Capsular Contracture

Capsular contracture is a tightening of the scar tissue that forms around your breast implant after surgical augmentation. Rates of capsular contracture after augmentation vary greatly in medical studies but have been reported between 10-50% of cases. Degree of contracture varies between patients. Some individuals may only develop a mild firmness to their breast implants. Others may develop a severe contracture which can cause significant hardness to the implant, pain, and distortion of the breast tissues.

The exact cause of contracture is not known for certain. However, we suspect any number of factors may play a role in this surgical complication. Old blood, from significant bleeding or hematoma, has been suspected of creating the inflammatory process of contracture. More and more studies indicate that the likely culprit of capsular contracture is a small bacterial “biofilm”. This small amount of bacterial contamination adheres to the implant and walls itself off from your body. This is thought to then promote a chronic inflammatory state within that capsule and thus a contracture.

What signs of capsular contracture should you be on the lookout for?

• Firmness or changes in implant consistency
  

• Distortion in your breasts or breast implant placement
  

• Development of breast pain
  

We would recommend being evaluated by one of our board-certified plastic surgeon at your earliest convenience. They will be able to listen to your concerns and evaluate these areas of concerns. After this meeting they can discuss all your options. In this way, we can develop an individualized plan to maximize your results and improvement.

How do we avoid capsular contracture?

Prevention is the easiest way to “treat” capsular contracture. With that fact in mind, we employ several steps and strategies to lower our patient’s risk of capsular contracture.

• Stopping all medications that may increase risk of perioperative bleeding 2 weeks prior to surgery
  

• Prophylactic administration of antibiotic medication
  

• Utilization of a breast fold incision (inframammary fold) which has lower long-term rates of contracture
  

• Precise surgical dissection of the breast pocket and immediate control of any pocket bleeding
  

• Irrigation of the breast pocket with triple antibiotic solution to remove any blood or loose debris
  

• Change of surgeon’s gloves prior to implant placement
  

• “No touch technique” of your implants with utilization of the Keller Funnel
  

What treatment options exist for capsular contracture?

Nonsurgical approach with oral medications, leukotriene antagonist, may be prescribed to soften a contracture. This may help you avoid surgery or provide improvement until you are ready for surgery.

Surgical management revolves around removal of the contracted capsule and its breast implant. Once these are removed a new implant will be replaced. This new implant will likely be placed into a new pocket where an acellular dermal matrix may be utilized to secure the implant and lower likelihood of your contracture coming back.

The leukotriene antagonists are typically used before and after any revision for capsular contracture.

What should I expect for surgery and recovery?

This revision surgery will be inherently more involved in amount of surgical dissection and time in the operating room. This increase in complexity is reflected by an increase of surgical costs. More time is required in the operating room. New implants and possibly acellular dermal matrix will need to be purchased. Finally, we tell our patients to expect a more prolonged recovery process when compared to their initial augmentation.

To offset costs, many implant manufactures have warranties in place that we will help you utilize. These often provide you with free or reduce cost new implants, and possibly a stipend to negate some of your surgical fees.