What's the best method to treat capsular contracture?

After an implant is placed in the performance of a breast augmentation the body forms a lining around the implant creating a barrier between the foreign object and the rest of the body. Normally this barrier is thin and soft and does not create any change in the appearance or feel of the breast. This lining is called a capsule. If this capsule thickens, becomes harder and shrinks in size the breast will feel firmer and possibly change shape. This shrinkage and or thickening of the capsule is called a capsular contracture. 92% of capsular contractures will occur within the first 12 months following surgery. Although the exact cause for a capsular contracture is not well understood there are a few things that seem to be related to this phenomena. Implants placed under the muscle have a lower incidence of capsular contracture than implants placed above the muscle. If bleeding occurs in the pocket after a breast augmentation, and is not removed the accumulated blood will gradually be broken down. As the blood is broken down inflammation occurs in the pocket which can then lead to the formation of a capsular contracture. Any type of infection in the pocket can cause inflammation leading to a capsular contracture. The infection can be very minor and not cause any other symptoms.

There are several different treatment options for an established capsular contracture. One of the simplest ways is to release a capsule contracture is is by performing a capsulotomy. In the performance of a capsulotomy the previous incision is opened, the implant is removed and the capsule is then cut in several different locations to release the constrictions and establish a softer breast. The implant was then replaced and the wound is closed. Unfortunately this procedure by itself has a relatively high rate of recurrence. Many surgeons feel that it is important to create a site change and replace the implant with a new one. A site change refers to moving the implant to a new pocket location. For instance if the implant had been placed underneath the breast the new pocket is made under the muscle layer. If the implant was originally under the muscle it can either be placed under the breast or in what's called a neo-pectoral pocket. A neo-pectoral pocket is developed by temporarily removing the implant and creating a new pocket behind the back wall of the capsule surrounding the implant. The implant is then placed in this new pocket. Most surgeons agree that it is also important to put a new implant in when treating a capsular contracture. This is due to the possibility that the old implant is covered by "biofilm". Biofilm is a barrier forms around some implants possibly secondary to a subclinical infection. A subclinical infection is one that affects the breast implant pocket but does not cause any other external symptoms.

Capsular Contraction is the #scar tissue that forms around the #implant is a natural response to a foreign object implanted in the body. The capsule can tighten and squeeze the implant making it firm. This is referred to as capsular contracture. This firmness (breast capsule) can range from slight to very hard. The firmest ones can cause varying degrees of discomfort or pain. #CapsularContracture can occur in one breast or both. Those experiencing this are candidates for Breast Revision Surgery. An implant revision or exchange intends to replace the damaged implants with new silicone or saline filled implants with newer technology. econdary breast surgery can be complex and needs to be done by an experienced plastic surgeon. The specific procedure to be performed will depend on the complications experienced and the condition of the implants.

It’s normal
for patients to form capsules around breast implants following breast
augmentation procedures.These capsules
are necessary to hold breast implants in proper position and, without capsule
formation, implants tend to migrate.Unfortunately, in a small percentage of patients, capsules become
exuberant.Under these circumstances,
they can cause implant distortion, implant hardening, implant migration, and
pain within the breasts.Unfortunately, the mechanism for
capsule formation is poorly understood.In some cases, it may be related to infection, while in other cases,
bleeding may be the cause.Regardless of
the precipitating event, inflammation appears to be a critical component.It’s important to note that the rate of
capsular contracture is significantly lower when breast implants are placed
beneath the pectoralis muscle.When capsule formation is relatively
mild, implant massage may occasionally improve the condition.Unfortunately, in many cases the problem
becomes progressive and the deformity worsens.When severe capsules occur, surgical
intervention may be necessary.In this
case, a procedure known as a capsulotomy can be performed.This procedure simply releases the capsule
and effectively increases the pocket size.In other cases, patients may undergo a procedure called a capsulectomy,
in which the capsule is actually removed.In some cases, removal of the implant and placement in a different
location, either on top of the muscle or below the muscle, may be necessary as
well.When these procedures are
performed, it’s not unusual to replace the current implant with a larger
implant.It’s important to wait for at
least six months before proceeding with surgical intervention to allow the
inflammatory response to diminish.The recurrence rate following these
procedures is relatively high and, for this reason, many surgeons utilize drugs
such as Singulair and steroids to decrease the inflammatory response.The use of these agents is somewhat
controversial and no scientific studies at this time have demonstrated
decreased rates of capsule formation.Once a severe capsule develops, it’s
important that the patient maintain close contact with their surgeon.Their surgeon should be able to formulate a
treatment plan that addresses their anatomic findings and hopefully achieves
their aesthetic goals.