with [[leukotriene]] pathway inhibitors (Accolate, Singulair),<ref name="Schlesinger2002">{{cite journal | author=Schlesinger SL, wt al| title= Zafirlukast (Accolate): A new treatment for capsular contracture. | journal=Aesthetic Plast Surg. | year=2002| pages=329–336| volume=22 | issue=4}}</ref> <ref name="Scuderi">{{cite journal | author=Scuderi N, et al.| title= The effects of zafirlukast on capsular contracture: preliminary report.| journal=Aesthetic Plast Surg. | year=2006| pages=513–20 | volume=30 | issue=5 | pmid=16977359| doi= 10.1007/s00266-006-0038-3}}</ref>and pulsed electromagnetic field therapy.<ref name="Silver1982">{{cite journal | author=Silver H| title= Reduction of capsular contracture with two-stage augmentation mammaplasty and pulsed electromagnetic energy (Diapulse therapy). | journal=Plast Reconstr Surg. | year=1982| pages=802–8 | volume=69 | issue=5 | pmid=7071225| doi= 10.1097/00006534-198205000-00013}}</ref><P>
Mentor, one of the two FDA-approved breast implant manufacturers, performed a study which documented patient's complications with the product. In an FDA meeting presentation in March of 2000, they found that 43% of saline implant patients reported a complication within three years. Ten percent of those complaints were of severe capsular contracture. [http://www.center4research.org/implantsL.html]
There are four grades of breast capsular contracture - Baker grades I through IV. The Baker grading is as follows:
* Grade I the breast is normally soft and looks natural
* Grade II the breast is a little firm but looks normal
* Grade III the breast is firm and looks abnormal
* Grade IV the breast is hard, painful, and looks abnormal.
== Sources ==
* [http://www.fda.gov/cdrh/breastimplants/handbook2004/localcomplications.html Section on Complications] from the ''[[Food and Drug Administration|FDA]] Breast Implant Consumer Handbook - 2004.'' Most of the above text was copied verbatim from this public domain source.
* Safety of Silicone Breast Implants. Institute of Medicine National Academy Press, Washington, D.C. 2000.
* [http://www.implantinfo.com Breast Augmentation and Breast Implants Information Website - ImplantInfo by Nicole]
==References==
{{reflist}}
==External links==
* [http://www.implantinfo.com/banda4/344stevens/index.html Capsular contracture photos at www.implantinfo.com]
* [http://www.implantinfo.com/banda8/779stevens/index.html Capsular contracture photos at www.implantinfo.com]
* [http://www.implantinfo.com/banda7/capsules/ Photos of a removed breast implant with capsule at www.implantinfo.com]
* [http://www.justbreastimplants.com/gallery/capsule_contracture_photos.htm Capsular contracture photos]
[[Category:Plastic surgery]]
[[Category:Breast]]
[[Category:Implants]]