Prevenção e tratamento da contratura capsular após implantação de prótese mamária

Introducao: A contratura capsular e definida como uma cicatrizacao esferica com contracao da capsula que envolve a protese mamaria. A proposta desse trabalho foi elaborar um protocolo para prevencao e tratamento da contratura capsular. Metodo: Foram avaliadas 9 pacientes que desenvolveram contratura capsular, 3 foram classificadas como Baker II, 5 como Baker III e 1 como Baker IV. As pacientes com contratura capsular Baker II foram tratadas clinicamente, associando-se microcorrente (MENS), ultrassom (US) e drenagem linfatica manual (DLM). Nos casos de contratura grau III e IV de Baker, substituiu-se a protese mamaria, reposicionando-a em plano submuscular, associando-se tratamento clinico (MENS/US/DLM) e zafirlucaste 20mg, via oral, de 12/12 horas, por 90 dias. Resultados: Oito (89%) pacientes tiveram resolucao completa da contratura, retornando a Baker I e uma (11%) apresentou reducao da contratura de Baker III para Baker II, mesmo apos substituicao da protese mamaria. Clinicamente, nenhuma paciente apresentou efeitos colaterais. Conclusao: A associacao MENS/US/DLM mostrou-se como uma importante ferramenta no tratamento das contraturas Baker II. Nos casos de contratura Baker III e IV, a associacao MENS/US/DLM, reposicionamento da protese no plano submuscular e utilizacao do zafirlucaste demonstrou bons resultados na resolucao das contraturas. Os resultados obtidos encorajaram-nos a utilizar a associacao MENS/US/DLM de maneira preventiva em todas pacientes submetidas ao implante de protese de silicone.(AU) Introduction: Capsular contracture is defined as a spherical scar with contraction of the capsule involving the prosthesis. The proposal suggested by this study is to elaborate a protocol to treat and prevent capsular contracture. Methods: Nine patients were evaluated, who developed capsular contracture. Three patients were graded as Baker II, five as Baker III and one as Baker IV. The Baker II patients were clinically treated associating micro electro neuro stimulation (MENS), ultrasound (US) and manual lymphatic drainage (MLD). The Baker III and IV patients had the breast implant replaced, repositioning the implant in submuscular plane, associating the clinical treatment (MENS/US/MLD) and zafirlukaste 20mg oral intake twice daily for a period of 90 days. Results: There was complete resolution of the contracture, returning to Baker grade I in8 patients (89%). There was reduction on Baker grade from III to II in one patient, even after breast implant replacement. Clinically, none patient presented side effects. Conclusion: The association of MENS/US/MLD demonstrated an important tool for the management of grade II contractures. The association of breast implant replacement and repositioning in submuscular plane, associated to the clinical treatment (MENS/US/MLD) and zafirlukaste demonstrated good results in capsular contracture resolution. These results encouraged us to use the MENS/US/MLD to prevent capsular contracture in all breast implant patients.(AU)