I had a lift and implants done two and a half years ago. I recently noticed that one breast seemed higher and firmer with slight discomfort now and then. After consulting with my doctor, he said I have Capsular Contracture. I have been reading up on it, specifically to see if this is something that could have been prevented. He said that most patients, although small in percentage, have the tissue taken out and/or a new implant. I know I paid top dollar for a very reputable surgeon. Am I wrong in thinking this should not have happened? Also, should this additional procedure be covered financially by the doctor? What are my "rights" in a situation like this?
Bad Breast Implant Results. What Are my Rights?
Doctor Answers (18)
Capsular contracture after breast augmentation
Capsular contracture, or scar formation after breast augmentation, is a common problem after surgery and a recognized complication. It is certainly not malpractice.
Capsular contracture occurs with every single busy surgeon. Capsular contracture is more common in implants placed above the muscle than implants placed below the muscle.
Modern techniques can minimize the formation of capsular contracture, but not prevent it altogether.
You should communicate with your surgeon about the problem and discuss with him what can be done now. Often, removal of the scar tissue in surgery is an option.
Capsule Contracture Can Occur
Sorry to hear you've developed a capsule contracture.
Capsule Contracture is a known albeit undesirable outcome with breast implant surgery.
It is impossible to guarantee a result with surgery.
That a complication occurs does not necessarily mean that someone did something wrong. Unfortunately, complications can occur, even in the hands of the best surgeons, staff and facilities.
Your best alternative is to consult with your surgeon about the options available to you, but it is unreasonable to expect financial support for treatment of a known complication.
Unfortunately, cosmetic surgery does not come with a guarantee.
To Stacy Tanner,
Hi Ms Tanner. You are faced with a recognized complication. Every good plastic surgeon gets a low but real number of capsular contractures. So there is no reason to blame your surgeon.
Setting aside the issue of fault, surgeons want their patients to be happy. After all, most of our new patients come from happy patient referrals. My own policy is not to charge for any revisions that are necessary within one year of the original surgery, but to charge after that. I am sure you can understand that we cannot offer lifetime guarantees. Your surgeon may have a different policy. Talk to him.
The bad news is that once you have had a capsular contracture, you are somewhat more likely to get another one. But the odds are still way in your favor
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Unless there was a deficiency in the informed consent or your doctor has insurance to cover complications of cosmetic surgery as mentioned by others, there is not much recourse. In certain situations, insurance companies may cover problems associated with breast implants such as capsular contracture. You should realize, however, that what you describe is not necessarily considered a complication since displacement and hardening are known and accepted risks of breast implants. If you still have a good relationship with your surgeon, carefully discuss your options. Or seek a second opinion by another reputable board-certified plastic surgeon. As a note, strictly speaking, a doctor offering a second opinion should not be expected to take over your case, merely confirm or not confirm your originally surgeon's assessment and recommendations.
This can happen to anyone!
Unfortunately, capsular contracture is a very well known complication of breast implant surgery that can happen to anyone at any time. To make matters even more confusing, we really don't completely understand why it happens or who it will happen to. Some people are at higher risk in general, and it may occur early after implanmt surgery or late (even many years later!) There are certain surgical maneuvers which can be performed to help decrease the chances of it occurring, such as trying to prevent infection, washing the pockets out with antibiotics and mainting excellent hemostasis with complete prevention and control of intraoperative bleeding and excellent technique. These should help guard against early capsular contracture (as in a few weeks to months after surgery). In addition, the placement of implants in a submuscular or dual plane location, as opposed to under the gland only, is thought to help prevent later capsular contracture. Late capsular contracture is a big unknown, however, and everyone is at risk!
As for the treatment - your doctor is correct - the treatment is surgical in nature: usually the capsule is removed and the implant replaced. All practices handle the costs differently. I do not charge my patients (the ones in whom I placed the original implants) for surgery to correct this condition; however they are responsible for the OR fee, anesthesia, and the cost of a new implant (if necessary) and patients are made aware of this policy (as well as the possibility of capsular contracture occurring) at the original augmentation consultation.
Good luck and I am sorry that you are dealing with this unfortunate, but well known, complication of breast implant surgery.
Unfortunately capsular contracture is a form of scarring that happens to be internal and there are no current methods for its prevention, just like scars on the skin cannot be prevented. Placing the implants below the muscle helps but does not prevent it.
This can be financially difficult. Sounds like you have a good surgeon who is working with you. Discuss your concerns and many surgeons will limit their fee for their own patients but typically you would pay for the anesthesia and facility fees.
You can also discuss the use of medication (Accolate) for treatment of capsular contracture that has been tried. However, this is off-label use of the drug, and you need to thoroughly discuss it with your surgeon.
Talk to your surgeon about capsular contracture
I'm sorry you're having problems.
Unfortunately, capsular contracture is a well-recognized risk of breast implant surgery, and while it is thankfully fairly rare, it does happen to many women if their implants are in place for a long enough period.
Early capsular contracture, as you have experienced, is even more uncommon but is known to occur in a small number of patients. We really do not have a clear understanding of exactly what causes this problem (although we know about a few things that increase your risk), and so it is impossible to say that something "could have been done to prevent" the problem.
When it does occur, the best and safest solution is unfortunately surgery to remove the capsular tissue. This will unfortunately generate costs, and those costs must be borne by you as the beneficiary of the intervention to correct this problem (that could have happened to anyone).
However, while I do not think that your surgeon is responsible for your problem (it happens to the best of us), I'm sure that he or she would like for you to be as happy as possible- talk to him/her and review your options for management, and ask about any financial consideration they might offer you as an existing patient. I bet you can work something out.
Capsular Contracture can occur in anyone
I am sorry to hear that you have developed a Capsular Contacture. It occurs in approximately 2-3% of women with submuscular/under the muscle implants and up to 10-12% of women with implants on top of the muscle. There is no predicting who will get a contracture and no reliable method of prevention. This is most likely not a fault of the Plastic Surgeon. That does not mean that they don't want to help you.
Unless your doctor provides cosmetic surgery insurance, you really have very little recourse. If it is a problem with the implant and you have the warranty, there may be some financial help. Both Mentor and Allergan will provide new implants and some financial compensation if the implant has a mechanical failure. This change in shape can only be evaluated by your Plastic Surgeon to tell if it is a tissue problem or implant problem.
Most Plastic Surgeons will work with you to correct the problem. If any of our patients develop a contracture, we reduce all the fees to assist the patient with the surgical revision. We do not perform the procedure for free. This requires OR time, anesthesia time and expense, supplies, nursing, scrub techs, etc. This additional cost is not built into the original fee. You should discuss these issues with your doctor. But you do not have any legal recourse to recoup any additional cost.
Capsular Contracture - Who Is Responsible ?
Capsular Contractures occur unfortunately in 5-10% of patients and in the vast majority of cases is unrelated to the surgeon, but rather your body's response to the implants. In other words your surgeon probably did nothing wrong.
In all surgical specialties and procedures you are paying for the surgeon's best surgical efforts and care. There are never any direct or implies guarantees of success and this is especially true of Plastic Surgery which is both an Art form and Inexact Science. For example if you rejected a kidney after it was transplanted you would not expect your money back. If you looked over the consent paperwork you signed, I am sure you will find this explained as it is standard for all surgeons.
Capsular contracture can not be predicted and is our bodies particular reaction to the implant.Your surgeon did not do anything wrong which is the reason for and necessity for to be responsible financially for additional procedures.
Development of capsular contracture
Although you may feel upset about the capsular contracture, there are many ways to correct the problem and minimize your risk of developing complications associated with it. I would advise you to speak with your surgeon about those options. He will provide insight into the development of the capsular contracture and its causes.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.