Thinking of getting Breast augmentation and I have a question.... What can I do about scar tissue forming?

I've heard about scar tissue forming around the implant. How will I know if this happens and what can I do to prevent it from occurring?

Doctor Answers 9

Reducing "Scar Tissue" Following Breast Augmentation?

By "scar tissue" we assume you are referring to the condition which plastic surgeons call capsular contracture. This a process whereby the typical thin and pliable capsule that everyone's body normally creates around an implant becomes thickened and tight and starts to squeeze down on the implant. This can result in changes from just an overly firm feeling implant to distortion of the shape or position of the implant to the implant being very hard and painful. Once established, capsular contracture almost  always requires surgical revision to correct and there is a variable but significant degree of recurrence. So the best approach is to do everything possible to prevent it from occurring in the first place. 


There are a number of factors that are known to increase the risk of capsular contracture and these include contamination of the implant surface with bacteria or foreign material at the time of placement, blood in the implant pocket, placement of the implant on top of the muscle (sub glandular), excessive handling of the implant (increase risk of contamination), and use of incisions where there is increased risk of bacterial contamination (periareolar and armpit). Therefore, in order to aggressively minimize the risk on capsular contracture, one would try to avoid any of the above risk factors. By avoiding these risk factors the incidence of capsular can reduced down to 1% or less. Before the problem was better understood a capsular contracture rate of 7% or higher was simply accepted as being a random and normal occurrence. With our understanding today of the causes of capsular contracture, it can be almost completely eliminated by avoiding all of the potential risk factors. 



Preventing Capsular Contracture (scar tissue formation)

Thank you for your question.

In breast augmentation, capsular contracture refers to tightening of the scar tissue that normally forms around the implants resulting in hardened, painful, and abnormal looking breasts with varying degrees of severity. The capsule is fibrous tissue that naturally forms when anything foreign is placed in our body – this happens with heart devices as well. However, when there is too much inflammation, fluid collection, or bacterial contamination, the fibrous capsule can start to scar down further and contract.

There are 4 grades/levels of capsular contracture:

Grade I — the breast is normally soft and appears natural in size and shape

Grade II — the breast is a little firm, but appears normal.

Grade III — the breast is firm and appears abnormal.

Grade IV — the breast is hard, painful to the touch, and appears abnormal.

You can know about the capsular contracture using these classifications and applying them to your case. Note that you will always have to get anything checked with your plastic surgeon for accurate diagnosis as breasts can appear hard and tight early in the post-operative period.

In case you do have capsular contracture, but your breasts do not appear abnormal, or painful, then you do not require surgery.

In fact, grades 1 and 2 CC do not require surgery, and can be fixed with breast massaging and singulair.

Massaging will keep the naturally occurring capsule stretched hindering it from contracting. However, this should not be done excessively as you may further aggravate the breast pocket causing inflammation.

The literature review by Dr. Chong & Dr. Deva titled Understanding the Etiology and Prevention of Capsular Contracture, clearly outlines what can increase and decrease the chances of capsular contracture and all things are ultimately related to implant contamination.

Initiators:

  • Bacterial Infection
  • Periareolar incision (natural bacteria of the breast can contaminate the implant during insertion)
  • Subglandular pocket (same reason as above)
  • Prolonged exposure of the implant to the surrounding surgical environment (lack of sterility in the surgical environment can cause contamination of the implant)
  • Hematoma (blood can increase inflammation and speed up fibrous capsule formation)
  • Use of drains (increase risk of infections by 5 folds, and thereby increase risk of CC)

Suppressors:

  • Avoiding large implants (large implants can easily be contaminated)
  • Textured implants with submammary pocket (Textured implants may not help in the submuscular pocket)
  • Submuscular pocket (the implant is not exposed to breast’s natural bacterial flora)
  • IV antibiotics
  • Washing the implant pocket with antibacterial solution
  • Using insertion sleeves (i.e., Keller Funnel) for the implants (reduces contact with bacteria)

These are the only things research has shown to influence the risk of capsular contracture.

That being said, you can also help prevent a capsular contracture by having regular follow-ups with your surgeon to make sure your breasts are healing beautifully.

Remember that your surgeon’s instructions should take precedence over everything else you read on here, so before doing anything, ask them.

Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 reviews

Prevention of Scar Tissue in Breast Augmentation

Assuming that you are talking about the scar that forms around an implant or a breast implant capsule, the real question becomes how do you avoid contraction of that capsule since formation of a capsule is a normal body reaction to any foreign body inside you such as a breast implant.  Normally this scar stays soft and pliable but it can shrink for a number of reasons that have been outlined by a couple of surgeon in this thread.  

The occurrence of capsule contracture in breast augmentation is the number one problem we deal with in breast augmentation.  For that reason, you may want to consider seeing a surgeon that uses Sientra breast implants.  Sientra textured gummy bear implants have a capsule contracture rate of just 2% if placed with a no touch technique as opposed to other breast implants that have reported rates of between 4 and 20%.

I have added a video and a link about these implants for you here.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 56 reviews

Capsule contracture

The occurrence os scar tissue around the implant is a process whereby the typical thin and pliable capsule  ( scar layer )that everyone's body normally creates around an implant becomes thickened and tight and starts to squeeze down on the implant.

Your surgeon should know about a list of preventive measures to lessen the chance of this occurring long term but even so a small percentage of women will get enough of a capsule contracture to be painful and/or distorting and require implant exchange

Thinking of getting Breast augmentation and I have a question.... What can I do about scar tissue forming?

It's a very good question and what you seem to be referring to is a capsular contracture. Scar tissue forms around all rest implants, but a capsular contracture refers to when this thin capsule becomes thickened. With severe contractor the capsule can shrink and deform the appearance of the breast and can even cause pain. There are several techniques that I use in my office to decrease the chance of a capsular contracture occurring. Implants placed under the muscle have a lower chance of contracture. It is thought inflammation caused by blood or bacteria increase the possibility of a contracture forming. The procedure is performed with precise dissection techniques. Bleeding is kept to an absolute minimum. I use waterproof covers over the nipple,  rinse everything with triple antibiotic solution, and insert the implant using a "no touch" technique with a Keller funnel. It's good to do your research when considering breast augmentation and learning about capsular contracture is an important complication to understand. Make sure that you find a board-certified plastic surgeon who will take the time to thoroughly answer all of your questions about breast augmentation surgery.

Thinking of getting Breast augmentation and I have a question.... What can I do about scar tissue forming?

Thank you for your questions. This is called capsular contracture and there are many factors that contribute to this problem and there are some other theories as well. I think that Dr. Jugenburg has given an excellent answer and you should reference his answer. If you look at the long term FDA data for silicone implants when they were put back on the market, the data shows that the CC rate for Allergan at 10 years was 19% and for Mentor at 8 years was 11%. This data is somewhat older and newer data on shaped implants is showing numbers more on the order of 2-5%. 

There is also some new information to suggest that immune modulator medications such as steroids or medications like Singulair can help prevent the formation of capsular contracture, so some surgeons, myself included, feel like these medications are usually well tolerated with low risk profile and are probably worth the potential benefit. You should ask your surgeon about these medications. 

Having an implant placed through the IMF approach in a submuscular position also optimizes your risk for CC. Discuss this in detail with the local board certified plastic surgeon of your choice. 

Hope this helps!

Ask about rates of capsular contracture

Ask your prospective surgeon how many cases they do each year of breast augmentation and how many revisions they need to do each year and how often they see capsular contracture in their practice. Hopefully they will be doing 100-200 cases per year and have a revision rate and capsular contracture rate around 1%. There are many things that can be done in technique and the use of a Kellar Funnel that can reduce the CC rates but hey will never be absolutely zero. But the national rates approximating 7-9% are unacceptable.

Scars and Healing

Hello,


Naturally, a thin layer of scar tissue will form around your implant as you  heal and this is part of the normal healing process. In rare cases the scar tissue can grow too thick and constrict the breast implant over time. This is referred to as capsular contracture. There are a variety or precautions and approaches that your Plastic Surgeon will take to help reduce this relatively low risk. If you see or feel something concerning about your breasts in the future your Plastic Surgeon will be able to examine you and let you know if this is the cause.


All the best 

Normal healing

Scar tissue form.  That is the way your body heals.  What we don't want is excess scar tissue forming around your breast implant.

Today, we have many techniques to reduce your risks.

Go and find a plastic surgeon.

Best Wishes,

Nana Mizuguchi, MD

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 45 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.