The capsular contraction is among the most formidable challenges of the augmentation and reconstruction with implants. Very frequent occurrence in the past, today is manifested rarely, thanks to the most sophisticated surgical techniques and prosthetic devices designed precisely to counter this phenomenon.
How they form and manifests itself?
Once implanted breast implant, the body is organized to isolate it, generating a thin sheet of tissue that envelops (periprosthetic capsule). The breast implant is essentially a foreign body like an artificial heart valve, a hip replacement, a pacemaker. And ‘therefore normal that the’ body should organize itself for incapsularla. But when the periprosthetic capsule is extremely thickens and contracts, the system becomes more palpable and the breast becomes hard. The capsular contraction is classified into four grades according to the degree of contraction, the implant hardness and pain. The greater the thickness the greater the hardness capsule. In the higher grades, the prosthesis, in the narrow capsule grip, comes from this distorted; udder he loses the natural and original form. Furthermore, since the capsular contraction is rarely symmetrical, the shape of the two breasts becomes different. The contraction occurs almost always after a short time from the plant but it is not rare that this happens even after many years.
But what makes a periprosthetic capsule “normal” to thicken and become contracted capsule?
The published and the latest scientific research studies, agree that the hyperreactivity of the capsule has certain causes and uncertain causes. The causes certain are as follows: preparation of the subject, of poor quality prostheses and postoperative problems (hematoma, seroma and postoperative infections stimulate the formation of the capsule). Among the causes uncertain should mention the theory of microinfezione, according to which the prosthetic reactivity would be due to the presence in the capsule of bacteria with characteristics insufficient to generate clinically detectable infections but sufficient to overstimulate the capsule.
What to do
There are no universally accepted guidelines for treating this problem. However, common sense and the surgical experience give these indications:
Contraction slight, slight hardness: the frequent and quite vigorous massage is almost always able to treat and maintain the contraction in the initial phase.
Medium contraction degree: the vigorous massage (squeezing) is still considered by some a viable technique to break the periprosthetic capsule, by others a technique to be abandoned because it brings additional stimulus to the capsule. The literature is not unanimous. Common sense says that if the contraction is not important the squeezing can be attempted. If the contraction is greater, then it must resort to capsulotomy (reoperation aimed to surgically open the capsule) and possibly present replace implants.
Contraction of high degree: the capsulectomy (removal of the capsule) and the replacement of the prosthesis, possibly changing the floor (for example, from subglandular to submuscular) are cornerstones of treatment. In more severe cases it can be useful the use of polyurethane implants (prostheses coated with a fine polyurethane membrane silicone), material that contrasts greatly the formation of periprosthetic capsule.
Then there are additional treatments, as proposed by some authors audiuvanti the fight against contraction, whose scientific nature has never been demonstrated that the administration of bronchodilators and the use of ultrasound.