What's the Best Method to Treat Capsular Contracture?
- Asked by Oct2009 in New Jersey
- 3 years ago
I had breast aug 10/15/09. Saline, under the muscle. I have capsular contracture in my right breast & have tried massaging & singlair per my surgeon. I am going to have to go back into the operating room to correct.
What is the better method--having the tissue cut and corrected or replacing the implants? I am not happy with the size of my implants (too small) and would like to upgrade. However I do not want to increase my chances of this happening again.
You may have heard of someone's breast implants 'turning hard'. It is not the implants themselves that turn hard, of course; what has really happened is that the fibrous capsule around the implants has tightened and thickened, making the implants less mobile and causing them to feel firm (and eventually, in some cases, even 'hard'). The medical term for this phenomenon is 'capsular contracture'. It is a problem that is best managed by avoiding it altogether, and fortunately there are a number of things that can be done on the day of surgery to guard against it.
Any time a foreign object is implanted in the body, whether it is a pacemaker or a breast implant or an orthopedic device or anything else, the body responds by forming a thin, wispy, fibrous membrane around it. In most cases this membrane or 'capsule' stays thin and wispy, but in some cases over time the capsule may tighten around the implant and thicken, making the implant feel firm or even hard. In advanced stages the contracted capsule can even distort the shape and position of a breast implant. Capsular contracture can be treated, but it is a surgical treatment, so avoiding capsular contracture is all about avoiding another trip to the operating room.
Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.
It is believed that capsular contracture is primarily a response to the presence of low-virulence or non-virulent bacteria (i.e. not the kind that generally produce an actual infection, with redness/tenderness/fever etc) that adhere to the implant surface on the day of surgery, and which over weeks and months following surgery stimulate the cells that make collagen (called fibroblasts) to make more collagen - thickening the capsule and stimulating it to contract and tighten around the implant. It is not an actual infection; there are no symptoms that this is going on, and taking antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient's skin, or the ductal systems of the breast that lead to the nipple, as both are normally colonized with bacteria.
Because plastic surgeons now have an understanding of some of the reasons why capsular contracture occurs, there are a number of measures that can be taken to significantly reduce the likelihood that it will happen following breast augmentation surgery.
Web reference: http://michaellawmd.com
Treatment of Capsular Contracture
The fact is that EVERY single foreign body or implant in our body becomes walled off by scar tissue. The body simply will not tolerate it otherwise. The scar tissue (also called CAPSULE) can be soft, impalpable and pose not symptoms (BAKER I class capsule) OR It can be hard, visible, palpable and associated with discomfort (BAKER IV capsule=CONTRACTURE).
Contractures have been associated with bacteria (placed at the time of surgery or by infections elsewhere in the body months to years later), by blood in the pocket, by cloth or surgical gown micro-fragments, by powder off the gloves - BUT the most common cause is never identified (in Medicalese - it is IDIOPATHIC).
Since we do NOT reliably know what caused a contracture, we cannot always reliably permanently fix it. Treatment with asthma drugs is based on nonscientific studies that it works in some cases. But - use of Accolate has been associated with rare cases of severe liver damage. So Plastic surgeons are justifiably leery of such use. In some cases Vitamin E and other drugs have been used with mixed success.
Partially weakening the scar with serial cuts (IE CAPSULOTOMY) helps immediately but in many cases the scar tissue reforms. Removal of the scar tissue (IE CAPSULECTOMY) can be complete or partial. Many of my colleagues would agree that complete capsulectomy is bloody (thereby increasing subsequent recurrence) and prone to major complications.
I think a partial capsulectomy, total irrigation of the pocket with antibiotic solution (both to remove any particulate matter and bacteria) and replacement with new implants (free of potential bacteria) is a safe way to proceed.
Personally, I would NOT "go larger" unless you have enough breast tissue to cover the new implants. But you and your surgeon need to discuss this. The act of removing the capsule makes the pocket larger which MAY make the implant look smaller.
Dr. P. Aldea
Capsular contracture treatment options
When any foreign object is placed in the body, the immune system responds by forming a lining around the object. While the causes for capsular contracture in breast implants are still unclear, the condition is fairly easy to treat surgically. Some surgeons will surgically reopen the breast and cut the scar tissue to release its hold on the breast implant. Most surgeons will surgically reopen the breast, completely remove the scar tissue that is causing the capsular contracture, and insert a new breast implant (or remove them completely based on the patient’s wishes). This option can offer an added benefit, because the scar tissue that may be causing the contracture can be removed and the size of your implant can possibly be increased all in one surgical procedure. As far as which option is the better method would be based on your individual case. It is important for you to discuss your best options with the plastic surgeon that performed your breast surgery as he/she is best suited to address the capsular contracture. If you are not satisfied with their answer then it is certainly your decision to be seen by another plastic surgeon to get another opinion.
Recent Breast Implants Reviews
Breast Implants Photos
It is unclear why capsular contractures develop in one patient and not another. It may be multifactorial. I usually remove the capsule and replace the implants.
Preveneting recurrent capsular contracture with revision breast augmentation
Treatment of capsular contracture
You have brought up an important topic.
Unfortunately, since we don't know the exact cause of capsular contracture, we cannot prevent this problem.
The only two methods which have any chance of correcting your situation is capsulotomy (where cuts are made in the capsule to "open up" the tightness) and capsulectomy (where the entire capsule is removed).
I reserve capsulectomy for patients who have had recurrent contracture, as it is a much more involved procedure and the chance of thinning the breast tissue is higher. This may make your implants more visible.
Unfortunately, there are occasional patients who develop recurrent contracture and may be better off with no implants.
Treatment of capsular contractures
Unfortunately, capsular contracture continue to plague plastic surgeons and our patients despite using the best techniques known to prevent them Non-surgiacl methods of treating capsular contractures include multiple sessions of external ultrasound and oral medications suche as Accolate, Singulair, PavaBid, and Vitamin E. I have had only rare success in treating capsular contractures non-surgically.
Most patients will require surgery to remove the entire capsule or create a neopectoral pocket-- a new pocket right on top of the old one. The addition of a material called Strattice, a type of acellular matrix, has been show to prevent the formation of a scar capsule completely around the implant and prevent contractures. Despite its expense, I have found Strattice to be very useful.
Remove the capsule and use new implants
The most successful treatment in my experience is removal of the internal scar, either partial or complete, and replacement with different implants. I would also consider silicone as you have encapsulated with saline already. I would also use the under the muscle position as I feel the risk of reforming a contracure is lower.
You must understand however that you may reencapsulate - some patients are very prone to this problem. Modern medicine has not completely solved this issue and you must take this into account. The good news is that this procedure usually works. Good luck.
Best method to treat capsular contracture
The best treatment for capsular fibrosis is to first find a cause. Like a postop bleed, infection or a scar former by genetic history or no excercise after surgery, combo of these. Than the BEST treatment is re operation and removal or incising the scar capsule.
From MIAMI Dr. B
Removal of the capsule will help
The best thing would be implant exchange and also release and removal of the old capsule. The other technique that may help is use of drains.
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.