Capsular Contracture

Lohogan · February 2017

My left breast is my radiated side. My left side did not tolerate radiation well needless to say. Long reconstruction story I will not get into but my left breast is borderline stage 3/4 capsular contracture. I am on the second implant for this side, have had it for three years now. Looks bad and as a jerk doctor put it two years ago "even ruffles have ridges" Yes, he referred to my breast as a potato chip. Anyway, I have put off doing anything about my sad breast because I was over all it. Was just going to deal with my funny lop sided boob situation and move on. Well, now the capsular contracture has gotten more severe and bothersome. I am in the process of referrals and going to engage again. So the reason for my post....I have been sick with the flu and cold combo. My cough has been horrendous. My coughing fits have been pretty violent and I have had sore abs and developed costochondritis. Well the new issue is when I cough, my left boob hurts, like scar tissue is ripping or pulling. I feel like the implant is so tight that the coughing fits are disrupting and causing trouble in there.

Anyone familiar with something like this???

Thank you in advance!!!

Meadow · February 2017

I am so sorry! I have had capsular contracture too, I am bumping your question to the top of the active threads so more people can see it and respond. Hoping you get more answers soon.

macb04 · February 2017

Have you tried Pentoxifylline and Vitamin E??? It is used to prevent Capsular Contracture, but I have also heard of it being used to treat it too.

Aldo found info on treatment of Capsular Contracture using Low Level Laser Therapy to resolve or greatly improve it.

Reduce skin fibrosis & possibly breast implant contracture after radiation therapy: vitamin E & pentoxifylline

Aug 1, 2011 Brian D. Lawenda, M.D.

Most patients typically develop only minimal skin fibrosis after their radiation therapy, however for those who have a more significant degree of fibrosis I often recommend a combination of vitamin E (400 I.U. twice a day) andpentoxifylline (400 mg, three times each day).

Fibrosis can develop months-to-years after radiation therapy to any region of the body, but is most common in theextremities, breasts (read more about implant contracture, below) and head and neck where higher radiation doses are often required on or just below the skin surface.

How does this treatment work?

It is not entirely clear how these molecules work to reduce fibrosis.

Vitamin E may act as a antioxidant, helping to prevent ongoing free radical damage to the radiated tissues.

Pentoxifylline may be involved in blocking the molecular signaling pathway that is responsible for the development of fibrosis as a response to inflammation and injury. Additionally, pentoxifylline increases the flexibility and permeability of red blood cells which enables them to more easily bring oxygen to the tissues and carry carbon dioxide away. It is because of this mechanism that pentoxifylline is used in the management of peripheral artery disease, leg ulcers, strokes, high-altitude sickness, eye and ear disorders, and sickle cell disease and diabetic neuropathy.

Results of treatment:

Significant improvement in pain, tightness, muscle strength, edema and range of motion have all been reported with this treatment.

It seems that the earlier that this treatment is started after the development of fibrosis the quicker the response, however this combination therapy is still effective (approximately 60-70% reduction in fibrosis) even when started many years after radiation therapy.

Have patience:

It is important to recognize that this medication combination can take 6-48 months to achieve the best possible results. In one study, it took a median of 16 months to achieve a 68% reduction in fibrosis for those who started treatment within 6 years of completing radiation therapy and a median of 28 months for those who started treatment greater than 6 years after completing radiation therapy. Relapses were found to occur more commonly among patients who took this treatment for less than 12 months.

Duration of treatment:

For severe skin fibrosis, I recommend that treatment continue for 3 or more years.
For mild-to-moderate fibrosis, I recommend that treatment continue for at least 1 year.

An increasingly common issue: Breast implant contracture following radiation therapy

As more patients undergo breast reconstruction (with eithertissue transfer/rotational techniques or implant prostheses), it has become more common in oncology and plastic surgery practices to have to address breast cancer treatments in this setting.

All patients with breast implants or expanders will eventually develop scar tissue (fibrosis) surrounding the prosthesis as a consequence of the body's normal immune/inflammatory response to a foreign body. This fibrotic response varies in severity among individuals, but it is estimated that up to 25% of women with breast implants undergo revision surgery (at 10 years) due to implant contracture (shrinking and or hardening of tissue surrounding the implant). Following radiation therapy, implant contracture rates are increased due to the effects of radiation fibrosis. (picture on left: This patient developed an implant contracture after radiation therapy to to her right breast and implant. The superior implant displacement and circumferential tightening are common findings.)

Although the rates or lower in women who select breast reconstruction with their own tissues (tissue transfer or rotational techniques), they are also at a higher risk of developing contracture and fibrosis of their reconstructed breast after radiation therapy to these tissues.

Vitamin E and pentoxifylline are being investigated as a prophylactic therapy to reduce the incidence and severity of implant contractures or implant loss after receiving radiation therapy to the chest wall or breast in the setting of breast cancer treatment. The results of these investigations will be important in helping us better direct our management of this condition.

Starting this treatment during radiation therapy is not recommended, as vitamin E may reduce the efficacy of radiation.

Bottom Line:

Vitamin E and pentoxifylline is a useful therapy for patients with radiation-induced fibrosis. It can reduce the signs and symptoms of this condition dramatically in the majority of those who continue taking it for at least 6-12 months (or longer in cases of severe, long-standing fibrosis.)

The use of vitamin E and pentoxifylline following radiation therapy to reduce the risk of breast implant contracture and failure is under investigation.

If you think that you might benefit from a course of vitamin E and pentoxifylline, discuss this with you radiation oncologist.

The dosing is:

Vitamin E (I recommend you buy "mixed tocopherols", as you want to include more than just the standard "alpha tocopherol" form): 400 I.U. twice a day and
Pentoxifylline (ask your doctor for a prescription): 400 mg, three times each day

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The American Journal of Cosmetic Surgery

Low-Level Laser Therapy: An Alternative Treatment for Capsular Contraction

Jason D. Johnson, DO, Paul M. Glat, MD, FACS, William L. Scarlett, DO, FACS First Published March 1, 2015 research-article

Abstract

Introduction:

Fibrous capsular contracture is the most frequent complication leading to patient dissatisfaction after breast augmentation and breast reconstruction. This multi-factorial phenomenon has been treated both surgically and nonsurgically with mixed results. At the present time, the more severe grades of capsular contracture are treated most successfully by surgical means.

Materials and Methods:

The LTU-904 laser was used on 33 patients with grades III and IV capsular contractures. Patients underwent laser treatments once a week for a period of 6 weeks. They received a 10-minute treatment using the 904-nm laser with a 2-cm square grid pattern with 1 minute of treatment in each area (300 mJ/1 min treatment = 1.5 J/cm²). Patients were administered a posttreatment survey to determine their level of improvement and satisfaction.

Results:

Surgical intervention was avoided in 93.9% of patients with grade III and IV capsular contraction. Of the patients who avoided surgery, the laser improved the stiffness of the breast by 10–95% (average, 43.6%) and an overall improvement in comfort ranging from 10–95% (average, 48.2%).

Conclusions:

Low-level laser therapy is a promising alternative treatment for grades III and IV capsular contracture. In most cases, both the patient and surgeon observed significant tissue softening and improved breast contour after treatment while avoiding surgical intervention.

References

1.	American Society of Plastic Surgeons. 2011 National cosmetic/reconstructive procedure statistics. Available at: http://www.plasticsurgery.org/News-and-Resources/2011-Statistics-.html. Accessed May 28, 2013. Google Scholar
2.	Katzel EB, Koltz PF, Tierney R, . A novel model for studying silicone gel-related capsular contracture. Plast Reconstr Surg. 2010;126:1483–1491. Google Scholar
3.	Cunningham B, McCue J. Safety and effectiveness of Mentor's MemoryGel Implants at 6 years. Aesthetic Plast Surg. 2009;33:440–444. Google Scholar
4.	Cheng A, Lakhiani C, Saint-Cyr M. Treatment of capsular contracture using complete implant coverage by acellular dermal matrix: A novel technique. Plast Reconstr Surg. 2013;132:519–529. Google Scholar
5.	Spear SL, Baker JL. Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg. 1995;96:1119–1123. Google Scholar Medline
6.	World Medical Association. World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–2194. Google Scholar CrossRef, Medline
7.	RianCorp. Products. Available at: http://www.riancorp.com/Products/low-level-laser-therapy-lllt.html. Accessed May 28, 2013.
8.	Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: A primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J Clin. 2009;59:8–24. Google Scholar Medline
9.	Carati CJ, Anderson SN, Gannon BJ, Piller NB. Treatment of postmastectomy lymphedema with low-level laser therapy: A double blind, placebo-controlled trial. Cancer. 2003;98(6):1114–1122. Google Scholar
10.	Stergioulas A, Stergioula M, Aarskog R, Lopes-Martins RA, Bjordal JM. Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic Achilles tendinopathy. Am J Sports Med. 2008;36:881–887. Google Scholar Abstract
11.	Caetano KS, Frade MA, Minatel DG, Santana LA, Enwemeka CS. Phototherapy improves healing of chronic venous ulcers. Photomed Laser Surg. 2009;27: 111–118. Google Scholar CrossRef, Medline
12.	Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: A systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet. 2009;374:1897–1908. Google Scholar CrossRef, Medline
13.	Huang YY, Chen AC, Carroll JD, Hamblin MR. Biphasic dose response in low level light therapy. Dose Response. 2009;7:358–383. Google Scholar Medline
14.	Society of Photo-Optical Instrumentation Engineers (SPIE). Biomedical optics and medical imaging. In: Huang YY, Hamblin M, Chen AC. Low-Level Laser Therapy: An Emerging Clinical Paradigm. Available at: http://spie.org/x35504.xml. Accessed May 28, 2013.
15.	Brown SA, Rohrich RJ, Kenkel J, Young VL, Hoopman J, Coimbra M. Effect of low-level laser therapy on abdominal adipocytes before lipoplasty procedures. Plast Reconstr Surg. 2004;113:1796–1804. Google Scholar
16.	Schlager A, Oehler K, Huebner KU, Schuth M, Spoetl L. Healing of burns after treatment with 670-nanometer low-power laser light. Plast Reconstr Surg. 2000;105:1635–1639. Google Scholar Medline
17.	Kozanoglu E, Basaran S, Paydas S, Sarpel T. Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: A randomized controlled trial. Clin Rehabil. 2009;23:117–124.Google Scholar Abstract
18.	Omar MT, Shaheen AA, Zafar H. A systematic review of the effect of low-level laser therapy in the management of breast cancer-related lymphedema. Support Care Cancer. 2012;20:2977–2984. Google Scholar
19.	Dirican A, Andacoglu O, Johnson R, McGuire K, Mager L, Soran A. The short-term effects of low-level laser therapy in the management of breast cancer-related lymphedema. Support Care Cancer. 2011;19: 685–690. Google Scholar
20.	Jackson RF, Roche G, Mangione T. Low-level laser therapy effectiveness for reducing pain after breast augmentation. Am J Cosmet Surg. 2009;26:144–148. Google Scholar Abstract
21.	Jackson RF, Dedo DD, Roche GC, Turok DI, Maloney RJ. Low-level laser therapy as a non-invasive approach for body contouring: A randomized, controlled study. Lasers Surg Med. 2009;41:799–809. Google Scholar
22.	Jackson RF, Stern FA, Neira R, Ortiz-Neira CL, Maloney J. Application of low-level laser therapy for noninvasive body contouring. Lasers Surg Med. 2012; 44:211–217. Google Scholar
23.	Nestor MS, Zarraga MB, Park H. Effect of 635nm low-level laser therapy on upper arm circumference reduction: A double-blind, randomized, sham-controlled trial. J Clin Aesthet Dermatol. 2012;5:42–48. Google Scholar
24.	Freitas CP, Melo C, Alexandrino AM, Noites A. Efficacy of low-level laser therapy on scar tissue. J Cosmet Laser Ther. 2013;15:171–176. Google Scholar
25.	American Society for Photobiology. Photobiological Sciences Online. Mechanisms of low level light therapy. Available at: http://photobiology.info/Hamblin.html. Accessed May 28, 2013.

Vol 32, Issue 1, 2015

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