LED therapy for capsular contracture requires patient commitment, but outcomes are promising.
Capsular contracture remains a concern among breast augmentation and breast reconstruction patients. There’s no gold standard for treating or preventing severe cases.
But cosmetic surgeon Jacob Haiavy, M.D., says he might have stumbled onto a safe and effective way to treat even severe capsular contracture by using noninvasive light therapy. He presented on the topic at the American Academy of Cosmetic Surgery meeting in February 2020. Dr. Haiavy, who practices in Rancho Cucamonga, Calif., recently completed a study using a light-emitting diode (LED) device with infrared, red and blue light (Celluma Light Therapy, BioPhotas). He found the therapy significantly reduced the need for surgery to treat capsular contracture among women who had started to develop capsular contracture after their first breast augmentations, as well as among women who had surgical intervention to treat capsular contracture and started to develop it again.
Breast augmentation is number one among the top five cosmetic surgeries in the U.S., according to the latest statics by The Aesthetic Society. However, in May 2020, The Aesthetic Society reported a nearly 15% decrease in breast augmentations since 2017. That’s while implant explantations rose by 34.4%, according to a Society press release.
“Overall, patients are very satisfied. I think satisfaction rates run from 95% to 98% in every study that comes out, but it doesn’t mean there are no issues with breast augmentation. I think one of the main problems with breast augmentation ever since the procedure existed is capsular contracture,” Dr. Haiavy says.
Every breast implant patient develops a layer of scar tissue around the implants as a normal part of the body’s defenses and the healing process, according to Dr. Haiavy.
“Usually the scar tissue is very thin and very soft and the implant moves around just like a normal breast and you’re fine. That’s what happens 95% of the time. But 5% of people can form a thick scar that can contract and shrink over the implant over time. It can make the breast feel hard. It can cause pain or discomfort. It can distort the breast,” he says.
It’s not entirely clear why it happens or who is at highest risk. Factors that can trigger capsular contracture include bleeding inside the pocket, an infection or bacteria on the implant surface. Sometimes, trauma years after breast implant surgery.
The FDA has not cleared or approved any devices to treat or reduce the incidence of capsular contracture. And while there is no magic bullet, research suggests some things might help prevent capsular contracture, including how the surgeon does the dissection, use of IV antibiotics prior to surgery, surgical technique, the degree of cauterization, how the surgeon places the implant and more.
“All those things can reduce the bacterial load on the implant and the patient,” Dr. Haiavy says. “I’ve been in practice for almost 20 years now. Breast augmentation is more than 50% of the practice. Our capsular contracture rate is lower than the national average, at about 3.6%. But it’s still a problem when a patient gets it, so we’ve been thinking for years how we can lower the percentage.”
Worldwide rates of capsular contracture vary by study, with reported incidence between 2.8% to 20.4%. The overall incidence is 10.6%, according to a paper published in 2015 in the Archives of Plastic Surgery.1
Dr. Haiavy says he heard a physician speak at a meeting about using an LED device to treat lymphedema in breast cancer patients. The physician presented a series of patients, all of whom had capsular contracture.
“He found that when he was using the device close to the breast, in the axilla and the area of the chest, the capsular contracture actually improved. That’s when the lightbulb went off in my head that this might be a possibility,” Dr. Haiavy says.
The infrared wavelength penetrates the muscle and breast tissue. Providers from physical therapists to dermatologists have safely used LED light therapy for many years.
“The blue light is approved for acne. Interestingly there are studies that show that the way the blue light works for acne is by reducing the bacterial load,” he says. “I wondered if blue light also has an effect on the bacterial load on the implant surface and the reduction of growth. The infrared light in combination with that reduces oxidative damage to the muscle and the breast tissue. It helps the cells, specifically the DNA and RNA portion of the cells, to repair themselves faster.”
Dr. Haiavy’s aesthetician already used Celluma Light Therapy for antiaging and other indications. Applying it to the breast would be simple because the device is flexible and conforms to different body surfaces.
“It’s large and has a preset mode at 385 diodes that emit this light for half an hour on its own,” he says. “The practitioner or staff do not have to be in the room.”
He started using the LED device about five years ago on patients at the first indication of implant hardness or stiffness.
“I noticed that over the course of using it that my reoperation rate on capsular contracture had gone down tremendously. The only change that I made in my treatment was adding the light,” he says.