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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

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.

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Capsular contracture

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

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 50 reviews

Capsular contracture

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 18 reviews

Why capsular contracture

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 33 reviews

Capsular contracture

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 35 reviews

Your body made the capsular contracture

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.

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.