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I Would Like to Know Why I Ended Up with a Capsular Contracture.

I am 5 mths post op I had textured implants under the muscle and took 800 iu a day since my surgery what went wrong help. Thank you

Doctor Answers (8)

Why Do You Have Capsular Contracture Around Your Breast Implants

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There are many factors that can contribute to the formation of capsular contracture around breast implants. The most common are:

  • Sub-clinical Infection-there are bacteria that can cause a mild infection that does not make the breast red or give you a fever, so it is not detected. This is a major cause of capsular contracture. This is why most surgeons use a careful sterile "no touch " technique when Breast Implants are inserted and many soak the Implants in an Antibiotic Solution and prescribe antibiotics during and after surgery
  • Excess bleeding during surgery- Excess blood in the pocket after surgery can encourage scar formation, and a capsular contracture is a scar.
  • Failure to do Breast Implant displacement exercises-by exercising and moving your implant around inside the pocket daily can stretch the normal scar and keep the implant mobile and soft.
  • A flu like illness soon after surgery-there is some evidence that a flu or other febrile illness soon after surgery can encourage capsular contracture
  • You are prone to develop capsular contracture-some women are naturally predisposed to form capsular contractue-there is no way I know of to predict this.
  • If you have a capsular contracture there is a 50% chance that you will form another one if revision and re augmentation is done.

Textured Breast Implants are the best implants to use to prevent capsular contracture. Ask your doctor about displacement exercises.


Boston Plastic Surgeon
5.0 out of 5 stars 34 reviews

Capsular contracture

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Dear patient,

Nothing went wrong; it is common for some women to have a capsule formation around any implant. However, there are varying degrees of capsule formation. Usually formation does not cause any negative symptoms. Some symptoms may include harder breasts and/or pain.

 

Teanoosh Zadeh, MD
Montreal Plastic Surgeon
5.0 out of 5 stars 5 reviews

Capsular contracture

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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. 

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.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.5 out of 5 stars 41 reviews

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Capsular contracture

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Why do some people get capsular contractures and other do not?  That is the big mystery in breast augmentation surgery.  There are several theories but none well proven.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Causes of capsular contracture.

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Capsular contracture is tightening and thickening of the scar every woman's body forms around her breast implants (or any implanted object, like a pacemaker, for example). If the scar capsule is soft, thin, and pliable the breasts are soft and natural; if the scar is thick, tight, and contracted firmly around her implants, this is called capsular contracture and the result is breast firmness (and sometimes pain).

Breast implants do not become hard, ever.

When a breast enlargement patient has abnormally hard breasts, the problem is the scar capsule around the implants — for one reason or another, the capsule has thickened and contracted, squeezing the implant into a smaller space and causing the hard "feel" to develop. The human body creates a scar around any kind of foreign body, whether it is a pacemaker, a breast implant, or an artificial hip. Since every person forms scar tissue around any foreign body, every woman undergoing breast augmentation will have a capsule, but fortunately, only a few will develop capsular contracture to a problematic degree. If the scar capsule is thin, soft, and pliable around a breast implant, the augmented breast will feel soft. Since all scar tissue contracts, an excessively thick, non-pliable, and contracted scar capsule around a breast implant can make an augmented breast feel hard. Capsular contracture can be mild (Baker grade 2), moderate (Baker grade 3), or severe and visibly deforming (Baker grade 4).

Many studies have been conducted over the years regarding capsular contracture, and how to control or minimize the likelihood that it will occur. With a surface skin cut or surgical incision, despite any surgeon's skill, best efforts, and technique, some patients will heal with a thick, wide, or ugly scar. This occurs rarely, and is slightly more common in patients with darker skin. Vitamin E massage, scar pads, steroid tape or injections, or even scar revision plus any or all of the above can be used to reduce visible surface scars. Radiation treatments have even been used for the most severe surface scars, known as keloids. Fortunately, these are uncommon. Similarly, internal scar contracture causing firmness or distortion of appearance is also uncommon, occurring in 5-10 percent of augmentation mammoplasty patients. If this occurs, surgical revision may be necessary, and contracture may in some cases recur despite careful re-operation.

Avoidance of most cases of capsular contracture is possible, in our opinion, by careful initial surgery and patient compliance with postoperative instructions. Bleeding (even a small amount) around your implants can lead to increased scar capsule formation, and is probably the number one cause of capsular contracture! If your surgeon used blunt dissection techniques, if you are wrapped in an Ace elastic bandage or tight surgical bra to "reduce bruising and bleeding," or if a drain is used "to remove the excess blood," you may be at increased risk for capsular contracture, simply because the way the surgeon does his or her operation.

Any foreign body, such as talcum powder from the surgeon's gloves, cotton fibers from surgical sponges, dust or bacteria from the air of the operating room on the surface of the implant, and bacteria from the ducts of the breast, as well as post-operative bleeding or bruising, can cause an increase in scar formation. This is analogous to a grain of sand in an oyster; in humans, a pearl is not formed, just layers of scar tissue, in response to one or several of these irritants. Every effort is taken to reduce all of these to an absolute minimum in order to minimize the likelihood of capsular contracture. I utilize a no-touch technique (facilitated by use of the Keller funnel) to place implants, as well as antiseptic irrigation, pinpoint cautery control of capillary bleeding, and avoidance of sponges in the pocket.

Most investigators now have identified bacterial biofilms on the surface of implants (from skin contamination, intraductal bacteria, or "normal" bacteria present in hair follicles or sweat ducts) as perhaps the second most common instigator of capsular scar contracture. Minimization of this biofilm by use of a no-touch technique, Betadine irrigations, or appropriate antibiotic irrigation helps keep capsular contractures from bacterial sources to a bare minimum.

I never use drains for breast augmentation. Drains may allow blood or fluid out of the pocket, but of greater concern is that they can allow bacteria in, increasing the risk of contracture or infection severe enough to require implant removal. Careful surgery and control of all bleeding points is preferable to a drain or a tight surgical bra or elastic wrap after surgery! Intravenous antibiotics are used prior to surgery, and oral antibiotics are continued for several days post-operatively.

Recently, a new type of medication (in use since 1999 for the treatment of asthma) known as a leukotriene inhibitor has been shown to be helpful in possible prevention, reduction of severity, or even reversal of capsular contracture. Though preliminary, the use of this medication (zafirlukast, trade name Accolate™, or a similar drug Singulair™) may be an alternative to re-operation for removal of capsular scar tissue, or may lessen the likelihood of capsular contracture recurring after surgery. If you have liver disease, this may not be a choice for you, as this medication can have hepatic side effects in a small number of patients. I usually also prescribe 400iU of Vitamin E twice daily in addition to a leukotriene inhibitor in cases where capsular contracture is being treated or (hopefully) prevented.

I also question the use of textured implants BELOW the muscle. Since textured implants "work" by having tissue "adhere" to the textured surface, this means the implant pocket must be the exact size of the implant, and no movement is advised, or the tissues won't "stick" to the textured implant. In the submuscular position I recommend smooth implants and a pocket slightly larger than the implant's size, with implant movement exercises (often incorrectly called "massage") designed to keep the pocket open and larger than the implants. Even if the scar capsule contracts slightly, the pocket will still be larger than the implant, and the breasts will still feel soft and the breast implants will drop to the side of the chest when reclining, as natural breasts do. (HINT: natural breasts don't point straight up like a couple of hard coconuts!)

So, after all this explanation, you may have an idea or two as to what happened with your surgery. Or perhaps your surgeon did everything "RIGHT." Capsular contracture still occurs in a few of my patients, but it has become quite rare since I follow the "rules" and scientific evidence as to how to best avoid capsular contracture in my practice. And I do well over 150 breast augmentations per year, so this is not random.

Talk to your surgeon, or get several more opinions from experienced ABPS-certified plastic surgeon who do lots of breast surgery. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 126 reviews

Why capsular contracture

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Unfortunatly we don't know why capsular contracture occurs in some individuals. All will develop a natural scar capsule around breast implants, though a very few, perhaps 5%, will develop a tight capsule and firm implant. Very often the capsule contracture happens on just one side. Despite all the measures we take to prevent them, a few continue to occur.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 29 reviews

Capsular contracture

+1

Unfortunately, capsular contracture has been a problem with breast implants since the first implants were used in the 1960's.  There are a number of theories as to why this happens but we do not know all of the potential causes.  As plastic surgeons we do a number of things to try to prevent this problem but some patients will develop capsular contracture despite taking these precautions.

In some cases aggressive massage may help. In most cases, however, patients end up having surgery to remove the capsule completely and ideally replace the implant so you are starting over.  Unfortunately, the problem may recur.

Thank you for your question and good luck.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
4.5 out of 5 stars 24 reviews

Your body made the capsular contracture

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There are a number of measures plastic surgeons take to minimize the risk of capsular contracture but nothing can take the risk to zero.  A CC is your body overreacting to the presence of an implant and making a harder scar around the implant than would be ideal.  100% of patients make a capsule, only around 5-9% make a CC.  There is no positive factor known to cause this but a bacterial biofilm is currently believed to be the culprit.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 49 reviews

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.