Capsule Contracture Information

Understanding Capsule Contracture

Capsule contracture is a rare complication of breast augmentation
surgery. It occurs when the scar tissue or capsule that normally forms
around the implant tightens and squeezes the implant. The capsule is
formed during the healing process at any time after the surgery, but is
more common in the first several months. It can happen to one or both
of the breast implants. Depending upon the severity of the capsular
contracture, the breast can feel firm, hard, distorted, and begin to
cause pain.

What causes it?

Capsule contracture occurs in about 5% of patient, but the causes are
unclear. However, certain outside variables increase your chances of
capsular contracture like hematoma, seroma, bacterial infection,
non-sterile equipment, radiation therapy either pre- or
post-operatively, and severe trauma to the breast.

Do You Have It?

If your breasts seem deformed, misshapen, painful, or are firmer than
when you first got them, you may have developed capsular contracture.
There are four levels of capsular contracture:

• Grade I: the breast is normally soft and looks natural
• Grade II: the breast is a little firm but looks normal
• Grade III: the breast is firm and looks abnormal (visible distortion)
• Grade IV: the breast is hard, painful, and looks abnormal (greater distortion)

Figure shows Grade IV capsular contracture in the right breast of a
29-year-old woman seven years after sub-glandular placement of 560cc
silicone gel-filled breast implants.

How to treat capsular contracture?

The treatment to avoid capsular contracture during surgery is to
irrigate the dissected pocket for your breast implant with special
antibiotic irrigation fluid during the surgery. After placement of
breast implant, there are both surgical and non-surgical options to
avoid capsular contracture.

Non-surgical Treatment of Capsular Contracture

Antibiotics and Vitamin E: While this is not always effective as a
cure, many surgeons will suggest that patients take a regular dose of
Vitamin E for the first year after augmentation as it helps to keep
tissue soft.

Closed capsulotomy: The breast is forcefully squeezed in the
hope that the capsule pops or tears. This is done rarely because it
could cause the implant to rupture and may void the manufacturer’s
warranty.

External Ultrasound: May help reduce swelling and inflammation and does not involve any major risks.

Accolate: An anti-asthma drug that reduces leukotrienes, a
substance which is released by your body that is thought to be related
to capsular contracture. This works relatively well, and is supported
by papers in the plastic surgery literature.

Surgical Treatment of Capsular Contracture

Open capsulotomy: The capsule surrounding the implant is surgically cut open in order to release the implant. Portions of the capsule are left in place in the surgical pocket. I can create a new pocket, or “neo-pocket,” in the area above the capsule. Also, I can put the implant in a completely different anatomic plane, such as moving the implant from above the muscle/ subglandular, to below the muscle/ submuscular.

Open capsulectomy: The entire capsule is removed, allowing new tissue to form around the implant. I can also use portions of the capsule as an internal bra to actually give strength to the new pocket.

Change in Implant: I can change a smooth shell implant to a textured shell implant.
There are several other surgical techniques which are quite detailed, but may also be able to improve your capsular contracture and overall position of your implant. I would be happy to discuss them with you in detail.

How can you prevent capsular contracture?

• Choose partial or complete sub-muscular placement instead of subglandular, or “above the muscle” placement.
• Take Vitamin E orally after surgery.
• Wear a compression bra.
• Do compression exercises and post-op massaging of the implants, which Dr. Kim can show you how to do after your surgery.

Make sure and follow-up with Dr. Kim after surgery, so that he can ensure that capsular contracture is not happening.

I would like you to realize that many situations are correctable, both non-surgically and surgically. For non-surgical treatment options, it is vital that they are used within the first 6 months after surgery, and optimally as soon as they are recognized.

Please contact our office to schedule a consultation.

Learn more about Breast Augmentation:

• On-Q Pain pump for plastic surgery patients.
• Breast Enhancement FAQ’s
• Breast Implant Sizing
• Silicone vs. Saline Breast Implants

To schedule an appointment or to
learn more about a breast enhancement, please contact
us today. Or, click to read more about
breast enhancement in San Francisco.