Some women may choose to have the implants removed after developing a capsular contraction, or may want to have the implants serviced and replaced. Recent studies have shown that implants should be removed and replaced after capsule removal, and that new implants should be used. It is not recommended to keep the original implants because the surface of the implant contains attached bacteria called biofilm. Most implant companies now offer a guarantee of this condition. The implant companies we currently use use DO warranty implants for contracture. Another risk associated with the use of implants is the possibility of anaplastic large cell lymphoma (ALCL). This is a rare type of non-Hodgkin lymphoma and most cases occur in the capsule that surrounds the implant, and is thought to be potentially associated with persistent inflammatory conditions, similar to the theoretical pathogenesis of capsular contracture. A recent review concluded that women with breast implants have an 18.2 relative risk of ALCL occurring in women with breast implants compared to those without implants by examining the 71 case studies published at the time, but the absolute risk remains low, ranging from 1 in 500,000 to 1/3,000,000 [87]. These figures have not yet been confirmed by other studies, and it is possible that they will change given the updated number of case reports and increased global awareness of the disease. It is important to note that most patients whose disease has been confined to the implant capsule have a good prognosis, with the majority achieving complete remission [88].

An example of the histological aspect of ALCL in conjunction with implants (Fig. 2). The overall incidence is quite low, estimated at 1 in 1 million per year [89], but women who develop this disease may have capsular contracture and effusion in the capsule. Alternatively, women may also have effusion and mass injury. Interestingly, those who occur with effusion with or without capsular contracture have a better prognosis than those who occur with a lump .[90] Recurrent capsular contracture has been identified as a possible independent symptom in patients with ALCL, and possibly capsular contracture that occurs years after the first surgery and appears to respond to common treatment techniques [91]. This should be taken into account when evaluating a patient with capsular contracture, as earlier treatment can lead to a better prognosis. However, more research needs to be done on the link between capsular contracture and ALCL before firm conclusions can be drawn: ALCL is rare and not all women who develop capsular contracture develop ALCL. For an official diagnosis, a physical examination is required.

A mammogram, MRI, or ultrasound may be able to detect thickened scar tissue, but they are not needed for diagnosis. If you are diagnosed with capsular contracture, your condition will be classified using the four-point Baker scale: Dr. Rudderman believes that the consultation is crucial for him and her. The consultation includes the following: comprehensive assessment of your original surgical experience, including the type and position of the implant, the placement and the technique used. This information can provide insight into the factors that contribute to capsular contracture. During the consultation, the positioning, size, severity of capsule contracture and soft tissue properties are evaluated to estimate the expected postoperative appearance. Many symptoms can quickly disappear after implantation and removal of the capsule. Removed capsules are usually sent for pathological evaluation and patients receive a written report of the pathologist`s results. The anti-adhesion barrier solution (AABS) (Guardix, Hanmi Medical Co., Seoul, Korea) has also been studied for its effect on reducing the development of capsular contracture. Animal studies have shown promising results. One study in rats that looked at the use of AABS and compared it to a control group and a fibrin-treated group found that there were thinner capsules and a significantly reduced amount of type 1 collagen in the treatment groups compared to the controls, but that there was no significant difference between the AABS group and the fibrin-treated group [84]. In addition, another group reported that using 0.1 ml of AABS with silicone blocks in the levels resulted in a significant reduction in the number of inflammatory cells and capsule thickness compared to controls at 4 weeks [85].

In addition, a rabbit study that maintained implants in situ for 2 months after treatment with AABS reported that although there was no significant difference in capsule thickness or contracture in the overall analysis, the capsules were histologically thinned and had a lower collagen density and a lower myofibroblast ratio than controls [86]. Although these results look promising, there are currently no long-term data, and clinical trials should be conducted in the future to assess whether these results can be replicated in a patient population. While it`s impossible to completely prevent capsular contractures, you can reduce your chances and maintain your peace of mind with a highly trained cosmetic surgeon. A new surgical management technique has been proposed, in which a neopocket is formed into which the implant must be inserted. This involves the creation of a new deep subpectoral level at the major pectoral muscle, but superficially at the anterior capsule that remains intact to prevent further tissue damage. This allows the use of the existing capsule and is usually done through an inframammary incision.[64] A retrospective review of 198 patients, 69.7% of whom had capsular contracture treated with this technique, found a high success rate in reducing contracture [65]. Another study by Castello et al. [66] concluded that neopocket training was an effective one-step solution to correct augmentation-induced deformities and that complications remained completely resolved after 24.1 months of follow-up. This could be a potential new standard of care for capsular contracture, as it allows the use of the existing capsule but provides a new vascularized pouch into which a new textured implant can be inserted.

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