In Early Stages of Capsular Contracture, Are there Prevention Methods? (photo)

Question

I had my first surgery in 2008, my first CC was removed in 2009 (left breast, 330cl Sil.) and only a few months later I started to sense a capsule. I ignored it until two weeks ago I had a corrective surgery. Both implants were replaced and new high-profile implants entered with a rough surface to avoid future contraction. From the swelling, light pain and general feel as I had this problem before, I am 99% certain I am in the early stages of having CC AGAIN. Could massage/medicine help??

Rian A. Maercks, MD · Answer

Some doctors that I respect very much use singulair and other medications as off label treatments for capsular contracture and have excellent long term results. I personally have not incorporated this into my practice but if you have access to a physician applying these treatments it might be worth talking to them. Ultrasound therapies combined with antibiotic treatment have been used with reported success although I do not have direct experience with these modalities. Massage will always help and if used properly is the most powerful treatment. When I am concerned I tell my patients to get a large firm body pillow and lay on their belly and watch TV with their breasts on the pillow taking all of their weight. this pressure along with stretching and massage can really tame down tightness in most patients. I hope this helps!

Jeffrey J. Roth, MD, FACS · Answer

Thank you for your question and photos.  There are non operative modalities, (taking singulair, message, Aspen treatment, short course steroids, etc).  There are also operative modalities, (capsulectomy, capsulotomy, change of pocket, placement of ADM, removal).  Please speak with your Board Certified Plastic Surgeon about all your options. You may be a better candidate for one over the other.Jeffrey J. Roth, M.D., F.A.C.S.Board Certified Plastic SurgeonLas Vegas Plastic Surgery

Austin Hayes, MD · Answer

In the early stages of capsular contracture there are some medications that may be beneficial. Speak with your surgeon about their recommendations for treatment of early contractures.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question!  Recurrent capsular contracture is a
 very difficult problem. Assuming you tried conservative measures in the
 past - implant massage and may add the medication Singulair and Vitamin
 E.  If these fail, surgical correction may be necessary. It is a matter
 of surgeon preference as well as what is seen during your procedure 
that will determine whether or not a complete capsulectomy is performed.
 If significant capsule formation is seen intraoperatively, a full 
capule removal may be warranted with a drain in order to completely 
remove all of the tissue and allow better adherence of your breast back 
to its normal anatomic position down on your chest wall. Irrigating with
 certain medications may also be if benefit. Some other things that may 
have been tried include changing the position of your implant, addition 
of a dermal matrix, or consideration for the the shaped, textured, 
anatomical gel implants.  Without knowing your issues and 
without an examination, it is difficult to tell you what may be the best
 thing for you. I tend to favor performing capsulectomies in order to 
create a fresh pocket, reshape the pocket, allow better shape and 
adherence of the overlying breast. I would discuss your issues with your
 plastic surgeon who will assist you in determining the right modality 
for you.  At a 3rd recurrence, it may continue to occur despite all of 
these modalities and consideration for explantation or living with the 
contracture are options. Hope that this helps! Best wishes!

Jed H. Horowitz, MD, FACS · Answer

some doctors and studies advocat Accolate   .  this is off label use for an asthma medication. 

	massage, and sometimes antibiotics (biaxin) can improve early changes if your surgeon believes in biofilm and colonization of the implant.

	its a very frustrating problem

Remus Repta, MD · Answer

Hello,

	Sorry to hear about your healing process.  There is still some debate and a few unknowns regarding capsule contracture.  I tend to address capsule contracture by "throwing the kicthen sink" at it: removing all of the capusle, replacing the implant, placing a drain (often), and instituting massage.  At this stage medication as indicated by the other plastic surgeons below and massage may help.

	All the best,

	Dr Repta

Darryl J. Blinski, MD · Answer

Yes try massage, ultrasound therapy, oral singular. But based upon your photos the left looks smaller and of differing volume and shape. It could be a CC but need in person examination.