I had saline implants for 10 years then one leaked (due to defective valve), deflated quickly, and encapsulated, so I had them both replaced with silicone. Now, a year later, i am experiencing swelling near my armpit, tenderness, and a small fever. My breast on this side has begun to itch, get smaller, and hard, while the other remains fine. my doctor says it is my fault for not massaging them everyday for the rest of my life, and it is a contracture. Is this really all me?
Silicone Implant Contracture: Is It the Patient's Fault?
Doctor Answers (19)
Capsular Contracture is Usually Not Anyone's Fault
Capsular Contracture is thought to be due to many reasons, and possibly a low-grade infection or hematoma. Implant massage is pretty standard for patients to do post-surgery, but it's not known how important it is to do this to prevent capsular contracture. I would recommend a 2nd opinion or 3rd opinion before deciding if you need more non-surgical treatment or surgical revision.
Capsular contracture is no one's fault
Is never the patient's fault
there are many potential causes for capsular contracture and it is a poorly understood problem. It is inappropriate for anyone to blame the patient for this problem. The goal should be to try and find the solution and make things better, not blame.
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Breast Augmentation and Encapsulation
Thank you for the question.
Encapsulation is the process of exuberant inflammatory tissue/scar tissue that builds up around a breast implant. It is unknown why some patients develop this process and others don't. Although there are a lot of “theories”, there is no science that is definitive when it comes to causation.
Placing blame or fault is not appropriate and/or helpful.
No evidence that massage works
The concept of massaging breast implants works in theory, not necessarily in practice. There is absolutely no scientific evidence that implant massage prevents capsular contracture. Sadly, some surgeons will do as yours has done and use 'inadequate massage' to blame their patients for capsular contractures. It is wrong and unethical. I suggest that you find another surgeon.
Capsular contracture...Who is at fault?
The answer to this question is no one! We do not really understand capsular contracture its causes or its prevention. What we know is that capsular contracture occurs and it is impossible to predict when and in whom it will occur. I recommend you find a surgeon you are comfortable with and have a discussion of this problem and its possible solutions. As you are having recurrent contractures I would also recommend that you discuss an acellular dermal matrix product such as AlloDerm or Stratice during your consultation.
Capsular contracture is not a fault of the patient.
Capsular contracture is a common occurrence after breast augmentation and a process which is poorly understood. There are several known risks to developing contracture including hematomas, infections, and radiation. However, most contractures appear to be idiopathic - meaning we do not know the cause. They are often one-sided and can recur several times. Some surgeons recommend massage and others do not. Simply removing the capsule and replacing the implant is an effective treatment for many patients. In refractory cases, the addition of acellular dermis (Alloderm or Strattice) to the augmentation seems to deter capsule formation and thus circumferential contracture, however this is a very expensive treatment option. The goal now should be proceeding to treatment rather than assigning blame.
Capsular contracture-it's not your fault
The cause of capsular contracture is not fully understood but it's felt to be due to an inflammatory process that develops due to microbacteria coming into contact with the breast implant. This bacteria can come from the breast tissue itself. Some patients just develop an exuberant inflammatory reaction to the implants and form thick, hard scar tissue (capsule). Most surgeons will coat the implant in an antibiotic solution to help minimize this risk. Also placing the implant under the pectoral muscle can help minimize the risk of capsular contracture. Regardless of what you or your surgeon does, the risk of developing capsular contracture is about 10%. We do know that smoking increases your risk, so you should not smoke before or after your surgery.
Although massaging your implants can help, it does not necessarily protect you from developing this condition. I usually have patients take high doses of vitamin E and sometimes Singulair-an asthma medication which is a potent anti-inflammatory drug which can help control/minimize the development of scar tissue.
Please consult with your plastic surgeon regarding treatment options for capsular contracture.
Capsular contractire in 1 year old silicone implant replacing 10 year old saline implants.
There are numerous factors that contribute to capsular contracture formation with biofilm formation being one of the most popular explanations. It is difficult to pinpoint the cause for your capsualr contracture in your description.
Capsular contractures are thought to be caused by many different things. There is no scientific support of massage and the avoidance of a capsular contracture. It may be multifactorial. There may be a genetic component, or an infectious cause to name a few. It is thought to be associated with hematomas as well.