How Long to Wait Before Fixing Capsular Contracture?

Question

Hello, I had my first breast augmentation on July 7th this year with smooth silicone implants under the muscle. My left breast started contracting in week 7 and now at my 3 month post-op my surgeon recommending replacing the implant and using Strattice this time. I am only wondering if my breast is now inflamed and contracting, would it be better to wait a few more months for the inflammation to go down before doing the surgery, so that the current inflammation doesn't affect the outcome?

Richard J. Bruneteau, MD · Answer

Unfortunately, you describe classic capsular
contracture following breast augmentation surgery.Whenever a foreign material is placed inside
your body, it will generate a reaction from the surrounding tissue.This typically results in a fibrous capsule
that surrounds the breast implant.When
this occurs, following breast augmentation we all this a capsular contracture.All
patients have some capsule formation.Indeed absence of capsule formation results in implant shifting.When capsule formation results in
contracture, patients may experience hardening of the breast, distortion of the
breasts and breast pain.Capsule
formation may occur at any time and as time goes on, this may be accompanied by
pain and progressive distortion of the breasts.The breasts may shift in an upward direction and develop an abnormal
shape.The
period of time immediately following breast augmentation surgery is
characterized by rapid change.During
this dynamic phase of wound healing, swelling, muscle spasm, acute inflammation
and the wound healing process itself all contribute to changes in the
appearance of the breast.For this
reason we delay capsulectomy and capsulotomy for at least 3 to 6 months following
stabilization of the situation.When
capsular contracture occurs, there are several treatment options.In mild cases, medical management and massage
may be necessary.This may require
release of the contracture by performing a capsulotomy, or removal of the
capsule by performing a capsulectomy.Treatment is associated with high satisfaction rates.

Jed H. Horowitz, MD, FACS · Answer

Typically, it's best to wait 6  to 12 months depending on the reason for #revision.  Matters such as sagging or drooping  and size change will not improve with time. As with all cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation.

Raffy Karamanoukian, MD, FACS · Answer

There is no evidence to confirm whether the inflammation will worsen or subside with time. I advise all patients to treat capsular contracture as soon as possible. Raffy Karamanoukian MD FACSLos Angeles

Gregory J. Mackay, MD · Answer

Your capsular contracture has occurred very early after an initial breast augmentation. It may improve over time with some regular massage of the breast. I generally will wait at least 6-12 months after an augmentation before considering any surgery . If I think surgery is indicated I will first try a capsulotomy ( cutting of the capsular tissue) often under a local anesthetic with light oral sedation. This will often correct the problem with a minimally invasive procedure and at a low cost to the patient.I don't think using a dermal matrix product is indicated after an initial augmentation. If may however be very useful in patients that have had recurrent capsular formation, or severally ruptured silicone implants with really bad capsule formation

John J. Edney, MD · Answer

I would wait 4-6 months after the contracture process has stopped changing before surgically correcting a capsular contracture.
There are several different treatment options for an established capsular contracture.. Many surgeons feel that it is important to create a site change and replace the implant with a new one.  A site change refers to moving the implant to a new pocket location.  For instance if the implant had been placed underneath the breast tissue the new pocket is made under the muscle layer.  If the implant was originally under the muscle it can either be placed under the breast or in what's called a" neo-pectoral pocket".  A neo-pectoral pocket is developed by temporarily removing the implant and creating a new pocket behind the back wall of the capsule surrounding the implant.  The implant is then placed in this new  pocket.  Most surgeons agree that it is also important to put in a new implant when treating a capsular contracture.  This is due to the possibility that the old implant is covered by "biofilm".  Biofilm is thought to be one of the causative agents for a capsular contracture.  Biofilm is a barrier that forms around some implants possibly secondary to a subclinical infection.  A subclinical infection is one that affects the breast implant pocket but does not cause any other external symptoms.  Some surgeons recommend the use of Strattice.  Unfortunately Strattice is quite expensive.
  One of the simplest ways to release a capsular contracture is  by performing a capsulotomy.  In the performance of a capsulotomy the previous incision is opened, the implant is removed and the capsule is then cut in several different locations to release the constrictions allowing the pocket to open up and return to its original size.  The original implant is replaced with a new one and the wound is closed.  In the past, however this procedure has been associated with a relatively high rate of recurrence.  Two years ago I received some advice from a well respected plastic surgeon from Grand Rapids Michigan.  He told me that he has been treating capsular contractures by performing the capsulotomy and then immediately placing the patient on a ten to fifteen day regimen of prednisone and a six-week regimen of Singulair.  Both medications are started on the day of surgery.  Over the last two years I have treated several capsular contractures with this regimen.  None of the patients have had a recurrence of the capsular contracture and all of the patient's tolerated the medication very well.

Alexander G. Nein, MD, MS, FACS · Answer

Statistically about 80% of women who get capsular contracture will develop it in the first two years and in my personal experience the vast majority of those will develop contracture in the first 2 to 6 months. There is no exact science as to when is the optimal time to perform a capsulectomy but I would probably wait until the process has stopped for about a month. In other words once the contracture is no longer getting worse or changing, then wait 4 to 6 weeks before having the capsulectomy performed. I personally wouldn’t use Strattice for the first episode of capsular contracture. I’ve only had one capsulectomy redevelop contracture; so the odds of getting a resolution to the capsular contracture without the use of ADM (acellular dermal matrix) are quite good. I would avoid the extra expense for something that probably is not necessary and that doesn’t guarantee that contracture won’t recur. If someone has had multiple recurrent contractures then ADM would be a very reasonable option.

Eleanor J. Barone, MD · Answer

what you can honorably postpone until tomorrow...this is because so much of the final results in plastic surgery depend upon formation and remodelling of scar tissue. This includes all of the scar tissue you do not see, under the skin. And just like the scar you see on your skin which tends to become less visible with time, the scar tissue under the skin is also softening and thinning out (usually). So if there is pain from the contracture, then operating early is often necessary, but in general it is preferable to wait 6 to 12 months, and sometimes find that no surgery is necessary at all! Good luck to you.

Alexis Verpaele, MD · Answer

Dear lady, I agree with our other colleagues that a 6 months cooling down period is recommendable. However, I am afraid that the chances of recurrence of capsular contracture are high. I know that they are not available anymore in the USA, but we have been using MicroPolyUrethane covered silicone implants for over 10 years, and the chances of recurrence of a capsular contracture with these implants is ten times lower than with any other implant. The quality of the result is also at least as good as with any other silicone implant, if not better.

David Bogue, MD · Answer

There is no hard and fast rule on when to operate to correct capsular contracture. Most surgeons will likely wait a minimum of 3 months. The reason for waiting is to allow for resolution of swelling, inflammation, and often times to give non-operative options a chance to work (aggressive massage, U/S therapy, etc.) However, every patient is different and correction is usually individualized. The use of Strattice is a good option for prevention of recurrence.

Robert Brueck, MD · Answer

I would probably wait a while.Exercise the pockets with massage and soem say ultrasound may help.soem surgeons may try singular to help soften a new capsule but I would probably wait a bit longer.

How Long to Wait Before Fixing Capsular Contracture?

Answers (16)

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