What is the Best Way to Deal with Capsular Contracture?

I had silicone implants under the muscle to correct tubular breasts 8 months ago. I now have capsular contracture baker grade 3 on the left for the past month. Now my right breast is starting to feel tight like it is now developing cc also. Does this mean I am going to have this problem over and over? I was going to schedule Surgery to fix the left but should I wait to see what happens to the right? Would it be a lower risk to get it again if I just switch to saline implants? Thank you

Doctor Answers 12

Correction of Capsular Contracture of Breast Implants by Fat Transfer is the newest most promising technique

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Capsular Contracture around Breast Implants following Breast Augmentation has traditionally been treated with Surgery. The Capsular Scar Tissue is removed and new breast Implants are placed. Typically Textured Breast Implants are used as Textured Implants have been shown to have less risk of Capsule formation. Although Saline Implants in the past have had less risk of Capsular Contracture when used initially, once a capsule has formed the chance of a second capsule forming after second surgery is close to 50% even with Saline Implants.

Exciting new results have been achieved most notably by Dr Sydney Coleman in New York by treating Capsular Contracture with Fat Transfer which is injecting your own Fat around the implants.

This is certainly less invasive and the results that I have seen have been impressive.

Polyurethane covered implants are the best prevention.

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Dear lady, I am sorry to hear about your problem. I am afraid to tell you that replacing your implants with saline ones is unlikely to help, as several studies have shown no difference in frequency of capsular contracture with either silicone of saline implants, and there is even no real difference between smooth or rough implants. 

The only implants that have a proven preventive action against primary or even recurrent capsular contracture are the ones covered with a polyurethane film. Unfortunately for you these implants are not available anymore in the USA, although they have been used a long time in the eightees and early ninetees. 

I have been using these implants for 10 years and the results are good, the incidence of capsular contracture remains very low. The implants come in many shapes and sizes, so they can be used to replace virtually any other implant.

Alexis Verpaele, MD
Belgium Plastic Surgeon

Capsular Contracture and Revisions

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I am sorry to hear about your problems with capsular contractures after your breast surgery.  Unfortunately, no one is completely certain why contractures occur.  There are many theories out there-the hottest being the relationship between Biofilm and breast implants-but again, no one really knows.

While in the past, studies showed a significantly higher rate of capsular contracture with silicone-gel filled implants, newer studies using the newer generation of silicone-gel implants do not seem to support this finding.  The contracture rates are not significantly different between silicone and saline filled implants.

You mentioned that your implants were used to help correct your tuberous breasts. You did not mention where your incisions were placed.   Many surgeons will use the around the nipple incision with tuberous breasts in order to correct the herniated, enlarged nipple-areolar complex and also use this incision for placing the implants.  There is some data suggesting a higher rate of contracture if this incision is used when compared to the under the breast incision.  If you are going to undergo a revision with removal of the implants and the capsule, you may want to discuss with your surgeon using a different incision such as the under the breast incision.  

What is the probabilty that you will again develop a capsular contracture after your revision is difficult to say.  Most studies do show a higher than average rate for developing a capsular contracture in patients who have already had a contracture but the majority of these revision patients do not have a reoccurance.

I wish I could be more precise but there is so much about capsular contractures that we do not know.  Please discuss your concerns with your plastic surgeon.  Also discuss with them your worries about your opposite right breast and the possibility of an early contracture developing.

Good luck.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 88 reviews

Concerned about Capsular Contracture

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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.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

How Do I Treat Capsular Contracture

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Capsular Contracture is relatively uncommon after breast augmentation. However when a patient does have capsular contracture (hardening of the breast) it needs to be treated appropriately to prevent recurrence.
Treatment of capsular contracture involves multiple steps to decrease the chance of recurrence. First the current implant is removed and replaced with a new implant. Second a complete capsulectomy (removal of all the scar tissue around the implant) is performed. This removes any irritant that might have caused the capsular contracture in the first place.

Lastly, if patients have had capsular contracture more then once then I will put a dermal mesh sling (Alloderm or Strattice) around the implant. This material has been shown to decrease the risk of capsular contracture. It prevents the scar tissue from forming completely around the implant.

This combination helps decrease the chance that the scar tissue will return after the implant exchange.

What is the Best Way to Deal with Capsular Contracture?

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 Sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons.  In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants, and the use of acellular dermal matrix.  Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source ( human, porcine, or bovine in origin).  I hope this, and the attached link ( demonstrating a case utilizing acellular dermal matrix) helps. 

Capsular Contracture is a Surgical Problem

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Hi there-

Unfortunately, and while we do not know the cause of Capsular Contracture, there is no effective and safe way to produce improvement without surgery.

Accolate did show some promise in the past, but has been abandoned by most experienced breast plastic surgeons because of the significant risks associated with its use.

Some surgeons have noted unpredictable degrees of improvement in patients with mild contractures after external ultrasound, but again, the improvement has not been universal or dramatic.

Your best bet is to have the problem managed surgically.

What is the Best Way to Deal with Capsular Contracture?

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If capsular contracture is caught early, you can sometime treat it with drugs, like Accolate, and aggressive massage.  More more advance cases like yours, you would need to have surgery to remove the capsule and change the implants.  Many times a capsular contracture does not recur.  In you case, you should have both breasts treated at the same time.

As far as switching to saline, there is no evidence that there is less capsular contracture with saline compared to the current silicone implants.  There is some evidence that a periareolar incision has a higher risk of capsular contracture, so you may want to make sure you have an incision under the breast for your revision.

Rigo Mendoza, MD
Tampa Plastic Surgeon
4.4 out of 5 stars 40 reviews

Capsular contracture

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If you have a capsular ocntracture in both breasts, you are better off dealing with both at the same time. It is unclear why they develop.  There are several theories.  Sometimes removing the capsule and replacing the implants does the trick and sometimes it doesn't.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Capsular contracture often does not come back.

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1)  The most common causes of capsular contracture are some blood around the implants or sub-clinical infection at the time of the original operation. ( This is specially true for Class III or IV contractures.)   So if these problems are avoided during the revision, you may well not get CC again.

2)  Using Alloderm definitely helps prevent CC.

3)  I would not do anything for several months, to see what happens in the right breast.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.