Capsular contracture is caused by bleeding and/or bacteria.
Obviously, your surgeon's assessment at that time was incorrect. Bruising is from blood, but the bleeding was perhaps within the breast (since the incision was periareolar and through the breast tissue), or perhaps also in the implant pocket. Whatever the amount of blood around the implant, it was likely contaminated by bacteria from within the breast ducts because of this incision choice (also why I do not like armpit incisions), increasing risk of bacterial biofilm on the surface of the implant, plus any part secondary to scar fibrosis from the "extra" blood, both causes of capsular contracture (CC). Of course, re-operation for hematoma requires additional "cost," and the wait and see approach ended up costing more in your case.
Preventing CC requires less bleeding and/or bacterial contamination, which obviously occurred in your other breast. If your surgeon can "guarantee" no bleeding or bacterial contamination, then your risk should be very low. But since he can't, reducing those risks is prudent. Most surgeons would NOT recommend a different incision and new scar, but that is why I prefer inframammary crease incisions in the first place--less initial risk, and certainly less risk if you have to re-operate for any reason.
I would also suggest Accolate or Singulair plus oral Vitamin E, as this can help reduce the potential for luekotriene-mediated inflammation as a potential component of CC causation. This is only effective in about half of cases, but any "help" in avoiding yet a third re-operation make this a worthwhile choice, IMHO.
Unfortunately, hematomas can occur to any patient and surgeon, and that is true even with the most meticulous surgeon and compliant patient. Reducing risk factors is always the name of the game, from initial incision choice, to any other controllable surgical decision options. It is NOT, in my opinion, just "Oh well, that sometimes happens" and do the same thing the same way the second time around. You really don't want to do this a third time.
You may be interested in the section How to avoid Capsular Contracture in my Comprehensive Guide to Breast Augmentation, available by clicking on the web reference link below. Best wishes! Dr. Tholen
Can I prevent capsular contracture happening again? From day 1 I had extremely bad bruising and appeared to be hematoma
Thank you for your question and photo, the best is follow up with your plastic surgeon as you all have different view on this and you also might need more time 6month to 1 year cover and healing.
Thank you for the question. This question
is best answered by your surgeon. We have different procedures in
handling post operation treatment. So best to follow up with your
board-certified plastic surgeon and follow his/her recommendations.Best of luck. Dr. Michael Omidi.
An in-person exam with a board-certified plastic
surgeon is the best way to assess your needs and provide true medical advice.
Can I prevent recurrent capsular contracture?
In retrospect the hematoma at the time of the original surgery was very sizable as evidenced by how long it took for the bruising to subside (a couple of months). Blood is a well known cause of capsular contracture.At this point you will likely benefit from a partial capsulectomy, leaving a drain in place, and I would personally strongly advise going through an inframmary fold incision. The other issue is bacterial coating of the implant (biofilm) which is much harder to avoid through a periareolar incision.
With an inframmary fold incision, partial capsulectomy, meticulous control of bleeding and placement of a drain, the success in preventing recurrent capsular contracture should be quite high. I agree with your sense to be cautious and doing everything that can be done.
While hematoma is a risk factor for capsular contrature, not all patients who get a hematoma, get capsular contracture. Ask your surgeon about putting you on a pill called Accolade and Vitamin E for 6-8 weeks. This may help avoid a capsular contracture. Good luck.
A hematoma can complicate any surgery. Though rare, every surgeon gets them and the thing is we can't tell you one thing that was different about the patient who got one vs the thousands of other patients we treated the exact same way who didn't. Discuss your worries with your surgeon pre operatively if you are concerned about recurrence.
There are things that you can do to prevent the bleeding such as avoiding aspirin, Vitamin E and anything that can thin the blood. Get a list from your surgeon. So sorry that this has happened to you, but there is really very little rhyme or reason to capsular contracture. Best, Dr. Nazarian
There are some things you can do now, but I would wait a full year to see if it loosens up on its own.
Can I prevent capsular contracture happening again? From day 1 I had extremely bad bruising and appeared to be hematoma (Photo)
Untreated homerooms can cause capsular fibrosis as seen in this case. Best to be off all aspirin produces, vitamin E, any thing that could thin blood. NO the surgeon was not the cause of bleeding but not treating early might have evolved this capsule. But the chicken or the egg theory applies..