I had 400cc silicone gel implants placed above the muscle a little over a year ago and recently noticed a hardening/tender left breast. I went for a follow up with my PS and he would like to repair this "grade 2" CC. He states it is not necessary to replace the implant, is this safe practice? It makes me feel like I am being set up for yet another CC. Also,I was never instructed to massage/use commpression postop,common? Could it have contributed to my problem? Is it too late to try Singulair?
Grade 2 Capsular Contracture - Implant Replacement Not Necessary?
Doctor Answers 6
Treatment of Grade 2 breast implant augmentation capsular contracture
The anecdotal reports of leukotriene esterase inhibitors were predominanlty reported with Accolate (twice a day) but the convenience of Singluair makes this more popular. However, these reports stated that it was most effective in the first 6 months of treatment. While the idea of a new implant will treat the concept of a biofilm, it is not the standard or universally practiced. Open capsulotomy may be the intial approach.
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Managing an Early Grade II Capsular Contracture: Guidelines to Consider
The surgical treatment of early capsular contracture in my practice is reserved for patients who have undergone conservative treatment first. A good percentage of the time, with conservative treatment, capsular contracture may stop progressing or even improve. I like to use massage techniques and Accolate as the medication of choice. Massage is more useful for smooth surface implants, so it will be important to discuss this option with your doctor before initiating any treatment. I do not see any downside to trying conservative treatment first!
If you elect a procedure, I would recommend replacing the implant. If there is a biofilm associated with the implant, recurrent capsular contracture is much more likely to occur with re-use of the old implant. Good luck!
Capsular Contracture After One Year
If your one breast is harder, painful or different in shape than your other breast then capsulotomy or even total capsulectomy would be my treatment of choice. Singulair has not been shown to be effective at this late date nor would massage be of benefit.. I would not replace your implant and with the implants being on top of the muscle capsulectomy is usually not much more difficult than capsulotomy.
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If you have a grade II capsule with some firmness around the implant and I am assuming an asymmetry to the other side, it is reasonable to keep that same implant. But you are at tisk in general for a recurrence.
Implants do not need to be replaced in capsular contracture
When treating capsular contracture, it is not essential to replace the implants. Sometimes patients want to changed the size or the type of the implant at the same time and this can be done. But that is not relevant to the treatment of capsular contracture itself.
You are not being set up for another CC. Unfortunately nobody really knows what causes capsular contracture, and there is no test we can offer our patients to predict to whom this will happen, and if it will keep happening again and again.
Ideal treatment is to move the implant into a new(fresh) pocket and minimize risk of any contamination or bleeding during the surgery. Postoperative massage is thought to help and we ask all our patients to do it, but there is no real scientific evidence to back this up. Singulair can help when capsular contracture is forming, but has not been shown to reverse a well established, hardened capsular contracture.
Treatment of capsular contracture
From your description, it doesn't sound as though have have a Grade 2 capsular contracture. This is the grading system for capsular contracture (Baker score):
Grade 1 - The breast is soft, and looks natural. This is pretty close to normal for all breast implant patients.
Grade II - The breast is a little firm, but appears natural.
Grade III - The breast is firm, and is begins to appear distorted.
Grade IV - The breast is hard and painful, and has become quite distorted.
As you can tell, the grading system is quite subjective. It sounds as though you have some pain and hardening, which would put you in the grade IV category; if your implants are sitting higher and tighter than they were a few months ago, this would confirm that.
The approach to treating a severe capsular contracture usually involves performing an excision of the capsule, converting the implants to a different pocket (either behind the muscular fascia or behind the muscle), and changing the implant. It's not common to operate on true grade 1 or grade 2 capsules, as they tend to be of minimal clinical significance. For a true Grade 2, Singular may have some efficacy, but probably not for what you are describing.
In regards to massage / implant compression, some surgeons recommend it to their patients, whereas other don't. I do have may patients do it, but I'm not sure how much benefit it really has.
Hope this helps. Best of luck - Sam Jejurikar
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