Capsular Contracture

What is a Capsular Contracture?

Capsular contracture is one of the frustrating drawbacks of having breast augmentation surgery with implants.  When any foreign material, such as a breast implant, is placed inside the body, the natural response of the body is to make a layer of tissue around it.  Usually, this lining layer, called the “capsule” is thin and flexible, and is of no significance to the patient.  While we often refer to it as “scar tissue”, it actually is different than the typical scar tissue we see in healing wounds that don’t have an implant involved.  Also, there is no link between the type of scars you form externally on your skin, and the risk of developing a tight capsule around a breast implant.

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In some women, the capsule becomes abnormal – and becomes thickened, and tighter, squeezing the implant into a tight, round ball shape.  This can distort and elevate the shape of the breast, make the breast feel abnormally firm, and, in the more severe cases, can be painful.  The implant itself is OK, but it is compressed by the thick, tight layer of capsule.

Risk factors for capsular contracture

We do know that there are some risk factors for the formation of capsules.  In multiple studies, implants that are “over” the muscle have a significantly higher risk for developing a capsule than those that were placed “under the muscle”.  Also, in at least 3 studies, implants that are placed through a nipple incision or an armpit incision have a higher risk of developing a capsule.  That’s why it makes sense to put the implants behind the muscle, and use an incision in the breast crease, when possible, during the first surgery.

In addition, large hematomas or major infections inside the breast can increase the risk for future capsular contractures. And some studies have shown a higher risk of capsules in smokers.

However, it is certainly possible that you might have none of these risk factors, and still develop a capsule.  That’s one of the unpredictable parts of breast augmentation surgery.  At this time, there is no useful blood test to know whether one’s risk for capsule formation is high or low, prior to surgery.

How do Dr. Fiala and Dr. Rhee reduce the chances of capsular contracture?

Since prevention is the key to success when it comes to capsules, Fiala Aesthetics uses almost every scientifically proven method available to reduce the chance of capsule formation.  These include:

  • using an inframammary incision, and placing the implant behind the muscle
  • using a “no-touch” technique
  • washing the implant pocket out with an antibiotic solution prior to implant placement
  • inserting the implant with the Keller funnel, to reduce contact with skin edges
  • appropriate antibiotic coverage
  • post-operative use of Singulair for the first 3 months (off-label use)
  • daily implant displacement exercises (“massage”) for smooth-walled implants

Treatments for capsular contracture:

Capsules can be treated in two main ways:  non-surgical treatments and surgical treatments.  The non-surgical treatments include use of oral medications that try to influence the body’s production of capsule.  Medicines like Singular, Accolate and papaverine fall into this category.  Other non-surgical treatments include massage of the implant, use of therapeutic ultrasound, and herbal remedies, like “B.I. Secret”.  All report some degree of success.

Surgical treatments of established capsules require a trip back to the operating room, but are much more definitive.  There are a number of treatment options, which are listed here.  In some cases, these may be combined.

  • capsulectomy – this is the removal of the capsule layer.  Think of it like peeling an orange, where the orange peel represents the capsule, and the implant represents the orange.  By removing the abnormal scar tissue, the breast becomes soft again.
  • capsulotomy – this is dividing the capsule into segments, breaking up the ring of scar tissue, but leaving the segments in place.  This is a smaller surgery, but has a higher rate of recurrence.
  • changing planes.  If your current hard implant is “over” the muscle, there’s good data to suggest that changing it to the “under the muscle” position will help to solve your problem.
  • using specialized materials like Strattice.  These tissue grafts, called ADM’s, have been found to be very helpful in reducing the chance of a second capsule problem.  They probably represent the best answer available at this time, for patients who wish to retain their implants.  Strattice and other ADM materials, however, are expensive.
  • removing the implant and doing fat grafting to the breast to restore the breast volume.
  • removing the implant without replacing it, and having a lift.

Fiala Aesthetics can advise you on the best treatment for your particular situation.

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