Capsular contracture is one of the factors that most concern patients when they are going to undergo a breast augmentation with prosthesis. When patients visit different plastic surgeons they usually receive different information and this implies an increase in uncertainty and a lack of confidence in the different professionals. We are currently fortunate that there are studies carried out by recognized researchers that can help us resolve our doubts. One of the factors that has been shown to have the most influence on the formation of a pathological capsule (hard to the touch and that can eventually deform the breast) in breast augmentation surgery is the bacterial contamination of the prosthesis during the insertion of the same. This contamination is usually subclinical, that is, it does not give a symptomatology to the patient: the patient will not have fever or redness of the breast and will not manifest as a habitual infection, but will be responsible for the formation of a film called “biofilm” that would increase the risk of capsular contracture.
Factors that reduce the risk of capsular contracture
To minimize this risk of contamination and consequent capsular contracture in breast augmentation surgeries, there are a number of factors that surgeons can adopt (1). Administration of intravenous antibiotics before and during the intervention. (5) Avoid the use of periareolar incisions (around the areola). Preferable the dual plane (subpectoral) or subfascial. (4) Cover the areola during the intervention. (6) Careful atraumatic dissection to minimize tissue devascularization. (1) Avoid dissection within the parenchyma of the breast. Meticulous hemostasis. Irrigation of the pocket with antibiotic solution. Change gloves and surgical instruments at the time of introduction of the prosthesis. Minimize the exposure time of the breast implant. Use of a sleeve to insert the implant. Minimize the manipulation of the breast implant once placed. Closure of the wound by planes. Avoid the use of drains. (3 and 8) Protection of implants in future procedures with antibiotic prophylaxis.
