I was diagnosed with capsular contracture and my surgeon tried to break the scar tissue in the office. Is this recommended?

I'm almost 12 month post op and I was diagnosed with capsule contactor. My breast look the same, but one of my breasts is firmer. I believe I'm a grade 2. My surgeon tried on two different occasions to break the scar tissue in the office. Is this recommended? Also if I do have to have surgery is it high risk to remove the scar tissue and be exchanged with implants a cup size bigger? I'm 4'11 110Ibs and I currently have 350ccs.

Doctor Answers 4

Closed Capsulotomy

Rupturing the capsule by squeezing it forcefully (closed capsulotomy) is an outdated technique that is shown to cause more problems than it solves.  The trauma of this approach has the potential to turn a milder contracture into a more noticeable one if there is any bleeding into the pocket caused by the maneuver.

With grade 2 contracture, I would simply try aggressive daily breast massage.  This may loosen the pocket slightly.  If this doesn't work, ultrasound and certain asthma medications like SIngulair may help, although the papers on these approaches are not conclusive.

Ultimately, you may end up having one breast that is firmer than the other, but if they look symmetrical and you do not have any discomfort, it is probably best to avoid surgery.  If the contracture progresses to a grade 3 (visible distortion) or beyond, an implant exchange with surgical removal of the capsule and possible placement of Strattice would be the best option.  If you choose to increase your size, you will have to operate on both breasts, so often the simplest choice is to correct the problematic side and leave the normal side alone to minimize risks.  Good luck!

Santa Monica Plastic Surgeon
5.0 out of 5 stars 53 reviews

Breast implants - is a closed capsulotomy recommended

Thank you for asking about your breast implants.

  • Your surgeon was trying to do a closed capsulotomy - rupturing the capsule with pressure on the breast.
  • It was popular in the early 1980s and some surgeons still do this but the research shows that besides being painful, the capsule returns and often ruptures irregularly, giving the breast an odd shape.
  • Capulectomy surgery is not high risk - but it seems you already have large implants for your frame.
  • Your surgeon will have to examine you to see if there is an implant that can be used that is larger.
Always consult a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Closed capsulotomy

 In my opinion, a closed capsulotomy such as you describe with a squeezing of the breast is seldomly used in contemporary cosmetic breast surgery. In the past, it was found that if the capsular contracture was relieved, it usually recurred. In my experience, a trial of Accolate as well as Z wave treatments, using linear soundwaves has proved to be successful for early capsules. For established capsules, it's best in my opinion to remove the capsule and replace part of it within ADM such as Strattice. Go back to your operating plastic surgeon for advice.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Does Closed Rupture Capsulotomy Work?

Unfortunately, the process of squeezing on the breast that has a capsular contracture is proven to be universally unsuccessful.  This technique was popular in the '70's and '80's, and if it worked at all, it only was successful for a very short time and it carried the risk of tearing the implant wall and also an increased chance of breaking some blood vessels which led either to a hematoma or a worse capsular contracture.

If you were my patient and you had a Grade 2 contracture, I would place you on Accolate for 90 days and do ultrasound on the breast.  This has proven to be successful in the first six months after the formation of a mild capsular contracture. 

As for an open capsulectomy (the removal of scar tissue directly), this is the treatment of choice if non-surgical intervention fails.  With open capsulectomy, there is always the potential for post operative bleeding and a slightly higher risk of recurrent capsular contracture, especially if non-pathogenic bacteria are the cause of the contracture.  

That being said, I very often do open capsulectomies to eliminate capsular contractures, and as an adjunct, I put Seri in to decrease the chance of recurrence. 

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.