Guidelines and Indications for Breast Implant Capsulectomy

Young, Leroy V.; Shaw, William W.

doi:10.1097/00006534-199809010-00045

Cited by 13 publications

(53 citation statements)

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“…MRI studies are not currently indicated to monitor implant status. Capsulectomy: There is no overall consensus regarding the role of capsulectomy in women with second-and thirdgeneration gel implants (77). Most surgeons routinely perform a capsulectomy when capsules are calcified.…”

Section: Indications For Explantationmentioning

confidence: 99%

“…Many surgeons also perform a capsulectomy if capsules are very thickened. Some surgeons recommend capsulectomy if implants are disrupted (77) in order to remove any silicone that could be present in the capsules. By contrast, many surgeons prefer to leave capsules in situ if they are thin, particularly if the implants are submuscular, when removal from the ribcage could lead to increased morbidity (70).…”

Section: Indications For Explantationmentioning

confidence: 99%

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Current status of breast implant survival properties and the management of the woman with silicone gel breast implants

Peters¹

2000

CAN J PLAST SURG

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The survival properties of silicone gel breast implants are dependent on their vintage (year of manufacture), duration in situ and manufacturer. A total of 527 gel implants have been explanted and analyzed in the author's laboratories. Of the 28 first-generation implants (1963 to 1972), 27 (96.4%) remained intact after 14 to 28 years in situ (mean 20.8 years). Of the 216 second-generation implants (1973 to mid-1980s) that were explanted from 1992 to 1998, 158 (73%) had disrupted. Kaplan-Meier survival curves demonstrated significantly different survival properties among second-generation manufacturers. Surgitek implants were by far the least durable. After 14 years, all second-generation Surgitek implants had disrupted. By contrast, after 20 years, about half of the Dow Corning and Heyer-Schulte implants remained intact. Among third-generation implants (mid-1980s to 1992), 43 of 46 (93.4%) remained intact after a mean of 6.3 years (range three to 12 years). The three disruptions were Surgitek implants. Implants from other manufacturers remained intact. However, the disruption frequencies of third-generation implants have yet to be measured over the relevant periods of time. Survival patterns appeared to be related to the thickness of the elastomeric shell of the three generations of implants. Mechanical strength analyses of the elastomeric shells of explants have exhibited little or no large scale material degradation, even after as long as 28 years in situ. The mechanism of implant disruption likely involves the 'fold flaw' theory, whereby an internal abrasion can develop over time at the site of a fold in the implant wall. Diagnosis of disruption is difficult. Mammography is helpful only if there has been extravasation of silicone gel into breast tissue. Extravasation was observed in only 4.2% of second-generation implants removed from 1992 to 1998. It was not seen with first-or third-generation implants. Ultrasound analyses are not generally helpful to predict disruption because they are very operator dependent and because capsular contracture causes folds in the implant wall, which result in false positives. Magnetic resonance imaging is the most accurate imaging modality to detect implant disruption. However, this technology is not indicated for monitoring implant status because it is too costly and time consuming, and because it has significant limitations, particularly with first-generation and textured implants. Careful explantation and direct visual examination are the standards for diagnosing gel implant disruption. Many implant disruptions are likely 'silent', with no specific symptoms or clinical findings. After disruption, none of the following are elevated above the levels seen in control women without implant exposure: serum autoantibodies, blood and serum silicon, and the incidence of breast cancer, autoimmune disease or any other medical disease. There is no evidence to support the existence of any 'novel' or 'atypical' syndrome associated with gel implants. Women over 30 years of age with breast...

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Section: Indications For Explantationmentioning

confidence: 99%

Section: Indications For Explantationmentioning

confidence: 99%

Current status of breast implant survival properties and the management of the woman with silicone gel breast implants

Peters¹

2000

CAN J PLAST SURG

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“…The only effective treatment for capsular contracture is currently capsulotomy or capsulectomy with implant removal or a change in the plane of insertion. 6 Nonsurgical treatment, perhaps in the form of NSAID administration, can be applied for 6 months as the initial measure in patients who are reluctant to undergo surgery, provided that there are no comorbidities that prevent the use of such drugs.…”

Section: Discussionmentioning

confidence: 99%

“…5 The only effective treatment method is capsulotomy or capsulectomy with implant removal or a change in the plane of insertion. 6 The gold standard is the combination of capsulectomy, site change, and implant exchange. Capsular contracture is one of the most common reasons for reoperation after breast augmentation (33.3%).…”

Section: Introductionmentioning

confidence: 99%

Nonsurgical treatment of capsular contracture: Review of clinical studies

et al. 2020

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“…Patients having moderate-to-severe capsular contracture (Baker grades III and IV) may initially benefit from partial or total capsulectomy with implant replacement. Young et al 19 reported on guidelines and indications for breast implant capsulectomy with implant exchange, which would be applicable in a variety of patients with capsular contracture.…”

Section: Discussionmentioning

confidence: 99%

Secondary Breast Reconstruction with Deepithelialized Free Flaps from the Lower Abdomen for Intractable Capsular Contracture and Maintenance of Breast Volume

Gürünlüoğlu

Shafighi

Schwabegger

et al. 2005

J reconstr Microsurg

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Although surgical techniques and the quality of mammary prostheses have been improved significantly in recent years, capsular contracture attendant on prosthetic mammary reconstruction remains a major flaw. Although rarely, some patients are confronted with recurrent and intractable capsular contractures with resultant breast deformity, even after multiple attempts at capsulectomies and implant exchange. Patients with recurrent capsular contracture often do not want replacement with a new prosthesis, but desire the maintenance of their breast volume with a safe alternative. In an attempt to maintain breast volume and to improve the aesthetic appearance, secondary breast reconstruction using bilateral deepithelialized free flaps from the lower abdomen was performed in a series of seven patients. Three bilateral muscle-sparing TRAM flaps, two bilateral DIEP flaps, one bilateral SIEA flap, one unilateral SIEA flap, and one unilateral DIEP flap (a total number of 14 flaps) were used following implant removal, total capsulectomy, and prophylactic subcutaneous mastectomy. The early postoperative course was uneventful, and all flaps survived completely with no complications. There were no donor-site problems, except in one patient (case 5), who had partial skin necrosis of the abdominal flap. The long-term results (mean follow-up: 4.8 years) demonstrated an aesthetically satisfactory appearance of the breasts, with no major donor-site problems. Several advantages, as well as drawbacks, are highlighted with this technique.

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Guidelines and Indications for Breast Implant Capsulectomy

Cited by 13 publications

References 0 publications

Current status of breast implant survival properties and the management of the woman with silicone gel breast implants

Current status of breast implant survival properties and the management of the woman with silicone gel breast implants

Nonsurgical treatment of capsular contracture: Review of clinical studies

Secondary Breast Reconstruction with Deepithelialized Free Flaps from the Lower Abdomen for Intractable Capsular Contracture and Maintenance of Breast Volume

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