The most frequent revision that is required after breast augmentation is capsular contracture treatment. The most common cause is thought to be due to bacterial contamination or the presence of blood around the implant. While there is evidence to justify these theories, the true nature of capsular contracture still remains an enigma. Surgeons can reduce the chances of a capsular contracture with good technique, but even when everything is done right, contracture can still occasionally happen. The critical components to minimize the chances of occurrence are: precise and bloodless surgery, avoiding any bacterial contamination of the implant, avoiding the nipples' incision, encouraging early activity, and using the proper type of antibiotic and irrigation.
Should capsular contracture occur, the treatment is invariably surgical. The procedure is called a “complete capsulectomy;” it involves removing all of the scar tissue in an exact and bloodless manner, using a brand new implant (since the contracture may be related to bacteria it is important to never reuse the old implant), and placing a drain. Some surgeons have spoken about using asthma medicines such as Accolate or Singulair to treat contracture, but not only is the evidence for these proposed treatments very tenuous, these medicines have significant side effects as well. Motrin, massage, ultrasound, Vitamin E, and many other remedies have been tried with mixed or minimal success.
With proper technique the rates of revision contracture are very low, but they are not zero.
Dr. Teitelbaum is a pioneer in using Alloderm, Strattice, and other “ADM’s” for the treatment of capsular contracture, and is considered not just an expert in Los Angeles but has been teaching it to surgeons even outside the United States for years. But he cautions that these products are not specifically FDA approved for this purpose and follow-up has not been long enough to know for sure how effective they are.
Dr. Teitelbaum was a member of the national plastic surgery task force that developed the Covid-19 protocols for plastic surgery offices. He is therefore well-versed in all of the recommendations and his office meets or exceeds all of them. By now you are familiar with all the obvious measures such as reminding patients and staff not to come to the office if they have any symptoms, taking temperatures, maintaining social distancing, having everyone wear masks, placing hand sanitizers everywhere, reducing the number of patients in the office at one time, testing all surgical patients, etc. One unique feature is that Dr. Teitelbaum’s operating room has "laminar flow" – a very advanced system that directs the flow of air from a large diffuser on the ceiling to exhausts near the floor, ensuring that the fresh air flows in one direction. This not only reduces the chance of COVID infections for the patients and staff, but it also reduces the risk of surgical infections.
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