Treatment Of Capsular Contracture Research Articles

Acellular Dermal Matrix for the Treatment and Prevention of Implant-Associated Breast Deformities

Acellular dermal matrix has been increasingly accepted in prosthetic breast reconstruction. Observed benefits include improved control and support of implant position, better implant coverage, and the suggestion of a decreased capsular contracture rate. Based on this positive experience, it is not surprising that acellular dermal matrix would be applied to other challenging implant-related problems. This study investigates the use of acellular dermal matrix for correction or prevention of implant-associated breast deformities. Patients who underwent primary aesthetic breast surgery or secondary aesthetic or reconstructive breast surgery using acellular dermal matrix and implants between November of 2003 and October of 2009 were reviewed retrospectively. Patient demographics, indications for acellular dermal matrix, and acellular dermal matrix type and inset pattern were identified. Preoperative and postoperative photographs, success or failure of the procedure, complications, and need for related or unrelated revision surgery were recorded. Fifty-two patients had acellular dermal matrix placed alongside 77 breast prostheses, with a mean follow-up of 8.6 months (range, 0.4 to 30.4 months). Indications included prevention of implant bottoming-out (n = 6), treatment of malposition (n = 32), rippling (n = 20), capsular contracture (n = 16), and skin flap deficiency (n = 16). Seventy-four breasts (96.1 percent) were managed successfully with acellular dermal matrix. Three failures consisted of one breast with bottoming-out following treatment of capsular contracture, one breast with major infection requiring device explantation, and one breast with recurrent rippling. There was a 9.1 percent total complication rate, consisting of three mild infections, one major infection necessitating explantation, one hematoma, and one seroma. Based on this experience in 77 breasts, acellular dermal matrix has shown promise in treating and preventing capsular contracture, rippling, implant malposition, and soft-tissue thinning.

Effect of the Inhibitor Peptide of the Transforming Growth Factor β (p144®) in a New Silicone Pericapsular Fibrotic Model in Pigs

Capsular contracture is the most common complication associated with silicone prostheses. It may take the form of anything from slight hardening to obvious deformity. The role of transforming growth factor beta (TGF-beta) in the scar physiopathology of any fibrotic process has been demonstrated. The effects of inhibition of TGF-beta have also been demonstrated in experimental models of fibrosis, which opens the way for new therapeutic alternatives in the treatment of capsular contracture. The aim of this study was to evaluate periprosthetic fibrosis with a newly synthesized TGF-beta peptide inhibitor (p144). Three experimental groups were formed: Group I, subcutaneous and submuscular textured silicone prostheses were left untreated; Group 2, the prostheses were left after being immersed in the vehicle; Group 3, the same protocol was followed as in Group 2, but the solution contained the vehicle with the inhibitor peptide of TGF-beta, p144 (15 mg/prosthesis). The animals were sacrificed 24 weeks after implantation, and the capsules were assessed both macroscopically and histologically. The results obtained showed that the inhibition of capsular thickness and soluble collagen content in pericapsular fibrosis did not significantly decrease in the group of animals treated with the TGF-beta inhibitor peptide in comparison with control cases. We detected no statistically significant reduction in fibrosis in the periprosthetic capsule after treating the implants with the inhibitor peptide p144, but we feel that the influence of trauma around the prosthesis is critical in impeding the antifibrotic activity of the inhibitor peptide.

Modification of Cysteinyl Leukotriene Receptors Expression in Capsular Contracture

Periprosthetic capsular contracture represents a specific iatrogenic phenomenon with different side effects. Recently, interesting data have disclosed a potential role of leukotrienes as important mediators of inflammation in the reactivation process of capsular contracture. Some preliminary studies have assessed the efficacy of leukotriene antagonists in the prevention and treatment of capsular contracture. These clinical data are still lacking of a potential biomolecular basis. The aim of our present study was to evaluate the expression of the protein receptor cysteinyl leukotriene receptors (CysLTR). We included 50 patients with severe capsular contracture (Baker III-IV) and a control group consisting of healthy patients who underwent an implant replacement. In both groups, we performed the protein extraction and semiquantitative analysis for the determination of protein concentration on myofibroblasts and macrophages. Western Blot analysis of protein levels shows a significant increase in the expression of CysLTR in patients with capsular contracture. Our final results show that the increase in the levels of mRNA coding for CysLTR actually translates into an effective increase in protein levels of these mRNA transcripts. These findings could at least partially provide a biomolecular basis that justifies the use of specific antileukotriene drugs in the treatment of this disease.

The Effects of Zafirlukast on Capsular Contracture: Preliminary Report

Capsular contracture after breast augmentation is a distressing, troublesome event both for the patient and the surgeon. Fibrosis transforms the prosthesis into a hardened sphere, turning the initially satisfactory cosmetic result into a deformed mass. Treatment for capsular contracture can be either surgical, consisting of capsulotomy or capsulectomy with implant replacement, or pharmacologic, consisting of intracapsular instillation of steroids and antibiotics. The success rates for both types of treatment vary. Although capsular contracture is a multifactorial process, one common denominator in the successful treatment of this complication is believed to be the abatement of inflammation. Leukotriene antagonists have emerged recently as effective prophylactic agents for reactive airway diseases. Anecdotal reports have indicated that zafirlukast and montelukast effectively reverse capsular contracture. The authors investigated whether capsular contracture varies significantly over time after zafirlukast therapy by studying 20 women who had breast prostheses implanted and then experienced the development of capsular contracture. The results suggest that capsular contracture responds favorably to treatment with zafirlukast. The findings indicate that zafirlukast may reduce pain and breast capsule distortion for patients with long-standing contracture who either are not surgical candidates or do not wish to undergo surgery.

The effect of zafirlukast (Accolate) on early capsular contracture in the primary augmentation patient: A pilot study

Background The development of capsular contracture following breast augmentation presents a challenge to the plastic surgeon. Treatment of capsular contracture with the leukotriene antagonist zafirlukast (Accolate, AstraZeneca, Wayne, PA) has received much attention in the media; however, there is limited proof of its effectiveness. Objective The purpose of this study was to prospectively examine a single surgeon's experience using zafirlukast in the treatment of capsular contracture in primary, submuscular breast augmentation with saline-filled, smooth-walled implants. Methods Thirty-seven patients (74 breasts) who underwent primary submuscular breast augmentation with saline-filled, smooth-walled implants were evaluated at 1, 2, 4, 6, 12, 24, and 48 weeks postoperatively by 3 independent observers and rated for capsular contracture using a modification of the Baker classification. Patients who demonstrated any capsular contracture (higher than modified Baker 1.0) were offered off-label use of zafirlukast 20 mg PO BID for 3 or 6 months after full informed consent was reviewed and accepted. In addition, patients were offered liver function chemistries at the start of treatment and at 1, 3, and 6 months following zafirlukast treatment. The patients were assessed for implant mobility and capsular contracture at the initiation of leukotriene therapy and then again at 3- and 6-month time points. Results Forty-one breasts in this series (55.0%) were found to have early, mild capsular contracture. Specifically, 25 breasts were graded 1.5 (33.8% of total), 14 breasts graded 2.0 (18.9%), 1 breast graded 2.5 (1.4%), and 1 breast graded 3.0 (1.4%). Mean follow-up was 6.3 months. A positive response (complete or partial) was seen in a statistically significant proportion of treated breasts (75.7%, P < 0.05). This response was maintained on a long-term basis, with a mean follow-up of 16.5 months. Conclusions Zafirlukast appears effective in treating early capsular contracture after primary submuscular breast augmentation using saline-filled, smooth-walled implants. Further prospective studies with control groups and long-term follow-up will be needed to address many unanswered questions, including whether leukotriene inhibitors have long-term effects on capsular contracture following breast augmentation.

Effect of intracapsular triamcinolone injection in treatment of capsular contracture after augmentation mammoplasty

Effect of intracapsular triamcinolone injection in treatment of capsular contracture after augmentation mammoplasty

Giving patients a chart displaying massage techniques may help to reduce capsular contracture rates

To the Editor: We read with interest Dr. Schlesinger and Dr. Heck's recent letter1 about a new pharma-cologic treatment for capsular contracture. We want to report our own experience with a different approach toward prevention of capsular contracture, which we believe can also be useful. Over the past few years, we have observed a low rate (about 2%) of capsular contracture among our patients. From June 1997 until June 2001, we performed 288 augmentation mammaplasties in which 5 third-degree capsular contractures (according to the Baker classification) and no fourth-degree contractures developed. We make use of a “no-touch” technique2 in which we replace our powder-free gloves with new ones before handling the implants. We …

Zafirlukast (Accolate): A new treatment for capsular contracture

Background: Capsular contracture after breast augmentation or reconstructive breast surgery is a difficult problem. Previous studies have suggested that alteration of the inflammatory response could have a role in reducing the incidence of capsular contracture. Objective: We report a series of patients with Baker class III or IV capsular contracture who underwent treatment with zafirlukast. Methods: Patients received a regimen of zafirlukast 20 mg by mouth 2 times daily for 3 months. Results: In many cases, dramatic softening of the breast capsule was evident after 1 to 3 months of treatment. Conclusions: Zafirlukast appears to effectively soften early capsular contracture and may prevent the formation of capsular contracture in those patients at risk. (Aesthetic Surg J 2002;22:329-336.)

A new treatment for capsular contracture

To the Editor: In the past, the only treatment for breast implant capsular contractures was surgery. Although open capsulectomies and capsulotomies are very effective, unfortunately the capsule often recurs. In addition to surgery, Vitamin E, 2000 IU daily, and breast massage have been used to reduce capsular contracture rates. These measures are beneficial but in themselves have not solved the problem. We have serendipitously discovered a new agent to add to our armamentarium in the …