Preventing the #1 breast augmentation complication [Adam Schaffner, MD, New York City]

Dr. Schaffner (00:00):
I'm Adam Schaffner. I'm a plastic surgeon. I'm located in New York City. We're on Fifth Avenue between 47th and 48th, two blocks south from Rockefeller Center.

Eva Sheie (00:10):
Is there anything that you do to help prevent capsular contracture from occurring in the first place?

Dr. Schaffner (00:16):
We do. We do a number of things. We have the patient shower with chlorhexidine soap the night before and the morning of surgery. We have no makeup, no body washes, no dyes or perfumes, no self tanner. We also have the patient take antibiotics intravenously before surgery as well as for a period of time after surgery to minimize the risk of infection and inflammation. If there's no contraindications, meaning no reason not to do so, we'll use a leukotriene antagonist like Singulair otherwise known as Montelukast. We'll use Celebrex, which is an anti-inflammatory as long as the patient does not have any allergy to sulfa or to nonsteroidals. When we wash out the pocket before putting in the implant, we will go ahead and irrigate with phase one, which is hypochlorous acid as well as half strength, Betadine irrigation with antibiotics, as long as the patient doesn't have any allergy to iodine.

Dr. Schaffner (01:18):
When we prep the skin, we will clean it with alcohol, then chlorhexidine soap, then chlor prep so that there is an antiseptic soap film to help minimize the risk of infection. We seal the incision in the operating room with Dermabond, which is a surgical crazy glue, so it's sealed sterilely as long as there's no adhesive allergy or sensitivity. We use powder free gloves so that there's no talc or any sort of inflammatory issues from a powder. We will also try to use a no touch technique where we use a Keller funnel so that the implant doesn't touch the gloves of the surgeon or the skin of the patient. So a number of different things to minimize the risk of development of capsular contracture.

Eva Sheie (02:01):
It really sounds like no stone unturned in that process.

Dr. Schaffner (02:05):
We try.

Eva Sheie (02:06):
How can you tell if capsular contracture is happening to you?

Dr. Schaffner (02:12):
If the breast implant is starting to feel tight, can be painful, you can have changes to the skin overlying the implant, you have displacement of the implant in an upward direction. All of those can be signs and symptoms of a capsular contracture.

Eva Sheie (02:34):
Does it usually happen within a certain timeframe?

Dr. Schaffner (02:38):
So it can happen anytime after a breast augmentation occurs. Sometimes if it's early onset, it'll be in the first couple of months after surgery, but I've even seen it developed years after surgery. So it's important to be vigilant and to do the things that we know help to minimize the risk of capsule contracture.

Eva Sheie (02:58):
If you get it once, what is the chance that you're going to get it again?

Dr. Schaffner (03:02):
There's no question that if you've developed a capsular contracture, you go to the operating room, you do a total capsulectomy, do everything we said, there's still a risk that you can develop another capsular contracture. One of the things that can be done in a recurrent capsular contracture, or even in a primary taking it out first time, is to use what is called an acellular dermal matrix or an ADM, something like AlloDerm or strattice, which serves as an interposition graft. If you think about a capsule, it forms a 360 degree sort of scar tissue around the implant to shrink wrap around it, and if you're able to break that circumferential contraction, that will go ahead and minimize the risk of developing a capsular contracture.

Eva Sheie (03:46):
Where can we find you on Instagram and what's your website address?

Dr. Schaffner (03:50):
So on Instagram, you can view us at Dr. Schaffner, Dr. Adam Schaffner, D-R-A-D-A-M-S-C-H-A-F-F-N-E-R. And our website, you can either go to drschaffner.com, that's D-R-S-C-H-A-F-F-N-E-R.com or plasticsurgeoninnyc.com. That's P-L-A-S-T-I-C-S-U-R-G-E-O-N-I-N-N-Y-C.com. Or you can call us at (212) 688-6600.

Eva Sheie (04:20):
Thank you for your wisdom.

Dr. Schaffner (04:22):
Thank you very much.

Eva Sheie (04:24):
On this podcast, we bring you directly to the doctors who are, where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. If you're a board certified plastic surgeon and would like to be a guest or a sponsor of the show, go to wherebeforemeetsafter.com for more information. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.