Capsular contracture

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Capsular contracture. Grade IV capsule contracture of the right breast of a 29-year-old female patient seven years after subglandular implantation of silicone gel-filled 560 ml implants.

In the capsule fibrosis ( English capsular contracture ) is the formation of a hard connective tissue , sometimes painful capsule as a result of breast enlargement is created by insertion of an implant. This foreign body reaction can lead to severe deformations of the breast.

Basically, a capsule of scar tissue is created around every foreign body. In most cases this is not a problem as the capsule is very tender. But why it comes to the development of a capsule with discomfort in up to 15 percent of breast enlargement cases is not exactly clear. One suspects an inflammatory reaction due to a colonization of the implants with bacteria, since these can be detected on them relatively often. However, the problem also occurs frequently after other complications, such as secondary bleeding. Capsular contracture also occurs more frequently after irradiation during breast reconstructions with implants. Various modifications to the implant surface are intended to reduce the risk.

Graduation

A clinical classification that goes back to a congressional contribution by the American plastic surgeon James L. Baker Jr. (Florida) is common.

  • Grade I: A slight hardening can be felt, but this is normal after every breast augmentation. The patient is painless and there are no visible or palpable signs of capsular contracture.
  • Grade II: A minimal capsular contracture is already present. The patient feels a feeling of tension and slight pain. Slight changes in the form of a hardening can be felt. Treatment of capsular contracture is not absolutely necessary for this degree.
  • Grade III: There is already severe capsular contracture with the beginning of deformation of the breast. The chest is very hardened, which is also visible from the outside. The implant begins to contract. It is possible that the patient is already experiencing severe pain, but this is not always the case. Surgical intervention is necessary if the breast is already painfully hardened and deformed.
  • Grade IV: The patient suffers from pronounced capsular contracture. The hardening of the breast is associated with persistent pain and the deformation of the breast is clearly visible. Pain is felt when the chest is touched lightly and the capsule is extremely hardened and contracted. Surgical intervention is required.

treatment

The therapy is usually done surgically by

  • Implant change with capsular resection or
  • endoscopic capsulotomy (breaking the capsule).
  • Manual pressure capsule rupture is no longer recommended as recurrences are common and the implant can be damaged.
  • A non-surgical method uses ultrasound (e.g. 2 MHz pulsed 500 W / cm in several sessions), but has only been tested in small case series so far.
  • Shock wave application and collagenase injections have so far only been tested in animal experiments.

Individual evidence

  1. ↑ Byung Ho Shin, Byung Hwi Kim, Sujin Kim, Kangwon Lee, Young Bin Choy: Silicone breast implant modification review: overcoming capsular contracture . In: Biomaterials Research . tape 22 , no. 1 , December 2018, ISSN  2055-7124 , p. 37 , doi : 10.1186 / s40824-018-0147-5 , PMID 30598837 , PMC 6302391 (free full text).
  2. ↑ 12. Baker JL, Jr: Classification of spherical contractures. Presented at the Aesthetic Breast Symposium, Scottsdale, Arizona 1975.
  3. ↑ Uwe Herrmann, Werner Audretsch: Practice of breast operations: tumor surgery - preservation of organs - restoration - change in shape . Springer-Verlag, 2013, ISBN 978-3-642-79608-1 , p. 90–93 ( limited preview in Google Book Search).
  4. ↑ James C. Grotting, Peter C. Neligan: Plastic Surgery E-Book: Mama . Elsevier Health Sciences, 2012, ISBN 978-1-4557-4039-0 , pp. 107 ( limited preview in Google Book search).
  5. ↑ Ronald P. Gruber, Hyzer W. Jones: Review of Closed capsulotomy Complications: . In: Annals of Plastic Surgery . tape 6 , no. 4 , April 1981, ISSN  0148-7043 , pp. 271-276 , doi : 10.1097 / 00000637-198104000-00003 ( ovid.com [accessed February 5, 2020]).
  6. ↑ Jorge Planas, Emilia Migliano, Jorge Wagenfuhr, Jr., Sebastian Castillo: External Ultrasonic Treatment of Capsular Contractures in Breast Implants . In: Aesthetic Plastic Surgery . tape 21 , no. 6 , November 1, 1997, ISSN  0364-216X , p. 395–397 , doi : 10.1007 / s002669900143 ( springer.com [accessed February 5, 2020]).
  7. ↑ Jorge Planas, Valerio Cervelli, Gabriel Planas: Five-Year Experience on Ultrasonic Treatment of Breast Contractures . In: Aesthetic Plastic Surgery . tape 25 , no. 2 , March 1, 2001, ISSN  0364-216X , p. 89-93 , doi : 10.1007 / s002660010102 ( springer.com [accessed February 5, 2020]).
  8. ↑ Sebastian Fischer, Wolf Mueller, Matthias Schulte, Jurij Kiefer, Christoph Hirche: Multiple Extracorporeal Shock Wave Therapy Degrades Capsular Fibrosis after Insertion of Silicone Implants . In: Ultrasound in Medicine & Biology . tape 41 , no. 3 , March 2015, p. 781–789 , doi : 10.1016 / j.ultrasmedbio.2014.10.018 ( elsevier.com [accessed February 5, 2020]).
  9. ↑ Sebastian Fischer, Yannick Diehm, Thomas Henzler, Martin R. Berger, Jonas Kolbenschlag: Long-Term Effects of the Collagenase of the Bacterium Clostridium histolyticum for the Treatment of Capsular Fibrosis After Silicone Implants . In: Aesthetic Plastic Surgery . tape 41 , no. 1 , February 2017, ISSN  0364-216X , p. 211–220 , doi : 10.1007 / s00266-016-0724-8 ( springer.com [accessed February 5, 2020]).