Capsular contracture - can partial capsulectomy happen due to different incision? (Photo)

Question

My first surgery was done through areolar incision. After 28 years I developed capsular contracture. Decided to switch from saline to silicone and fix CC. The surgeon performed total Capsulectomy through inframammary incision. On my 2 week appt. he said i developed capsular contructure again. i went for a second opinion, where i was told that most likely the capsular was not completely removed as i could not have developed CC that quick. Can partial capsulactomy happen due to different incision?

Gerald Minniti, MD, FACS · Answer

Your photo does not help surgeons like myself give you relevant or helpful information other than what you were told: after a capsulectomy, especially the most appropriate kind - a total capsulectomy - there is no capsule around the implant after surgery and it takes about three months for one to fully form. The concept of early contracture is likely a fluid accumulation that makes the breast look full or hard, so that's a possibility. Alternatively, scar capsule was either incompletely removed (partial capsulectomy) or simply just cut and left in place (capsulotomy). Usually drains are placed after a capsulectomy. Did you have any?

Daniel Barrett, MD · Answer

Dear lanakrtolica1,
capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  I have been in practice for almost 30 years and a large portion of my practice is dedicated to revision breast surgery.  It is very unusual to develop capsular contracture within 2 weeks after surgery.  Your surgeon probably did indeed perform a total capsulectomy and you do not need the whole capsule removed to treat capsular contracture.  If it does get hard that quick sometimes it is related to a hematoma and that should be evaluated very quickly.  Additionally, I would avoid anything containing vitamin C and start you on Accolate.  Accolate is a antiasthma drug that has been shown to diminish capsular contracture.  At this time, unless you have a hematoma, there is nothing to do but wait or perform explantation.  Best wishes to you.

Connie Hiers, MD, FACS · Answer

The inferior incision carries the lowest risk of capsule formation and I have seen thick capsules develop in just a few weeks, usually from a low-grade infection or bleeding. Try oral Accolate and external ultrasound treatments to soften this new capsule.

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