Any Chance of Capsular Contracture Getting Better on Its Own?

Question

I was told today I have capsular contracture grade 2 with silicone implants. My dr put me on 400-600mg of motrion 3 times a day and to do massages till I go back to see him in 3 weeks. He Said health ins usually covers taken the implant out so then I'd pay out of pocket for removing the scar tissue and to put the implant back in. Is it ok to use the same implant? Does ins ever actually cover that? And does cc ever get better without surgery? I'd appreciate any advice! Thank you so much!

Amy T. Bandy, DO, FACS · Answer

I agree with Dr. Hayn, if you have had surgery recently, and the CC is diagnosed early, then accolate, ultrasound and compression can help and sometimes reverse a grade 2 CC. If you have had it for a while, it is unlikely to improve. In California, we do not see insurance covering this an longer. Good luck!

Jed H. Horowitz, MD, FACS · Answer

One of the most common problems is breast capsular #contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. Severe capsule contracture probably occurs in less than 15% of augmentation patients. Every woman has a breast capsule around their implant and this is a normal phenomenon. The capsule itself could be as thin as Saran Wrap but may also become calcified and thickened. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer #implant. Nicotine users, such as smokers, have up to a 30x increased risk of #capsular contracture.

Saline implants may deflate spontaneously. When the patient has significant #symptoms, complete or partial leakage of their saline implant, or concerns regarding silicone leakage, it is recommended that the implant is removed and exchanged. Frequently, this is performed on both sides depending upon the age of the implant. Capsulotomy or opening of the capsule may be required or frequently capsulectomy, which is removal of the scarred capsule, is recommended to ensure adequate pocket dimensions.

New implants may then be placed in the same existing position or may undergo a change of #placement frequently from submammary to subpectoral position and, on occasion, the other way around.

Don W. Griffin, MD · Answer

Massage may help and certainly will do nothing to worsen your problem so it is worth a try.  I am not aware of the anti-inflammatory effects of NSAIDs like Motrin having any effect on capsular contracture.  You could try Accolate although I think the data on its effectiveness is not really that strong.  Surgery does not need to be done unless the contracture is bothering you.  If you have surgery, I believe that placing new implants is the right approach often utilizing a new implant position.  Even in the most experienced hands, and doing everything right, your risk of recurrent CC is high enough that I wouldn't recommend the procedure unless your CC was severe.  I have never had insurance cover any of the proposed procedure.

	Good Luck

Laurie A. Casas, MD, FACS · Answer

Capsular contracture can sometimes go away with massage. I also recommend that patients not wear a bra so that the breast can move during the day. It is my understanding that insurance does not cover the treatment of implants placed for cosmetic reasons.

Steven Wallach, MD · Answer

Insurance as far as I know rarely covers it. It can be covered under breast reconstruction after cancer .  Capsualr contractures do not get better on their own.

Ernesto Hayn, MD · Answer

Dear me,

	I have a couple of questions.  How long ago was your initial procedure.  If you are recently post op and are starting to develop the capsular contracture massage, Accolate, and Ultrasound therapy can help improve the situation.  However, if you are 6 months post op it is unlikely that any non surgical treatment will improve the contracture.  In Florida it is highly unlikely that insurance will cover any procedures involving capsular contractures after implant placement.

Karol A. Gutowski, MD, FACS · Answer

Insurance rarely covers treatment of capsular contracture related to breast augmentation. In most cases, surgeons don't recommend more surgery for Grade 2 contracture. You could try Accolate after discussing it with your surgeon. It is unlikely to get better on its own.

Robert L. Kraft, MD, FACS · Answer

Once the capsule, or scar tissue, has formed, it is not likely to improve and I would not expect Motrin at standard doses to have any significant effect. However, I will disagree with your surgeon. Health insurance in New York does not pay for removal of an implant unless it was placed for reconstructive purposes, for example, after mastectomy for breast cancer. Insurance carriers are no one's fools and they do have access to your medical records to know that you didn't have cancer surgery. They will deny payment for the removal after the fact and you will be left hanging with the hospital and anesthesia costs at full fee. Insurance does not pay for release of capsular contractures or any other procedure which results from an initial cosmetic operation. Best of luck!

Tom J. Pousti, MD · Answer

Thank you for the question.

	Capsular  contracture may improve without the need for surgery.

	It is unlikely that health insurance will &ldquo;cover&rdquo; surgical intervention for breast implants placed for aesthetic reasons.

	Best wishes.

Bill Kortesis, MD · Answer

Capsular contracture can occur post-operatively.  There have been numerous studies trying to determine how to stop the effect and to actually reverse it.  Implant massage can help to alleviate the contracture from getting worse.  Accolate ( a medication ) has been shown in studies to alleviate capsular contracture.  I believe that both accolate and massage would be a reasonable treatment option.  Accolate does have some side effects so you must be evaluated first to determine if you are a candidate.  

	As for the insurance information -- I would check with your insurance provider.  Policies vary with the procedures that are covered.

Any Chance of Capsular Contracture Getting Better on Its Own?

Answers (11)

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