Tag: capsular contracture

Are antibiotics needed if you have breast implants for Dental Work?

Dr. Larry Nichter
Dr. Larry Nichter

This is a very controversial topic with no clear answer. To my knowledge there is not a definitive study or consensus on this topic. Here is the background information: Breast implants (and other implantable medical devices) are widely believed to increase a patient’s risk of infection or capsular contracture from bacteria entering the blood stream (oral bacteremia) and settling on the implant causing an infection or capsular contracture. As dental treatment bacteremia is a rare cause of metastatic infections it makes it difficult to attribute causality.

Some surgeons treat their patients with prophylactic oral antibiotics in the period directly after breast augmentation with breast implants as well as for any procedure that causes transient bacteria, such as dental surgery, colonoscopy, urological procedures (e.g. cystoscopy), and gynecological procedures. Probably a single dose, one hour prior to the treatment followed by single dose after the treatment should be sufficient, as long as the patient is not immunocompromised.

Whether this should be done for the first 6 months to 1 year after the breast implant placement is unclear at best. To my knowledge, there isn’t any compelling data to support this. Intuitively many surgeons treat breast implants like other implantable medical devices like pacemakers and total joint replacements.

Even vaguer is dental cleaning. One could argue that we cause a bacteremia when we simply brush our teeth and so dental cleaning is only a more aggressive cleaning. Some surgeon’s recommendations may differentiate between superficial dental cleaning (no antibiotics) and deep cleaning and periodontal treatment (antibiotics therapy). There have been anecdotal reports of infection and capsular contracture following dental treatment. Therefore some plastic surgeons and patients after considering the risk of 1–2 doses of antibiotics vs the unlikely but potentially irreparable problems with your implant is worth the risk. As there is no great answer to this controversy, my recommendation is to follow the advice of your plastic surgeon and or other members of your health care team.

Capsular Contracture: Prevention and Treatment

Dr. Larry Nichter
Dr. Larry Nichter

Although capsular contractures following breast augmentation can occur just about any time, most women start having symptoms around three months after their breast implant surgery. This is because it takes some time for a capsule to form and then to scar down (contracture).

Capsular Contracture is a condition in which the capsule surrounding the implant thickens and contracts, squeezing the implant making it overly firm or hard and often changing the shape and position of the implant. As the capsule contracts it moves the implant further up your chest wall making upper portion of your breast too large and unshapely. It is more far more common in nicotine users (e.g. smoking, vaping or nicotine gum or patches).

Treatment for capsular contracture often involves en bloc capsulectomy, complete removal of the capsule, or making the pocket larger by capsular incisions (capsulotomy) with implant replacement. Recent studies suggest that using the same implant may increase the chance of recurrence. Placement of the implant in an new pocket is also often done as well as using textured implants. In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used but has been associated with implant rupture and other complications and few surgeons use this technique any more not to mention that your warranty will be void. On occasion, the use of a biological fabric like Strattice or Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9–11%, in my practice it is significantly lower after the primary implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. Capsular contractures are lower with non-smokers, and with use of textured silicone implants placed below the muscle. The location of the incision also plays a role. Inframammary incision also has the lowest and periareolar and axillary (arm pit) incisions have the highest capsular contracture rate. Smoking/nicotine use greatly increases your risk for capsular contracture greater than 10 times the incidence of a non nicotine user.

Non-surgical management includes prophylactic massage to prevent it and if it occurs, the use of certain anti-asthma medications: Singulair and sometimes Acculate as off-label FDA usage to treat Capsular Contracture and in some cases of recurrence of capsular contracture in a preventative fashion. In my experience this works best for early diagnosed early contractures and used as a prophylactic, perioperatively when doing a capsular contracture surgery. The price for capsular contracture surgery varies greatly by geographical location, experience of the surgeon, whether in an outpatient surgery center vs hospital (hospital more expensive), type of breast implant, whether it is ruptured or not, estimated length of operating room time, and other factors.

Sientra TRUE Texture™ Implants come with Unique Guarantee

sientraBreast implant maker Sientra has announced their Capsular Contracture Care Program, the first of its kind in the industry. The C3 Program provdes breast implant patients with a guarantee beyond the standard manufacturer’s warranty. From Sientra:

Under the C3 program, a primary augmentation patient will qualify for a free replacement implant if she requires revision surgery to correct Baker Grade III or IV capsular contracture within the first two years after implantation.

Capsular contracture is an unusual response of the body to medical implants, including all types of breast implants. It involves tightening of the tissues around the implant, which makes the breast feel firm to the touch and possibly alter its aesthetics.

Sientra’s TRUE Texture™ implants were found to carry a significantly reduced risk of capsular contracture compared to its smooth implants, according to a study published this month in Plastic and Reconstructive Surgery. The analysis looked at more than five thousand implants over a five-year follow up process, providing a very robust set of data as a foundation for this finding. It is with this statistical confidence in the resilience of their textured implants against capsular contracture that Sientra introduces the C3 Program.

As with the implants themselves, Sientra’s C3 Program is only available through plastic surgeons certified by the American Board of Plastic Surgery. This is done to improve patient confidence even further — it ensures that surgical procedures using Sientra implants are only done by the most qualified doctors.

Dr. Larry Nichter is proud to offer Sientra’s implants at the Pacific Center for Plastic Surgery, as well as the C3 Program and the warranty that comes with all Sientra implants.