Capsular Contracture - 4 months post op. What's the best treatment option? (Photo)

I am so sorry that you are experiencing this. Make sure to find out what type implant you have as some cover capsular contracture for first time patients. Which would be a good thing to know if you do have to have revision surgery. Your surgeon has recommended the right course of action for now so fingers crossed that it works. Best, Dr. Nazarian

Treatment for capsular contracture often involves en bloc capsulectomy, complete removal of the capsule, or making the pocket larger by capsular incisions (capsulotomy) with implant replacement. Recent studies suggest that using the same implant may increase the chance of recurrence. Placement of the implant in an new pocket is also often done as well as using textured implants. In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used but has been associated with implant rupture and other complications and few surgeons use this technique any more not to mention that your warranty will be void. On occasion, the use of a biological fabric like Strattice or Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9–11%, in my practice it is significantly lower after the primary implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. Capsular contractures are lower with non-smokers, and with use of textured silicone implants placed below the muscle. The location of the incision also plays a role. Inframammary incision also has the lowest and periareolar and axillary (arm pit) incisions have the highest capsular contracture rate. Smoking/nicotine use greatly increases your risk for capsular contracture greater than 10 times the incidence of a non nicotine user.Non-surgical management includes prophylactic massage to prevent it and if it occurs, the use of certain anti-asthma medications: Singulair and sometimes Acculate as off-label FDA usage to treat Capsular Contracture and in some cases of recurrence of capsular contracture in a preventative fashion. In my experience this works best for early diagnosed early contractures and used as a prophylactic, perioperatively when doing a capsular contracture surgery. The price for capsular contracture surgery varies greatly by geographical location, experience of the surgeon, whether in an outpatient surgery center vs hospital (hospital more expensive), type of breast implant, whether it is ruptured or not, estimated length of operating room time, and other factors.

Thank
you very much for your question and photograph.
I am sorry that you are having a difficult time with your implants. My suggestion is for you to speak with your
surgeon about adding a course of ultrasound therapy in your left breast, in
hopes of relieving some of the bonding in the capsular contracture. This will allow the breast pocket to increase
in size and soften. I have found that
this is useful in about 1/3 of my patients, especially those with early capsular
contracture.

Mild capsular contracture in my opinion should first be treated with a combination of anti-inflammatories such as singulair or accolate, antibiotics, and implant massage.  If this fails to correct the problem, a surgical revision  may be necessary.  Close follow up with your surgeon is critical.  Good luck!

So it is unfortunate that you developed a capcon so soon, but this is a possible risk any time implants are placed.  Se your PS and discuss the possibility of a surgical correction.  There are no true proven non surgical therapies to correct grade 3 capcon.

Hello,I am sorry you are experiencing this problem. There are no nonsurgical modalities that can treat capsular contracture with any degree of efficacy or regularity. This includes Singular/Accolate, high dose vitamin E, external ultrasound/radio frequency, and implant massage. The only reliable way of treating this problem is by removing the entire scar capsule in one piece, along with the implant through an inframammary incision, then replacing a new implant. This should lower your risk of recurrance to that of primary surgery, and will not be improved upon with the use of very expensive biologic materials known as ADMs (Alloderm/Strattice).Best of luck!

You are almost certainly going to benefit from surgery with a partial or complete capsulectomy to minimize your chances of recurrent contracture.  With augmentation mastopexy, the need for revision is higher. The surgery is best deferred for at least 6 months after your original surgery.  Singulair has had mixed results, and is unlikely to correct the high position of the implant.

I appreciate your question.

If you aren't ready to have your left implant removed and replaced with capsulectomy, ask your surgeon about adding Trental and Vitamin E to your current regimen.



The best way to assess and give
true advice would be an in-person exam.

Please see a board-certified
plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!



Dr. Schwartz

Sorry to hear about your ordeal.  Generally speaking, capsular contracture does not resolve on its own.  There are several methods employed by surgeons in the hopes of PREVENTING contracture (steroids, massage techniques, pocket selection, etc) but there is no known non-surgical method at successfully treating contracture.  The standard of care includes removing the capsule, exchanging the implant, possibly creating a new pocket, and possibly using a biologic mesh for support.  Follow the guidance of your surgeon to determine the best plan for you moving forward.  Also as a sidenote, many implants come with a standard warranty which would certainly apply to your situation so be sure to check on this with your surgeon.  Good luck!

Dear cp75,



First, you need to double check with your
surgeon what brand of implants you have as Allergan and Sientra in the last
several months have instituted a capsular contracture warranty for first time
breast augmentation patients. If you do require surgery, that will help
alleviate any charges.



We offer the Aspen After Surgery nonoperative
treatment for capsular contracture. In grade III capsular contracture
particularly as new onset as yours is, we have an 80% success rate of improving
the contracture using a combination of the breast specific ultrasound treatment
combined with Singulair and antibiotics and vitamin E. Information on Aspen After Surgery is available on our website. 



I hope this has been helpful.



Robert D. Wilcox, MD