Management of Capsular Contracture in Cases of Silicone Gel Breast Implant Rupture with Use of Pulse Lavage and Open Capsulotomy

• Published in: Aesthetic plastic surgery Vol. 43; no. 5; pp. 1173 - 1185
• Main Authors: Lam, Martin C., Walgenbach-Brünagel, Gisela, Pryalukhin, Alexey, Vorhold, Jens, Pech, Thomas, Kalff, Jörg C., Kristiansen, Glen, Walgenbach, Klaus J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-10-2019; Springer Nature B.V
• Subjects: Breast implants; Irrigation; Medicine; Medicine & Public Health; Original Article; Otorhinolaryngology; Plastic Surgery; Prostheses; Silicones; Transplants & implants; Capsular contracture; Pulse lavage irrigation; Silicone gel leakage; Breast implant rupture; Open capsulotomy
• ISSN: 0364-216X; 1432-5241
• DOI: 10.1007/s00266-019-01463-w

Introduction
Pulse lavage (PL) irrigation of prosthesis pockets has prior been described for breast implant salvages. However, PL for removal of leaked silicone from prosthesis pockets after implant ruptures has not been studied yet. Since open capsulotomies are regarded as equal treatment of capsular contracture (CC) than capsulectomies, this study analyzed the clinical outcome of PL for silicone removal and subsequent capsulotomy in cases of concurrent CC and breast implant rupture.
Methods
Between 2012 and 2017, 55 patients (75 breasts) with suspected silicone implant rupture and CC (Baker grade III/IV), after primary breast augmentation or implant-based breast reconstruction, were included in a retrospective, observational study. Mean patient follow-up was 12.2 ± 3.6 months.
Results
In all preoperatively suspected ruptured silicone breast implants, around a quarter were intact. In contrast to previously published data, implant exchanges in cases of implant ruptures did not lead to significantly higher CC recurrence rates (27.6% vs. 22.2% in cases of intact implants,
p
 = 0.682), if the prosthesis pockets were treated with PL irrigation followed by open capsulotomy. PL reduced the amount of encapsulated silicone remnants histologically. The age of patients with CC after failed implant-based reconstruction was significant lower for salvage surgeries with flap reconstruction than for implant exchanges,
p
 < 0.05.
Conclusions
PL irrigation of prosthesis pockets prior to open capsulotomy is a safe and effective treatment of CC with concurrent silicone leakage. Remaining silicone remnants in breast capsules may affect the development of a recurrent CC. To avoid CC recurrences, patients should consider conversion to autologous tissue.
Level of Evidence IV
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www.springer.com/00266
.