Treatment for Capsular Contracture, What are My Options

I had breast augmentation in late January and in May was diagnosed with capsular contracture on my left side. It has not dropped nearly as much as my right side and is firmer and starting to have some pain as well. I am confused regarding whether to go back to my original surgeon because he does not believe in putting in a new implant or finding another surgeon that specializes in revisions or trying ultrasound treatments before opting for surgery again.

Doctor Answers (9)

Treatment and prevention of capsular contracture

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All breast implant surgery carries some chance of capsular contracture, in which the natural scar capsule contracts and the breast then feels hard. Contributing factors include hematoma (bleeding around the implant after surgery), and radiation treatment (for breast cancer). Probably the most common cause is an invisible layer on the implant called a biofilm, which is formed by bacteria from either the skin or the milk ducts within the breast tissue. For this reason it is typically recommended to replace the implant. For recurrent or severe problems, consider Strattice or Alloderm which seems to be very helpful in preventing a recurrence.


Seattle Plastic Surgeon
5.0 out of 5 stars 23 reviews

Capsular Contracture Options

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In general, once a patient has capsular contracture, very little that you can do externally will make a difference.  The external ultrasound is hit-or-miss, and does not make a difference in most patients.  In order to address it properly, you need to go back in there and release/remove the scar capsule as gently as possible.  This does not mean you have to change the implant.  Contracture generally comes from trauma/bleeding in the pocket during or after surgery.  The implant would play little role in its development when it has only been in a few months.  The fact that you noticed things pretty early on means it is probably related to the original surgery.  You do not change the implant unless someone wants to change the size, or the patient has persistent contracture that keeps re-occuring.  Since this is your initial surgery, I would undergo a capsulectomy, keep the implant, and see what happens.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.5 out of 5 stars 18 reviews

Treatment of breast implant capsular contracture

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Alexa, as you probably know, capsular contracture is the formation of abnormal scar tissue around the breast implant. Every breast implant has a capsule, but when the capsule is too tight around the implant, it usually requires surgical intervention. Its a little too early to jump into revision surgery (6 months post-op). I agree with some of my colleagues.

I recommend the following after 1 year

1) Capsulectomy

2) Implant exchange (Use same implant?)

3) Implant pocket change

4) Acelluar Dermal Matrix (ADM) such as AlloDerm and Strattice. They can be expensive but some of the earlier studies are showing promising results.

Other modalities such as closed capsulotomy, massage, ultrasound, and leukotriene inhibitors like Singular and Accolate have not been proven to help. As a matter of fact, some of them has additional risk you need to consider.

Whatever you decide to do, discuss this with your Board certified Plastic surgeon. A second opinion is fine. A free consult may be a sales pitch and may not be in your best interest. Pay for the surgeons time & real opinion. Look for a Plastic surgeon with extensive experience in secondary breast surgery.

Good luck, Dr Okoro

Stanley Okoro, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 81 reviews

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Treatment of capsular contracture depends on the severity of the problem

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Dear Alexa,

Sorry to hear that your implant hasn't dropped, is firm and is causing pain. It sounds as though you have a Grade IV capsular contracture, which is the most severe type; patient's often complain of pain, firmness and a round, tight implant visually. Proven treatments for this include capulectomy, in which the implant is removed, placement of the implant behind the chest wall muscle, replacement of the implant with a new implant, and possible drain placement. For the most severe type of capsular contracture, nonoperative methods are not effective in treatment.

Hope this helps. All the best - Sam Jejurikar
 

 

Sam Jejurikar, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 28 reviews

Options for capsular contracture are limited

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The options for a capsular contracture are limited and there is no firm evidence that any medications will help, and even massage and ultrasound are of limited value. The treatment which gives the best success is open capsulotomy or capsulectomy (open and release, or remove the capsule) and for some replacement of the implant in a sub-muscular location. We have published success rates of 50% or slightly better. You can wait and give things a year or longer if you wish without harm.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 27 reviews

Capsular Contracture

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Dear Alexa1208,

Capsular contracture should be treated in a way that is proven to yield complete resolution of the problem with the lowest risk of recurrance.  Evidence based medicine indicates that closed capulotomy, massage, external ultrasound or leukotriene inhibitors like Singular and Accolate do not improve your condition.

Total capsulectomy and replacement with a new implant is the most appropriate and effective way to procede.  Please see a breast surgery specialist who is certified by the American Board of Plastic Surgery and is a member of the American Society for Aesthetic Plastic Surgery.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 28 reviews

You may start with primary plastic surgeon

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The symptoms that you have described is consistent with capsular contracture. I would suggest going back to your plastic surgeon for revision.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 54 reviews

Capsular contracture

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dear alexa, it might be a good idea to get a second opinion. revisional surgery after 5 months is somewhat early but it depends how severe your capsular contracture is, if you have pain etc. good luck

Bianca Knoll, MD
Frankfurt Plastic Surgeon
5.0 out of 5 stars 18 reviews

Treatment for early capsular contracture

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Dear Alexa1208,

Capsular contracture vexes breast augmentation patients as well as plastic surgeons.  At this point I believe here are your options besides doing nothing:

1) Trial of Singular( a medication) as an "off label" use to attempt to soften your breast.  Some surgeons favor other medications attempting a similar response.   By this point in your recovery, I would not expect this to be a fruitful option but could be a "first step" noninvasive option.

2)Surgical removal of the capsule and implant exchange and adding Strattice( a sheet of treated dermal substitute).  The Strattice is expensive but has proven at least on the short term to achieve softer capsules.  Re operations are very expensive both emotionally as well as financially.  This should give you your best shot at softer capsules.  There is some debate on whether or not you should reuse your current implant or replace it with a new one.  This topics was addressed again at our recent Aesthetic meeting and for patients who develop capsules in the first 6 months the majority opinion is to use a fresh implant is your best option.

I would recommend continuing your relationship with your original surgeon.  Second opinions never hurt anyone. 

Good luck

Craig Harrison, MD, PA
Tyler Plastic Surgeon
5.0 out of 5 stars 3 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.