BACKGROUND: Capsular contracture (CC) is the most frequently reported complication following alloplastic breast augmentation. At present, none of the available preventive measures are effective, and various treatment modalities have been advocated. Reduction of the inflammatory process is critical for successful treatment. Late intracapsular glucocorticosteroid (GC) injections have been somewhat effective for the treatment, but the fine balance between the effectiveness of therapeutic GC dosages and their potential serious side effects is of utmost importance. OBJECTIVES: The authors investigate whether instillation of a rapid-acting water-soluble GC in the implant pocket during the early proliferative phase of wound healing is more effective than delayed instillation during the remodeling phase. METHODS: Between 2003 and 2009, 33 consecutive patients presenting with CC (Baker grades III and IV) were managed by capsulectomy with implant replacement and corticosteroid therapy immediately as well as 2 to 3 days later through an indwelling catheter left in place for that period. This delayed but early administration is a novel technique for GC injection. RESULTS: Complete correction of the contracture with no recurrence was achieved in all patients with a follow-up range of 2 to 10 years. CONCLUSIONS: This GC administration technique avoids the potential complications of long-term, slow corticosteroid release. It has a targeted anti-inflammatory effect, probably at a critical stage of the healing process, and could effectively prevent CC following alloplastic breast augmentation.
BACKGROUND: Capsular contracture (CC) is the most frequently reported complication following alloplastic breast augmentation. At present, none of the available preventive measures are effective, and various treatment modalities have been advocated. Reduction of the inflammatory process is critical for successful treatment. Late intracapsular glucocorticosteroid (GC) injections have been somewhat effective for the treatment, but the fine balance between the effectiveness of therapeutic GC dosages and their potential serious side effects is of utmost importance. OBJECTIVES: The authors investigate whether instillation of a rapid-acting water-soluble GC in the implant pocket during the early proliferative phase of wound healing is more effective than delayed instillation during the remodeling phase. METHODS: Between 2003 and 2009, 33 consecutive patients presenting with CC (Baker grades III and IV) were managed by capsulectomy with implant replacement and corticosteroid therapy immediately as well as 2 to 3 days later through an indwelling catheter left in place for that period. This delayed but early administration is a novel technique for GC injection. RESULTS: Complete correction of the contracture with no recurrence was achieved in all patients with a follow-up range of 2 to 10 years. CONCLUSIONS: This GC administration technique avoids the potential complications of long-term, slow corticosteroid release. It has a targeted anti-inflammatory effect, probably at a critical stage of the healing process, and could effectively prevent CC following alloplastic breast augmentation.
Entities:
Keywords:
breast augmentation; capsular contracture; intracapsular glucocorticoid; recurrent capsular contracture