XỬ TRÍ BAO XƠ CO THẮT

BAO XƠ CO THẮT
TRONG PHẪU THUẬT NÂNG NGỰC
(CAPSULAR CONTRACTURE AFTER BREAST AUGMENTATION)
BS. LÊ CHÍ CƯỜNG
HỌC VIÊN CK1 TRƯỜNG ĐHYK PHẠM NGỌC THẠCH


ĐỊNH NGHĨA (DIFINATION)
Capsular contracture is a local
complication thought to occur due to an
excessive fibrotic foreign body reaction
to the implant. It is thought to be an
inflammatory reaction which causes
fibrosis through the production of
collagen,  leading to excessively firm and
painful breasts

Siggelkow W, Faridi A, Spiritus K, et al. Histological analysis of silicone breast implant capsules and correlation with
capsular contracture. Biomaterials. 2003;24:1101–1109


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RISK FOR CAPSULAR CONTRACTURE DEVELOPMENT

1. Silicone gel rather than saline implants
2. Smooth implants rather than textured implant

surfaces
3. subglandular rather than sub-pectoral
positioning
4. postoperative hematoma
5. Infection
6. Silicone gel implant ruptures.


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 TREATMENT CONSIDERATIONS

Treatment of capsular contracture has been
segregated into three major categories:
1. Preventive
2. Medical
3. Surgical


PREVENTATIVE TREATMENT
CONSIDERATIONS
1. Avoidance of nipple discharge which would reduce the potential for
bacterial colonization of the milk duct, thus contaminating the
breast implant pocket. Another consideration is trauma to the milk
ducts permitting entry of inflammatory producing glandular breast
excretions into the breast pocket.
2. Insistence on meticulous hemostasis during surgery and before
closing.
3. Avoidance of excessive cauterization, both electrical and chemical

during dissection of the pocket.
4. Avoidance of irritants into the pocket such as glove powder, iodine
solutions, and peroxide.


PREVENTATIVE TREATMENT CONSIDERATIONS
6. Pocket irrigation with triple antibiotic solution.
7. The use of a no-touch technique for implant implantation especially
with utilization of a Keller Funnel.
8. Utilization of proper incision site and pocket locations including subpectoral pocket development and utilization of the inframammary
crease incision site hich causes the least amount of trauma to the
breast gland.
9. The use of saline implants instead of silicone gels and the use of
textured implants vs. smooth implants.
10. Avoidance of smoking.
11. Avoidance of the use of drains which may serve as a conduit to


MEDICAL TREATMENT CONSIDERATIONS
1. Steroids in the form of 60 mg of prednisone in a 12-day decreasing
dose schedule.
2. Leukotriene inhibitors, such as Accolate, 20 mg BID, or Singulair, 1
capsule QID, are started for at least 1 month and may be continued up
to 4 months.
3. Antibiotics.
4. Milk thistle as a herbal with anti-inflammatory action.
5. Omega 3 is also reported to be anti-inflammatory.
6. Papaverine 150 mg twice daily as a smooth muscle relaxant.
7. Angiotensin-converting enzyme (ACE) inhibitors to limit the foreign
body response.

8. The use of external ultrasound, as promulgated by Aspen
Rehabilitation, in which multiple applications of a igher-energy
lowfrequency ultrasound associated with antibiotics and vigorous
Carmen JC, Roeder BL, Nelson JL, Ogilvie RL, Robison RA, Schaalje GB, Pitt WG. Treatment of biofilm infections on implants with low frequency
massage
maneuvers to weaken and stretch the capsule have been
ultrasound and antibiotics. Am J Infect Control.2005;33(2):78–82.


SURGICAL TREATMENT
CONSIDERATIONS

Capsulectomy, either total or partial, still remains the
primary surgical treatment of choice
+ PRP spray into the pocket
+ using ADMs (acellular dermal matrices), AlloDerm
+ autologous fat grafting (AFG)


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