BACKGROUND: Capsular contracture is the most common complication after breast augmentation using implants. In case of severe capsular contracture, surgical correction is inevitable. We introduce a treatment for severe capsular contracture with serial fat grafting before augmentation using implants. METHODS: In severe cases of capsular contracture, we removed the implants and performed partial capsulectomy. We harvested fat from the flanks or thighs using liposuction. The first fat graft was performed in the subdermal, subcutaneous, and subglandular layers of the breast. The harvested fat was frozen and stored. One month after implant removal and the first graft, a second fat graft was performed. One month later, a third fat graft was performed. Six months after implant removal, we augmented the breasts with implants. RESULTS: The cases of severe breast contracture were treated without any complications. The volume and contour of the breasts were satisfactory. CONCLUSIONS: After implant removal in cases of severe capsular contracture, breast augmentation may be needed. Serial fat grafting before augmentation using implants prevents scarring of the breast envelope and provides sufficient volume with a secure breast envelope.
Breast* ; Cicatrix ; Contracture* ; Implant Capsular Contracture ; Lipectomy ; Thigh ; Transplants*

BACKGROUND: Polyurethane coating of breast implants has been shown to reduce capsular contracture in short-term follow-up studies. This 30-year study is the longest examination of the use of polyurethane-coated implants and their correlation with capsular contracture. METHODS: This study evaluates the senior surgeon's (F.D.P.) experience with the use of polyurethane-coated implants in aesthetic breast augmentation in 382 patients over 30 years. Follow-up evaluations were conducted for six months after surgery. After the six-month follow-up period, 76 patients returned for reoperation. The gross findings, histology, and associated capsular contracture were noted at the time of explantation. RESULTS: No patient during the six-month follow-up period demonstrated capsular contracture. For those who underwent reoperation for capsular contracture, Baker II/III contractures were noted nine to 10 years after surgery and Baker IV contractures were noted 12 to 21 years after surgery. None of the explanted implants had macroscopic evidence of polyurethane, which was only found during the first five years after surgery. The microscopic presence of polyurethane was noted in all capsules up to 30 years after the original operation. CONCLUSIONS: An inverse correlation was found between the amount of polyurethane coating on the implant and the occurrence of capsular contracture. Increasingly severe capsular contracture was associated with a decreased amount of polyurethane coating on the surface of the implants. No contracture occurred in patients whose implants showed incomplete biodegradation of polyurethane, as indicated by the visible presence of polyurethane coating. We recommend research to find a non-toxic, non-biodegradable synthetic material as an alternative to polyurethane.
Breast ; Breast Implants* ; Capsules ; Contracture ; Follow-Up Studies* ; Humans ; Implant Capsular Contracture ; Polyurethanes ; Reoperation

Ideal results of augmentation mammaplasty consist of symmetry, natural shape, soft feeling and inconspicuous scar. In addition, patient's preferences about size and shape should be included. Static implants could not perfectly satisfy patients' desires for size and shape, but expandable implants enable to change the volume after the operation. From September 2001 to September 2004, 76 patients(150 breasts) underwent breast augmentation using permanent expandable implant. The procedure was unilateral in 2 women and bilateral in 74 women. Age ranged from 19 to 50 years(mean, 29 years). Fifty nine patients underwent simple augmentation mammaplasty, 7 patients were corrected of their severe asymmetry, 2 patients with the congenital breast deformity underwent mammaplasty using this, and 2 patients who had undergone unilateral mastectomy were reconstructed of their breasts using expandable implant. There were no definite complications such as capsular contracture, implant rupture, asymmetry. And there reported little dissatisfaction about the size. The permanent expandable implants might be good alternatives in cases of ordinary breast augmentation as well as tissue deficient patients, asymmetry, congenital anomaly, and breast reconstruction.
Breast* ; Cicatrix ; Congenital Abnormalities ; Female ; Humans ; Implant Capsular Contracture ; Mammaplasty ; Mastectomy ; Rupture

BACKGROUND: Silicone implants are frequently used in augmentation rhinoplasty in Asians. A common complication of silicone augmentation rhinoplasty is capsular contracture. This is similar to the capsular contracture after augmentation mammoplasty, but a classification for secondary contracture after augmentation rhinoplasty with silicone implants has not yet been established, and treatment algorithms by grade or severity have yet to be developed. METHODS: Photographs of 695 patients who underwent augmentation rhinoplasty with a silicone implant from May 2001 to May 2015 were analyzed. The mean observation period was 11.4 months. Of the patients, 81 were male and 614 were female, with a mean age of 35.9 years. Grades were assigned according to postoperative appearance. Grade I was a natural appearance, as if an implant had not been inserted. Grade II was an unnatural lateral margin of the implant. Clearly identifiable implant deviation was classified as grade III, and short nose deformation was grade IV. RESULTS: Grade I outcomes were found in 498 patients (71.7%), grade II outcomes in 101 (14.5%), grade III outcomes in 75 (10.8%), and grade IV outcomes in 21 patients (3.0%). Revision surgery was indicated for the 13.8% of all patients who had grade III or IV outcomes. CONCLUSIONS: It is important to clinically classify the deformations due to secondary contracture after surgery and to establish treatment algorithms to improve scientific communication among rhinoplasty surgeons. In this study, we suggest guidelines for the clinical classification of secondary capsular contracture after augmentation rhinoplasty, and also propose a treatment algorithm.
Asian Continental Ancestry Group ; Classification* ; Contracture ; Female ; Humans ; Implant Capsular Contracture ; Male ; Mammaplasty ; Nose* ; Prostheses and Implants ; Rhinoplasty ; Silicon* ; Silicones* ; Surgeons

Periprosthetic capsular contracture, implant rupture, and deflation are well-known delayed complications of augmentation mammaplasty. However, infection remains the most common cause of reoperation after breast implant surgery. We report the case of a nontuberculous mycobacterial infection with huge abscess formation after augmentation mammaplasty. A 29-year-old woman visited our clinic with enlarged breasts after undergoing breast augmentation at a local clinic 4 years ago. She had no pain and tenderness, except some hardness around the breast margin. Nine months after surgery, her breasts began to grow larger, but showed no other typical symptoms, which led the patient to neglect the enlargement. After exploring through an inframammary approach, a large amount of serous fluid leaked out on both sides and we identified a huge abscess in a pocket localized in the submuscular plane. During exploration, the infected implants, which contained a pus-like fluid with a foul odor, were completely drained. The specimen culture revealed growth of Mycobacterium abscessus, which is a rare cause of infections after breast augmentation. While the overall incidence of mycobacterial infections after breast augmentation is low, our case demonstrates that huge abscess and granuloma formation should be considered as a potential complication of breast surgery.
Abscess* ; Adult ; Breast Implantation ; Breast Implants ; Breast* ; Female ; Granuloma ; Hardness ; Humans ; Implant Capsular Contracture ; Incidence ; Mammaplasty ; Mycobacterium* ; Nontuberculous Mycobacteria ; Odors ; Reoperation ; Rupture

BACKGROUND: Capsular contracture is the most troublesome complication in breast implant surgery. Although capsule formation can be seen as a normal reaction to a foreign body, it can induce pain, hardness, deformity, and other pathologic problems. Surgical intervention is required in severe cases, but even surgery cannot guarantee a successful outcome without recurrence. This experimental study confirms that single topical administration of leukotriene antagonist zafirlukast (Accolate, Astrazeneca) reduces peri-implant capsule formation and prevents capsular contracture. METHODS: Twelve smooth-surfaced cohesive gel implants were implanted in New Zealand White rabbits. These miniature implants were designed to be identical to currently used products for breast augmentation. The rabbits were divided into 2 groups. In the experimental group (n=6), the implant and normal saline with zafirlukast were inserted in the submuscular pocket. In the control group (n=6), the implant and normal saline alone were used. Two months later, the implants with peri-implant capsule were excised. We evaluated capsule thickness and collagen pattern and performed immunohistochemical staining of myofibroblasts, transforming growth factor (TGF)-beta1, 2. RESULTS: The thickness of the capsules in the experimental group was reduced in both dorsal and ventral directions. The collagen pattern showed parallel alignment with low density, and the number of myofibroblasts as well as the amounts of TGF-beta1 and TGF-beta2 were reduced in the experimental group. CONCLUSIONS: We suggest that single topical administration of leukotriene antagonist zafirlukast can be helpful in reducing capsule formation and preventing capsular contracture via myofibroblast suppression, modulation of fibroblastic cytokines, and anti-inflammatory effect.
Administration, Topical ; Breast ; Breast Implants ; Capsules ; Collagen ; Congenital Abnormalities ; Contracture ; Cytokines ; Fibroblasts ; Foreign Bodies ; Hardness ; Implant Capsular Contracture ; Myofibroblasts ; Rabbits* ; Recurrence ; Transforming Growth Factor beta1 ; Transforming Growth Factor beta2 ; Transforming Growth Factors