Breast augmentation is by far the most common plastic surgery procedure in Toronto, along with body contouring and liposuction. It is for sure the case now, during spring and summer, as everyone wants to look and feel sexy for bikini season.
I wrote this blog post to discuss an important issue associated with breast implants: capsular contracture. It is a rare complication with all body implants that plastic surgeons must discuss with their patients. While not dangerous in itself, a contracture (or contraction) of the capsule will lead to an aesthetic asymmetry and deformity (misshapen and hard breasts), requiring surgical correction.
I’m all about results and safety in my practice, so there are several steps I take in order to minimize this issue, hence this post.
It is normal for a thin layer of collagen to form around a foreign body such as breast implants over 2–3 months (as well as with chin, pectoral, buttock, hip and calf implants). In a small percentage of women, the capsule will contract and lift one breast up, giving the breast a more “stuck-on” and misshapen look as well as a firmer feel.
Aesthetic plastic surgeons grade the deformity from 1 to 4 (on the Baker scale), with 1 being a normal capsule, which the patient will have no knowledge of, to 4 being a severely contracted breast that’s firm and tender. Capsular contracture resulting in a significant aesthetic deformity will require surgery. The capsule is removed (capsulectomy) and often the implants are replaced. (Keeping the same implants increases the risk of recurrence to almost 40%.)
Going back for correction means additional fees for the patients, hence the importance of minimizing the contracture.
The theory behind a capsular contracture is that there is a colonization of the implant’s surface with bacteria, which leads to a slime formation (bacterial environment) and possibly a reactive thickening of the capsule.
So, in my accredited surgical centre, I perform several techniques to limit the potential for contamination. Some are scientifically supported, others just make plain sense.
Dr. DuPéré’s No-Touch Technique in Breast Augmentation With Implants:
1. Intravenous antibiotics are given to the patient prior to incisions being made.
2. I stay away from sites such as the underarm and the nipple-areolar complex, as these areas are known to have bacteria, in both the breasts ducts and the sweat glands. The theory of capsular contracture has therefore led to fewer transaxillary and periareolar incisions, in exchange for safer, small incisions in the breast folds. That being said, some patients still opt for periareolar incisions, often because they already have an incision there or they are known to scar darker (post-inflammatory hyperpigmentation) or thicker (hypertrophic scars or keloids).
3. After antibacterial surgical cleaning of the surgical field, I apply an adhesive water-tight dressing over the nipples, called “nipple shields”, so that the nipple-areolar complexes have no potential of contaminating the implants.
4. I perform a gentle atraumatic “always-under-direct-vision” dissection with electrocautery for minimal trauma and no bleeding, as we know excessive bleeding around an implant is a factor favouring capsular contracture.
5. I irrigate the breast implant pockets with 3 antibiotics; I also bathe the implants in the same 3-antibiotic solution.
6. I change my gloves to new ones just prior to inserting the implants.
7. I will commonly use one drain per site for 1–3 days; contrary to popular belief, removing the drains after a few days is usually not painful.
8. I use the Keller Funnel: this funnel is a great invention! Not only does it allow me to make a smaller incision, it also allows me to insert the implants without the implants touching the gloves or the skin edges.
9. I recommend a short post-op course of oral antibiotics.
With all the above safeguards, my capsular contracture rates have dropped from 3–5% to under 1%. You may say that the numbers are low, it is true, but if you are one of the patients with a capsular contracture who has to go back into surgery, with the associated fees and downtime, you may have wished your surgeon had performed all those important steps.
Now, doing all those extra steps does increase the fees slightly, in large part because of the added time it requires to perform them, along with the atraumatic and gentle, meticulous, bloodless dissection. The Keller Funnel adds a slight cost to your procedure as well. I also like sitting my patients up during surgery to verify and confirm the symmetry of the two breasts, which adds a few additional minutes to your procedure but decreases revisions significantly.
My typical breast augmentation takes 90 minutes to 2 hours, and “I don’t believe in speed in surgery; I rather aim for efficiency and safety”.
In conclusion, my capsular contracture rate is now less than 0,8%, and my patients enjoy an uncomplicated and safe breast augmentation procedure. My recommendations for patients researching a plastic surgeon in Yorkville or Toronto for their breast augmentation is to not only consider price but also the care and considerations of the plastic surgeon for a safe, uncomplicated and successful procedure, both in the short term and long term.
Dr. Marc DuPéré
