Grade 2 Capsular Contracture - Implant Replacement Not Necessary?

Hi,

From your description, it doesn't sound as though have have a Grade 2 capsular contracture. This is the grading system for capsular contracture (Baker score):

Grade 1 - The breast is soft, and looks natural. This is pretty close to normal for all breast implant patients.
Grade II - The breast is a little firm, but appears natural.
Grade III - The breast is firm, and is begins to appear distorted.
Grade IV - The breast is hard and painful, and has become quite distorted. 

As you can tell, the grading system is quite subjective. It sounds as though you have some pain and hardening, which would put you in the grade IV category; if your implants are sitting higher and tighter than they were a few months ago, this would confirm that.

The approach to treating a severe capsular contracture usually involves performing an excision of the capsule, converting the implants to a different pocket (either behind the muscular fascia or behind the muscle), and changing the implant. It's not common to operate on true grade 1 or grade 2 capsules, as they tend to be of minimal clinical significance. For a true Grade 2, Singular may have some efficacy, but probably not for what you are describing.

In regards to massage / implant compression, some surgeons recommend it to their patients, whereas other don't. I do have may patients do it, but I'm not sure how much benefit it really has.

Hope this helps. Best of luck - Sam Jejurikar

The surgical treatment of early capsular contracture in my practice is reserved for patients who have undergone conservative treatment first.  A good percentage of the time, with conservative treatment, capsular contracture may stop progressing or even improve.  I like to use massage techniques and Accolate as the medication of choice.   Massage is more useful for smooth surface implants, so it will be important to discuss this option with your doctor before initiating any treatment.  I do not see any downside to trying conservative treatment first!    If you elect a procedure, I would recommend replacing the implant.  If there is a biofilm associated with the implant, recurrent capsular contracture is much more likely to occur with re-use of the old implant.  Good luck!

The anecdotal reports of leukotriene esterase inhibitors were predominanlty reported with Accolate (twice a day) but the convenience of Singluair makes this more popular. However, these reports stated that it was most effective in the first 6 months of treatment. While the idea of a new implant will treat the concept of a biofilm, it is not the standard or universally practiced. Open capsulotomy may be the intial approach.