Signs That Breast Implants Are Encapsulated?

I've had saline implants for a year now. I kept telling my doctor that it felt as if the left one had never even "set in" and that both feels unnatural. He brushed this off. I have an appointment next week...Now they are saying it is probably encapsulated. Does this sound right? They are both so hard I now turn my body to give a hug! The right side is somewhat softer, but nowhere near others I have talked to.

Doctor Answers 42

You have severe capsular contractures which need to be treated correctly

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To benhazed,

Hi! I am afraid you need a revision, and how it is done is crucial.

1) You need CAPSULECTOMIES. That means the existing lining around your implants needs to be removed. This lining has myofibroblast cells which cause capsular contracture.

2) You need NEW IMPLANTS. Your current implants have a biofilm on their surface which may contain bacteria, and even a few bacteria will cause capsular contracture. You don't need to have an obvious infection to develop another capsular contracture. This biofilm cannot be washed off.

3) The wounds should be irrigated with antibiotic solution, for the same reason.

4) Every last little bit of bleeding around the implants needs to be completely stopped, because even a small amount of blood can cause capsular contracture. I often use drains for a day or two in this situation.

Manhattan Plastic Surgeon

Capsular Contracture - How to prevent it

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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
4.8 out of 5 stars 123 reviews

You may have a capsule forming or may want to consider silicone implants

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You need to discuss your concerns with your doctor. Without examining you it is difficult to know exactly what is going on. Encapsulation can cause firm or even hard breasts. It is also possible that you are feeling the saline implants especially if you have very litlle breast tissue covering the implants. If that is the case, you might want to consider changing to silicone implants which can for some patients make the breasts feel softer even though they have little breast tissue to camoflage the implants .

Susan E. Downey, MD
Los Angeles Plastic Surgeon

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Signs that Breast Implants are Encapsulated

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The firm, hard breasts that you are describing sounds like capsular contracture. This is scar tissue that can form around the implants and cause them to become more firm and distorted. If they look unnatural and are uncomfortable, you may need surgery to remove the capsules of scar tissue. It is usually recommended to also exchange the implants and place new implants under the muscle. Capsular contracture is less common with implants placed under the chest muscle.

Stanley Castor, MD
Tampa Plastic Surgeon
4.8 out of 5 stars 129 reviews

Capsular contracture

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 If the breasts are firm and the implants are not mobile, then you probably have a capsular contracture.  This is something that you should definitely talk with your doctor about.  Most of the time you have to have the capsule removed to improve this situation.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

You may have a capsular contracture

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Either you have a capsular contracture or your implants were too overfilled at the time of their insertion. These are basically the only ways a saline implant can feel too hard. Maybe your expectations of what is normal for a saline implant are also incorrect.

I would suggest you visit another surgeon with your operative note and ask their opinion as to what is going on here. If you have a capsular contracture, a revision could be very helpful. If the implants are too overfilled, a revision may also be advisable. Probably you should consider gel implants this time because they are definately the preferred impants when patients place a high priority on the "feel" of their outcome.

A capsular contracture is the most likely problem

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One of the potential complications of breast augmentation surgery is development of a capsular contracture. This is when scar tissue, which forms around the implant, becomes hard and potentially painful. Unfortunately, there is no easy way to address this problem other than surgery. The surgery would involve either making incisions through the scar tissue at several locations to allow the capsule to expand or removing the capsule completely. However, there is no guarantee you will not develop a new capsule in the future.

Discuss these options with your surgeon before making a final decision on whether to have a surgical revision.

David A. Robinson, MD
Munster Plastic Surgeon
4.7 out of 5 stars 46 reviews

Likely capsule formation.

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Benhazed, The most likely explanation is that you have capsular contraction around your breast implants. This is a rare reaction by the body to the presence of a foreign material (the implant). Basically, the body forms a hard scar around the implant. You will likely need another operation to remove the capsule. If you implants were placed above the muscle the first time, it may be best to put the new implants under the muscle. Good luck.


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It sounds like you do have encapsulation. During your next post operative consultation convey your concerns to your  surgeon and explore all the possibl alternatives.

Barry H. Dolich, MD (Retired)
Bronx Plastic Surgeon

How do I know if I have capsular contracture?

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Thanks for the question.

Plastic surgeons have better ways to lower the risk of capsular contracture at the time of first breast augmentation, but unfortunately, even in the most skilled hands, we still occasionally see patients with capsular contracture of varying degrees. The move to subpectoral and dual-plane breast augmentation, in addition to innovations in breast implant technologies like cohesive gel, the Keller Funnel, Ideal Implant® saline devices, and better silicone fabrication, have all helped to reduce the overall incidence of capsular contracture. We have learned that one risk factor for this complication is the exposure of implants to “biofilms” – thin layers of protein, bacteria and other biologic substances that can be introduced into the implant pocket during surgery or afterwards. To reduce biofilm exposure, many plastic surgeons now use an antiseptic regimen that includes antibiotics in the pocket, special handling of the implants, Keller funnels where indicated, and a general “no-touch technique” on the skin.

Capsular contracture may be improved by creating relaxing incisions in the capsule internally, which creates more “breathing room” for the implant. Sometimes this is enough, but in many cases, partial or complete removal of the old capsule with the implant is required. Most patients can have a new implant inserted in the same operation. Some patients unfortunately have a tendency to have capsular contractures come back (recurrence), but most patients get a significant improvement with treatment.

Treatment of capsular contracture is usually done through an existing scar on the breast, but in some cases, depending on the original incision performed for breast augmentation, a new incision may be required. For example, if your original implant was placed through the transaxillary approach (armpit) or TUBA (trans-umbilical breast augmentation through the belly button) technique, an incision in the inframammary fold may be needed to remove or release the capsule. This may also be true if the original incision was around the nipple.

Physical exam is the only way to know for sure if a patient may have capsular contracture and to allow the plastic surgeon to consult about options, including capsulectomy, en block removal of the implant and capsule, or simple capsulotomy (opening the capsule with internal incisions).

Tim Sayed, MD, MBA, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 22 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.