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Breast Implant Reoperation Capsular Contracture
What is Capsular Contracture?
Correction of Capsular contractur and Breast Implant Complications in Orange County and Los Angeles
Capsular contracture happens when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant. It can happen over time in one or both of the implanted breasts. The chance of capsular contracture occurring may increase over time, though its causes are unknown. Capsular contracture may be more common following infection and blood clot formation. Also, the risk capsular contracture increases with every breast augmentation. Capsular contracture is a risk factor for implant rupture, and it is the most common reason for reoperation.
Symptoms of capsular contracture range from mild firmness and mild discomfort to severe pain, distorted shape of the implant, and palpability (ability to feel the implant). Depending on its severity, capsular contracture is graded into four levels. Baker Grades III or IV are considered severe and often additional surgery is needed to correct these grades:
Baker Grade I: the breast is normally soft and looks natural
Baker Grade II: the breast is a little firm but looks normal
Baker Grade III: the breast is firm and looks abnormal
Baker Grade IV: the breast is hard, painful, and looks abnormal
A reoperation may be needed to correct capsular contracture, usually for Grade III or IV capsular contracture. Correction of Grade IV capsular contracture is often coverd by most insurance plans in Dr. Agha’s practice.The surgical procedures range from removal of the implant capsule tissue (capsulectomy) with or without implant replacement. Capsulectomy, removing the entire capsule surrounding the implant, is the definitive treatment for capsular contracture. This surgery may result in loss of some breast tissue. The procedure is often combined with moving the implants into a totally submuscular position which has a lower rate of capsular contracture. Alternatively, a textured surface implant may be used in a subglandular plane to reduce recurrence rates. Capsular contracture may happen again after this reoperation.
31 year old female who developed capsular contracture about four months after her submuscular breast augmentation with Saline implants. The patient underwent a complete capsulectomy and implant exchange by Dr. Agha at 6 months after her first surgery. Post-Op picture is shown at three months after reoperation.
In Mentor’s Core Study, for women receiving augmentation implants for the first time, the risk of severe capsular contracture was 8% over three years. For women receiving revision-augmentation implants, the risk of severe capsular contracture was 19% over three years.
Can capsular contracture be prevented?
Unfortunately, there is no way to completely eradicate the chances of getting capsular contracture. However, there are things that you can try:
Textured breast implants were developed to reduce the incidence of capsular contracture. However, several studies have shown that when the implants are placed under the muscle, there is really no difference in capsular contracture rates between smooth implants and textured implants. When implants are placed over the muscle (in a subglandular plane), a textured implant may reduce caspular contracture rate.
Subpectoral or Submuscular Implant Placement reduces risk of capsular contracture by an average of 8 – 10%. Implants placed over the muscle come into contact with the breast ducts, which harbor bacteria. Having the implants placed below the muscle helps to minimize this. The muscle also “massages” the implant constantly which in turn may reduce capsular contracture.
Breast Massage. Early and continued breast massage may prevent capsular contracture. Dr. Agha will instruct you on appropriate breast massage at the first post-operative visit. He advocates regular massage for at least the first 6 months after the surgery.
Implant Wash in Triple Antibiotics. Bathing the implants in a solution of triple antibiotic solution has been shown to reduce the risk of capsular contracture.
The “no-touch” technique. Only Dr. Agha handles your implants during preparation and insertion. These measures help to ensure that no foreign substances attach to the implant, which could inflame the surrounding tissue and cause complications such as capsular contracture.
New treatments for capsular contracture
Accolate, a drug used in the treatment of Asthma, has been used in several studies to effectively improve capsular contracture. It is used due to its anti-inflammatory properties. Patients with recognized capsular contracture showed improvements with use of Accolate. Accolate is said to work best on early contractures, but may reverse existing capsules. If the capsule is well-formed, it can take several months to successfully treat it. Prophylactic treatment may be used in women who are at a higher risk for capsule contracture. Further, clinical studies still need to be done regarding the use of Accolate as a form of treatment for capsule contracture.
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