All statements regarding capsular contracture are correct except:
Using a smooth/saline-filled implant and retropectoral pocket results in greater capsular contracture rates than the retroglandular pocket. This statement is incorrect; the aetiology of capsular contracture is still not clear. However, there are two hypotheses: hypertrophic scar formation (haematoma, granulomas, hereditary diseases, etc.) and infection. Myofibroblasts are known to be present on the capsule around the implants. They contribute to capsular contracture as part of the foreign body reaction initiated by silicone. Subclinical infections have also been implicated as a major contributor to capsular contracture. Staphylococcus epidermidis was the dominant organism found among culture specimens taken from open capsulectomies. S. epidermidis seems to correlate strongly with capsular contracture incidence. The no-touch technique using a sterile sheath to introduce the implant without contact with the skin should provide less capsular contracture. Using preventive antibiotic irrigation of the pocket is also effective. Capsular contracture is less reported with saline implants, low-bleed silicone implants, textured implants, submuscular placement, and in primary augmentation. Polyurethane-covered implants were reported to have the least capsular formation, but they have been banned in the USA since the eighties due to sarcoma induction risk demonstrated in mice. This risk has not been proved in humans and PU implants have been used widely in South America and in some European countries.
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Autologous breast reconstruction is not possible with:
Which of the following is not true about anatomical implants?
They may affect the early diagnosis of breast cancer. This statement is incorrect. The development of anatomical implants added more options to breast augmentation. Using anatomical implants has the following advantages: decreases tendency of upper-pole fullness, edge visibility and roundness, allows more natural breast projection, and gives better volume support for the lower pole of the breast. Due to the risk of rotation, careful implant selection and a ‘just-adequate’ pocket is essential to avoid this complication, which is estimated at a 1-2% rate. Therefore, using anatomical implants requires more clinical experience. Most anatomical implants are newly developed and use the less-bleeding cohesive-gel silicone, which improves implant safety and reduces capsular contracture. For all these reasons, favourable aesthetic results are reported with anatomical implants. Several studies have shown that breast implants, whatever the kind, do not affect the early diagnosis of breast cancer or the stage at diagnosis.
1. Heden P, Bone B, Murphy DK, Slicton A, Walker PS. Style 410 cohesive silicone breast implants: safety and effectiveness at 5 to 9 years after implantation. Plast Reconstr Surg 2006; 118(6): 1281-7.
A 45-year-old woman is scheduled to undergo mastectomy of the right breast followed by reconstruction using a free TRAM flap. She has a 15 pack/year history of cigarette smoking. This patient is at increased risk for development of each of the following postoperative complications except:
Fat necrosis.
Which one of the following statements regarding autologous breast reconstruction is incorrect?
Skin-sparing mastectomy yields more local recurrences. This statement is incorrect; breast reconstruction with autologous tissue has no interference on local recurrences.
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