Capsular Contracture

  • Capsular Contracture Overview
  • Etiology of Capsular Contracture
  • Procedure Walk-Through
  • Capsular Contracture FAQs

 


 

Capsular Contracture Overview

Among the most common breast revision surgeries performed among plastic surgeons is capsular contracture surgery. A capsular contracture is hardening of the breast secondary to an abnormal thickening of the breast capsule. When any foreign object, such as a breast implant for example, is placed within the body, the body forms a lining around it. Normally, this lining is gossamer thin and pliable. Should the lining become abnormally thickened, this is referred to as a capsular contracture.

 

Baker Classification for Capsular Contractures

  • Grade 1: The breast is soft and natural
  • Grade 2: The breast may appear normal but feels a little firm
  • Grade 3: The breast appears abnormal and feels firm
  • Grade 4: The breast is abnormal, rigid and firm, and the patient may experience pain — the worst case scenario

 

 

Breast hardening

 


Etiology of Capsular Contracture

During breast augmentation surgery, a pocket is developed within the breast in preparation for implant placement. During the healing process, a thin capsule forms, which is comprised of fibrous tissue. The body is genetically programmed to shrink scar tissue somewhat.

Under normal conditions, the pocket remains open, and the capsule remains pliable, allowing the implant to move unrestricted within the implant pocket, while at the same time remaining soft to the touch. In a small percentage of women, however, the capsule will thicken, causing tightness, upper migration of the implant, pain, and distortions in the breast appearance.The underlying cause of capsular contracture formation remains unclear, and there are several suspected causes for its formation. These include:

1) Transient bacterial contamination –  Bacterial contamination of the implant shell can cause an inflammatory reaction with the development of biofilm, which is thought to be a cause of capsular contracture formation.

2) Sub-glandular implant placement – Breast implants placed above the muscle tend to have higher capsular contracture rates, versus breast implants placed in behind the muscle, also known as sub-muscular placement.

3) Infection – Capsular contractures are more commonly seen in breasts which have developed infections following implant placement.

4) Seroma –  Patients who develop seromas or fluid collections, may be at greater risk for capsular contracture formation.

5) Hematoma – Hematomas, or blood collections in the breast pocket may cause an inflammatory reaction, which can lead to capsular contracture formation.

6) Smoking –  Smoking decreases the oxygen levels in the blood, which could result in delayed healing, and possibly an inflammatory reaction.

 

 

Capsular Contracture – Before and After Photos 


Procedure Walk-Through

The development of capsular contracture is the most common complication of breast augmentation surgery and can develop at any point following the breast enhancement procedure. It is an unpredictable event.  One or both breasts may become affected at any point following breast augmentation. The treatment for capsular contracture is a capsulectomy.

A capsulectomy is a surgical procedure in which the surgeon removes the capsular contracture, preferably in its entirety. Because biofilm is suspected of being a potential culprit of capsular contracture formation, complete removal of the capsule is recommended, along with replacement of implants with new breast implants. Additionally, Dr. Vallecillos may recommend that the implant pocket be changed, such as going from a subglandular implant pocket to a submuscular.

  • Preparation – If you believe you are suffering from capsular contracture, the first step is to make an appointment for a consultation. Dr. Vallecillos will assess the severity of your condition and recommend an individualized treatment plan. Following initial evaluation and surgical date has been scheduled, you will be instructed to stop taking any blood-thinning or anti-inflammatory medications, herbs, or vitamins (such as aspirin and Ibuprofen) for two weeks beforehand. If you smoke, you will be asked to quit for at least two weeks before and after your procedure. Patients over the age of 45 will require medical clearance from an independent physician prior to undergoing a breast revision surgery.
  • Anesthesia – General anesthesia is most commonly used in capsular contracture treatment surgeries.
  • During your surgery, Dr. Vallecillos will reopen the original incisions and remove the original implant and the surrounding scar tissue, known collectively as the capsule. Once all of the associated tissue has been removed, the breast pockets will be restored or in some cases, new pockets will be created (such as when moving the breast implants from a subglandular to a submuscular placement is recommended). Then new implants will be inserted, and the incisions will be closed.

Capsular Contracture FAQs

 

Who should have breast capsulectomy surgery?

Patients who have developed a capsular contracture may require breast capsulectomy surgery, especially if they are symptomatic and there is significant distortion and/or associated pain of the breast.

What are the benefits of breast capsulectomy surgery?

The primary benefit of the surgery is to relieve the constriction that the capsules in the breast cause. Additionally, replacing the implant will provide a much more natural, softer appearance, increasing self-confidence. Following surgery, patients will have breasts that are relieved from the prior constriction, and which feel softer to the touch and feel more natural.

Can the breast capsulectomy be avoided?

Understandably, the thought you may develop a capsular contracture following breast implant surgery is a frightening prospect. Capsular contractures are rare, however, and the majority patients will never experience them. Currently, there is no proven strategy to avoid the development of capsular contractures. Additionally, the majority of patients that require capsulectomies for correction of capsular contractures never experience a recurrence of the problem.

Who may not have breast capsulectomy surgery?

Any patient who develops a capsular contracture secondary to breast implant surgery is a potential candidate for capsulectomy surgery. Typically, guidelines for surgical selection include a history of contracture for no less than a year from when the implant was placed. At a year’s time, the capsule surrounding the implant is well formed and is much easier to excise, increasing the chances that it will not recur. Assuming that the patient is cleared medically for surgery and doesn’t have risk factors such as smoking, they may be a candidate for surgical correction of the capsular contracture.

Why choose Dr. Vallecillos for capsulectomy surgery?

Dr. Vallecillos is a Diplomate of the American Board of Plastic Surgery in Beverly Hills, California with a practice emphasis on breast revision surgery.  During your consultation, Dr. Vallecillos will give specific recommendations regarding capsular contracture management and treatment options.

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