Capsular Contracture in Plano, TX
If you’re looking for capsular contracture treatment in Plano, Frisco, or the greater Dallas metro area, visit Dr. Wilcox at the Plastic & Cosmetic Surgery Center of Texas. As a highly skilled and experienced board-certified plastic surgeon, he can help you make your aesthetic goals a reality!
Although breast augmentation is an overwhelmingly positive experience, there are potential problems that can develop. The most common of these is called a capsular contracture.
Whenever a foreign body is placed within a human being – whether it is a breast implant, a pacemaker, an artificial joint, etc. – within the first week, the body surrounds it with a layer of tissue which is called the capsule. The capsule is, in fact, the patient’s own tissue. Normally it stays soft and pliable and moves along with whatever device it surrounds. However, it can occasionally start to constrict tightly around the object and, in the case of a breast implant, cause hardening and possibly visual distortion. In its most advanced stage, it can actually become uncomfortable or painful.
Plastic surgeons grade the quality of the capsule around breast implants using a system called Baker Classification. When a breast implant has a perfect result of softness and appearance, it is called a Baker Grade I. If the implant starts to develop firmness, but still looks completely normal, it is called a Baker Grade II. If a contracture advances enough, such that it not only feels firm, but also now is asymmetric or drawing the implant upwards, it is called a Baker Grade III. The most advanced capsular contracture is a Baker Grade IV, which means the implant feels hard, looks asymmetric or distorted and is now painful.
In a seven-year study, capsular contracture developing to a stage Baker Grade III or IV was found to develop in as high as 15% of patients. It was also the most common cause for reoperation in the postoperative period. Generally, patients with Baker Grade II contractures do not require any treatment. When a patient reaches Baker Grade III or IV, we call this advanced capsular contracture, and treatment is generally sought.
The capsular contracture rate differs markedly for different surgeons. This is a reflection of the recognition of the various causes of capsular contracture. It is known that any irritants within the pocket will increase the chance of advanced capsular contracture. In addition, it is well known that any blood left around the implant increases the chance of capsular contracture. Increasingly, research implicates the presence of bacteria as by far the most common cause leading to capsular contracture.
Recent research is demonstrating that bacteria on a foreign body such as a breast implant behave differently than bacteria simply floating around the body. These bacteria found on the surface of an implant interact to form what is called a biofilm, a protective layering around the bacteria that make them resistant to a simple course of antibiotics.
Our own capsular contracture rate is far below the stated 15% over seven years. We employ numerous techniques to decrease the chances of hardening to a minimum. First, no blood is left remaining around the implant at the end of the operation. The entire operation is done with a cautery device that seals blood vessels as we move along to remove this as a possibility.
Powder-free gloves are also used, so as not to introduce any irritants into the pocket, and only Dr. Wilcox handles the implants. In addition, all patients receive antibiotics through their IV, and the surgical pockets are rinsed with antibiotic solutions as is the skin around the operative site. Oral antibiotics are also prescribed for several days after surgery. Placement of the implants through the middle of the breast is discouraged, since the breast always has bacteria present, even when antibiotics are used, and increase the chance of advanced contracture. We prefer to place the implants in the submuscular position, which also has been shown statistically to lower the chance of hardening.
Despite all of these precautions, advanced contracture sometimes occurs. Traditionally, it has been taught that the only treatment is to reoperate to remove the capsular tissue, but this offers no guarantee that advanced contracture will not simply recur. The search for a nonoperative solution to advanced contracture led us to the Aspen After Surgery ultrasound treatment. This is a patented device that is specific for breast capsular contracture. It is not the same as ultrasound given in a physical therapist’s office for muscle aches and pains. The ultrasound heads are specifically designed for treatment to the breasts in cases of advanced capsular contracture.
The obvious question is how does it work? Most research increasingly points to bacteria contaminating the implant and forming the biofilm described above. Bacteria are always found in the breasts and may actually spread to the breast implant months after surgery. A standard course of antibiotics, or even a prolonged course, is frequently ineffective because the biofilm prevents the antibiotics from eradicating the bacteria. It is believed that the application of ultrasound causes disruption of the biofilm and allows the antibiotics to be more effective and eradicate the bacteria, as well as increase blood supply and hence antibiotic delivery to the area. The Aspen After Surgery ultrasound treatment is also combined with specific specialized massage techniques, and then specialized banding techniques that we use in the interval time between each treatment. Typically, a series of 10 treatments will be administered over a three and a half week period. Each visit requires the patient to spend roughly one hour in our center. For patients who travel a longer distance or can only be in our proximity a shorter time, we may fast track the 10 visits into a one-week or two-week period.
Along with the Aspen After Surgery ultrasound treatments, we also prescribe one month of antibiotics that are specific against the bacteria most commonly found to cause capsular contracture, as well as a medicine called Accolate or Singulair which was serendipitously found to also help relax the hardening in the capsular contracture.
Patients with Baker Grade III capsular contracture generally can be very optimistic, particularly when it is of recent onset with response rates around 80%. On the other hand, more established or Baker Grade IV contractures have a lower rate of 1 in 3 successes. Generally, by the fifth treatment we can tell whether this is going to be successful or not, and can then recommend continuing the full course of 10 treatments or advising whether surgery would be more beneficial instead.
At the time of this writing, we are delighted to be one of only four centers in North America that offer this non-operative, exciting and effective technique. We have been so impressed by its results and the response times that we think this is going to be in most plastic surgeons’ offices one day. Our patients are very happy that we offer this as a non-operative treatment, and many choose to have their original breast augmentation with us, knowing that we have the capability of handling this complication should it arise. The addition of the Aspen ultrasound treatment fits nicely with our philosophy of total patient care from start to finish in a comprehensive, caring, and professional manner at all times.
What is the Cost of Capsular Contracture in Plano?
The price of capsular contracture varies for each person. The cost depends on the extent of treatment necessary. The Plastic & Cosmetic Surgery Center of Texas accepts CareCredit as a financing option.
When you choose to undergo capsular contracture, finding the right physician is crucial to the success of your procedure. Dr. Wilcox of the Plastic & Cosmetic Surgery Center of Texas offers highly qualified services to residents and visitors in the Plano, TX and Frisco, TX areas, as well as the communities surrounding Dallas.
We offer the highest level of patient care available by customizing each treatment plan for the patient’s unique needs and concerns, and Dr. Wilcox’s record of success speaks for itself. Our clients love their new aesthetics, self-confidence, and outlook on life!