Capsular Contraction 1 Year Later?

Thank you for this thought provoking question.  Accolate is an asthma medication, now generic, which has worked in the past to decrease capsular constracture.  Laurie Casas, M.D. did a 42 patient study showing that Accolate, when used on capsular contractures within the first 6 months after surgery with implants in the subpectoral space, decreased the firmness.  My own experience when using Accolate plus ultrasound (the kind physical therapists use for sore muscles) has shown improvement, and sometimes, complete cures of some capsular contractures.  

I recommend you discuss this possible contracture treatment with your personal plastic surgeon. 

Capsular contracture refers to scar tissue which can form around breast implants making the breasts feel firm or creating shape changes in the breasts.  The exact causes are unclear, but appear to be related to inflammation and the formation of a thick collagen lining around the breast implants.   We do know that low levels of bacteria can initiate scar tissue, as can blood from surgery, and other irritating factors.

 

Most capsular contractures occur either early (first year) or late (after many years).  My impression is that a capsular contracture occuring after a year is likely related to a bacterial cause, either a low level of bacteria which contacted the implant at insertion and many months later have initiated inflammation, or perhaps bacteria which have contaminated the implants from the bloodstream.

 

If caught early, medications such as Singulair and Accolate, as well as massage, may be useful to treat capsular contracture.   Other treatments, and of course surgery, may also be effective.

Capsular contracture is a risk for anyone who has breast augmentation or reconstruction with implants. It unfortunately occurs more frequently than we would like it to. It can occur early or late after surgery, with saline or silicone implants, in subpectoral or subglandular placement, and in one breast or both. Capsular contracture is probably caused by some excessive scarring; the etiology of the scarring may be unknown, but subclinical infection and long-term failed silicone gel implants probably lead to capsular contracture as well. There is no specific way to prevent it, but measures taken during surgery to reduce scarring and infection may help. Capsular contracture is graded using the Baker classification: I (normal breast) thru IV (severe contracture). Grades III and IV usually require surgical correction.

Allergan’s Core Study followed 455 women following their primary silicone gel-filled breast augmentation. At 7 years post-op (follow-up 74%) the incidence for capsular contracture (Baker III/IV) was 15.5%. At 10 years post-op (follow-up 59%) the incidence for capsular contracture (Baker III/IV) was 19.1%.

The Allergan Core Study also enrolled 147 revision-augmentation patients. At 7 years post-op (follow-up 72%) the incidence for capsular contracture (Baker III/IV) was 20.4%. At 10 years post-op (follow-up 50%) the incidence for capsular contracture (Baker III/IV) was 27.5%.

Mentor’s Core Study followed 552 women following their primary silicone gel-filled breast augmentation. At 3 years post-op (follow-up 67%) the incidence for capsular contracture (Baker III/IV) was 8.1%.  At 8 years post-op (follow-up 52%) the incidence for capsular contracture (Baker III/IV) was 10.9%.

The Mentor Core Study also enrolled 145 revision-augmentation patients. At 3 years post-op (follow-up 79%) the incidence for capsular contracture (Baker III/IV) was 18.9%.   At 8 years post-op (follow-up 53%) the incidence for capsular contracture (Baker III/IV) was 24.1%.

The reason Allergan has 10 year data and Mentor does not is because Allergan began enrolling patients about one and one-half years earlier.

As you can see, the risk of capsular contracture is higher in revision-augmentation patients. If you ask many surgeons (me included) what the incidence of capsular contracture is in their practice they would probably state numbers much lower than this. Our (speaking for the collective group of surgeons) top of mind recollection of complications and re-operations is not always very accurate…but the numbers, are the numbers. Unless a surgeon has specifically studied the details of his or her practice, and has good patient follow-up, the Core study numbers are the ones that should be used when speaking with patients.

So the bottom line is that your capsular contracture is not unlike others, and can be improved/corrected with surgery. A thoughtful approach to capsular contracture may be helpful in reducing recurrence yet again, but there are no guarantees.

Best wishes, Ken Dembny

A capsular contracture if present will not get better on its own.  Commonly patients undergo surgical excision to improve this problem.

Yours is the typical story of capsular contracture as a well placed implant starts out soft, and over the first year or two the implant begins to round up and become firm. Short of surgery little else will soften the implant again and yes, even after revision it can happen again.

The chances of capsule contracture resolving spontaneously decrease the longer out from surgery this has occurred.  You will likely need surgery, but capsule contracture can recur even if you have all the scar removed and a new Implant placed.  An ADM may significantly decrease the chance of contracture recurrence, but is costly...discuss these options with your surgeon.

Hard capsular contractures need surgery for correction with the scar removed and new implant placed.  No medications will fix this.  There are a few anecdotal reports of improvements with some medications but they may have toxicity that you don't want.