CAPSULAR CONTRACTURE TREATMENT

Previous evidence seemed to show that using textured implants over the muscle could decrease rates of capsular contracture. However, a study published in the Aesthetic Surgery Journal in September 2019 concluded that using smooth implants under the muscle didn’t significantly increase capsular contracture risk.

Most doctors now believe bacterial contamination during surgery could be the biggest culprit for triggering capsular contracture down the road. “Although it’s incompletely understood, capsule contracture, the tightening of scar tissue around a breast implant, is thought to be related to chronic bacterial contamination in the implant pocket,” says West Palm Beach, Florida, plastic surgeon Dr. Richard G. Schwartz in a RealSelf Q&A. 

The 2019 study urges breast implant surgeons use an aseptic surgical technique to minimize contamination, saying this is “of greater clinical significance than implant surface characteristics, when discussing capsular contracture.” 

You may also be able to take steps to prevent capsular contracture yourself by taking a prophylactic antibiotic before any procedure, including a teeth cleaning and Pap smears—both of which can send bacteria into the bloodstream and increase your risk of contamination.

While some claim that massaging the implant can reduce the risk of capsular contracture, that doesn’t seem to be the case. In one RealSelf Q&A, Beverly Hills, California, plastic surgeon Dr. Gerald Minniti says, “Data shows us that implant massage works no better than not doing it at all. This has been established for years, and surgeons who adhere to evidence-based best practices don't have their patients massage.”

One of the first capsular contracture symptoms is firmness to the touch in the area around the implant. If it progresses, the breast can become distorted. 

It’s important to see your doctor in person, if you suspect you may have capsular contracture. “The look and feel of hardness surrounding your implant is seen and/or felt. At its worst, you experience pain,” says Scottsdale, Arizona, plastic surgeon Dr. Lewis Albert Andres in a RealSelf Q&A.

Capsular contracture surgery, which removes and replaces the implant, is recommended for Grades III and IV. There are two types of surgery: a capsulotomy and a capsulectomy.

A capsulotomy creates more space around the implant. This surgery can be either open or closed. An open capsulectomy involves an incision created at the implant site, to make more room and remove the capsule of tissue, while the closed capsulotomy entails manually compressing the area, to break up the scar tissue. Though the latter is less invasive, it comes with a greater risk of rupturing the implant.

A capsulectomy, on the other hand, removes the implant entirely from the capsule of scar tissue. The surgery can end there, if you don’t want a new implant. 

Alternatively, a new implant may be placed in a new pocket under the muscle (if it was originally over the muscle) or vice versa. The goal is to avoid bacterial contamination, which could lead to recurrent capsular contracture. A scaffolding material or acellular dermal matrix (a tissue graft) may be inserted around it, to provide support around the new implant.

Recovery is similar to that of any major surgery. Dr. Jed Horowitz, a plastic surgeon in Newport Beach, California, says in a RealSelf Q&A: “You may feel sore and tired during the first 48 to 72 hours following surgery. During these first few days, you may engage in light activities but must refrain from lifting or raising your arms above your head. Swelling and bruising will subside during the first week after surgery and can be managed with pain medication.” 

You’ll be able to shower after about three days and can return to work within a week. 

You may have drains to alleviate fluid buildup. Those will likely be removed at your first follow-up appointment.

There are few less invasive capsular contracture treatment options. “Leukotriene inhibitors such as Singulair and Accolate have been used off label, to treat capsular contracture,” says Dr. Geldner in a RealSelf Q&A. “The results vary but are best if treatment is started early.” 

Another option may be the Aspen system, a device that softens the tissue using ultrasound—but doctors are divided about its efficacy.

• Average Cost:
• $7,452

• Range:
• $60 - $12,001

The capsular contracture treatment photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.