I've had saline implants for a year now. I kept telling my doctor that it felt as if the left one had never even "set in" and that both feels unnatural. He brushed this off. I have an appointment next week...Now they are saying it is probably encapsulated. Does this sound right? They are both so hard I now turn my body to give a hug! The right side is somewhat softer, but nowhere near others I have talked to.
Signs That Breast Implants Are Encapsulated?
Doctor Answers (28)
You have severe capsular contractures which need to be treated correctly
Hi! I am afraid you need a revision, and how it is done is crucial.
1) You need CAPSULECTOMIES. That means the existing lining around your implants needs to be removed. This lining has myofibroblast cells which cause capsular contracture.
2) You need NEW IMPLANTS. Your current implants have a biofilm on their surface which may contain bacteria, and even a few bacteria will cause capsular contracture. You don't need to have an obvious infection to develop another capsular contracture. This biofilm cannot be washed off.
3) The wounds should be irrigated with antibiotic solution, for the same reason.
4) Every last little bit of bleeding around the implants needs to be completely stopped, because even a small amount of blood can cause capsular contracture. I often use drains for a day or two in this situation.
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
Because of a number of techniques I use during breast augmentation surgery that are outlined below, I see very few capsular contractures in my breast augmentation patients. However, the reality is that if you are a breast augmentation patient with a capsular contracture, the incidence - at least to you - feels like 100%. A well-established capsular contracture can be corrected, but doing so involves a return to the operating room, removing and discarding the implant, removing or excluding the contracted capsule, creating a completely new implant space, and putting in a new breast implant (that statement may be somewhat controversial, but I believe the procedure just described is what is what provides a patient with the lowest risk of recurrent contracture). So I think that surgeons should feel obliged to do everything possible to limit the likelihood that a patient develops this frustrating postoperative problem.
Studies have shown that a bacterium called Staph epidermidis can be cultured from as many as 70% of capsule specimens obtained during surgical procedures for capsular contracture. So I employ a number of measure that address the possibility that skin bacteria or nipple duct bacteria may adhere to the implant surface during the augmentation procedure. We prep the skin using potent antiseptic solutions prior to draping the surgical site with sterile drapes, however the microscopic surface of the skin is full of peaks and valleys, and `nooks and crannies' - like sweat glands, hair follicles and sebaceous glands - that may harbor bacteria despite thorough application of an antiseptic prep solutions.
After prepping, we apply a new skin sealant product called InteguSeal to the skin surface where the incision is to be made. This effectively seals off all of the `nooks and crannies' that may harbor bacteria, and the sealant lasts for several days postop. We also apply it over the nipple and areola to seal off the nipple ducts which may also harbor bacteria.
Over the course of the surgery, we irrigate the implant space several times with a large volume of a saline solution containing three antibiotics (which can be modified in patients with an allergy to any of the antibiotics in the solution). Prior to implant placement, we irrigate the implant space with full-strength Betadine, a potent topical antiseptic that has been shown in clinical studies to reduce the incidence of capsular contracture.
I think one of the greatest advances in reducing the possibility of implant contamination by skin bacteria during breast augmentation surgery is the development of a soft, sterile, paper funnel for insertion of silicone gel implants into the implant pocket. This simple yet clever device actually looks much like a pastry chef's bag. It allows me to introduce the implant into the subpectoral pocket without ever touching it with my gloves, and without the implant ever contacting the patient's skin surface. The implant package is opened, the implant is irrigated with antibiotic solution then `poured' into the funnel, the small end of the funnel is inserted in to the skin excision which is held open with retractors, and I gently `squirt' the implant into the pocket. Before this was available, there was a great deal of implant contact with the patient's skin, under great pressure, as a pre-filled gel implant is forced into the pocket through a relatively small incision. The implant insertion funnel completely eliminates what I think has been the most concerning aspect of breast augmentation surgery in regards to the potential contamination of the implant with bacteria during the procedure.
There is no breast augmentation practice with a capsular contracture rate of zero. Yet there are obviously a number of measures that can be taken to make the rate of contracture as low as possible. I think it is important for patients to have confidence that their surgeon is focused not only on providing a breast enhancement that is beautiful and natural-appearing, but also on maximizing the likelihood that their aesthetically pleasing result will remain beautiful and natural-appearing over the long term.
Capsule Contracture Can Be Repaired
Your description of hardness is characteristic of capsule contracture.
Speak with your surgeon about options for repair and prevention of another capsule contracture, including:
- Surgical removal of old capsules (complete capsulectomies)
- Replacement of implants
- If your implants were in front of the muscle, the new implants should be placed behind the muscle
- Switching to textured surface silicone implants to prevent recurrence might be considered
- With smooth implants, an aggressive implant manipulation regimen after surgeryis important
Speak with your doctor about a possible post-operative medication regimen that includes:
- Vitamin E
- A prescription for Singulair or Accolate
- Avoiding caffeine
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If the breasts are firm and the implants are not mobile, then you probably have a capsular contracture. This is something that you should definitely talk with your doctor about. Most of the time you have to have the capsule removed to improve this situation.
You may have a capsular contracture
Either you have a capsular contracture or your implants were too overfilled at the time of their insertion. These are basically the only ways a saline implant can feel too hard. Maybe your expectations of what is normal for a saline implant are also incorrect.
I would suggest you visit another surgeon with your operative note and ask their opinion as to what is going on here. If you have a capsular contracture, a revision could be very helpful. If the implants are too overfilled, a revision may also be advisable. Probably you should consider gel implants this time because they are definately the preferred impants when patients place a high priority on the "feel" of their outcome.
A capsular contracture is the most likely problem
One of the potential complications of breast augmentation surgery is development of a capsular contracture. This is when scar tissue, which forms around the implant, becomes hard and potentially painful. Unfortunately, there is no easy way to address this problem other than surgery. The surgery would involve either making incisions through the scar tissue at several locations to allow the capsule to expand or removing the capsule completely. However, there is no guarantee you will not develop a new capsule in the future.
Discuss these options with your surgeon before making a final decision on whether to have a surgical revision.
It is likely you have a capsular contracture.
It is likely you may have a capsular contracture if you feel that your breasts are quite hard and do not appear as though they have 'settled'. The other possiblity is that your saline implants were overfilled significantly more than is recommended. This would also cause your implants to feel quite hard.
You may have a capsule forming or may want to consider silicone implants
You need to discuss your concerns with your doctor. Without examining you it is difficult to know exactly what is going on. Encapsulation can cause firm or even hard breasts. It is also possible that you are feeling the saline implants especially if you have very litlle breast tissue covering the implants. If that is the case, you might want to consider changing to silicone implants which can for some patients make the breasts feel softer even though they have little breast tissue to camoflage the implants .
Likely capsule formation.
Benhazed, The most likely explanation is that you have capsular contraction around your breast implants. This is a rare reaction by the body to the presence of a foreign material (the implant). Basically, the body forms a hard scar around the implant. You will likely need another operation to remove the capsule. If you implants were placed above the muscle the first time, it may be best to put the new implants under the muscle. Good luck.
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.