Q: I currently have silicone breast implants that became hard and encapsulated. This was treated by having the scar tissue removed and new implants placed. Unfortunately, my implants became encapsulated again. In searching for what to do now, I have several consults with different plastic surgeons and have gotten differing opinions as to my options. One plastic surgeon suggested that I try the scar removal again with the use of dermal grafts and PRP. (??, not sure what this is) Another plastic surgeon suggested that I remove the implants and replace them with fat injections. Is this a reliable method? What would you recommend?
A: Recurrent capsular contracture, although uncommon, can be a difficult breast implant problem. The conventional approach is total scar removal, with or without replacing the implants with those that have a textured surface. If the implant was originally above the muscle, relocating it to a submuscular position can also be tremendously helpful. These combined techniques are probably effective about half the time, maybe more. But when they fail, different strategies need to be explored.
One alternative approach is to wrap the new implant partially in a dermal graft after the repeat capsulectomy. This ‘out-of-the-box’ graft is intended to heal around the implant lessening the risk of new scar formation, essentially serving as a part of the new capsule rather than fresh new scar tissue which has a high propensity for contracture. PRP, also known as platelet-rich plasma, is a concentrate from the patient’s blood which can be sprayed onto the internal breast tissue surfaces. Its theoretical benefit is that it causes less scar tissue to form. The addition of a dermal graft is a more proven capsular contracture approach but the use of PRP has no downside and is simple to apply.
Fat injections as an alternative to the use of a breast implant for the treatment of capsular contracture may be novel but is both unproven and biologically flawed in my opinion. The survival of fat injections in breast augmentation is based on the graft being injected into the midst of healthy tissue where it can survive by revascularization. Injecting fat into a large empty open space would not only have it not survive but would likely become a liquefied pool of oil and fat that is prone to infection.
Dr. Barry Eppley