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Capsular Contracture of Breast Implants
Capsular Contraction ~ Capsular Contracture Repair


Capsular Contracture
- Prevention - Treatment - Capsulectomy
El's Capsular Contracture True Story Experience
Mamie's Capsular Contracture True Story Experience


Capsular Contracture PhotoCapsular Contracture

After breast augmentation with breast implants, excessive scar tissue may form around the breast implant which causes the breast implants to harden (similar to what a contracted muscle feels like) as the naturally forming scar tissue around the breast implant tightens and squeezes it. Every patient will have some scar tissue form around the breast implant, however if it forms a lot the implant will feel firmer or even harder depending on the "grade" of capuslar contraction the patien has. Capsular contracture grades from 1-4 with for being the worst. While capsular contracture is an unpredictable complication of breast surgery, it is also the most common complication of breast augmentation.

Capsular Contracture Prevention

  1. Textured implants help deter capsular contracture because of their rough surface of the breast implant which is intended to discourage a hard capsule from forming around the implant.
  2. Under the muscle (sub-pectoral or 'partial sub-muscular') placement of the implant reduces risk of capsular contracture by an average of 8 - 10%. Whereas over the muscle (in front of the muscle or 'sub-mammary') has 10 - 25% or more chance of capsule contracture. Complete unders (total sub-musculofascial) provide even more protection in preventing capsular contracture of the breast implants.
  3. Massage and or compression. This is usually only done with smooth breast implants and may be suggested for a period between a few weeks to as long as you have your breast implants. Do not massage bruises! More can be found on Dr. DeWire's massage page
  4. The "no-touch" technique. This method includes meticulously re-washing surgical gloves before handling any instrument and implants. Only the head surgeon touches the breast implant, using a unique Teflon cutting board and immediately inserting the implant underneath the muscle. All of these measures help ensure that no foreign substance attach themselves to the implant, which could inflame the surrounding tissue and cause complications such as capsular contracture.
  5. Vitamin E - Is rumored to help prevent capsular contracture, it can't hurt and it also beneficial to the skin. However, it may cause bleeding so don't take 2 weeks before & after surgery.
  6. Grafts - Acellular dermal grafts (Flex HD, Alloderm, Neoform & Strattice) add structural support to internal repairs, strengthening the permanent suture placement, and adding soft tissue thickness, as well as potentially reducing recurrence of capsule contracture. I personally have not seen studies on acellular dermal grafts but do have one friend who has used it to deter capsular contracture (after two previous capsular contractures). According to the makers of Strattice it can increase implant coverage and reduce the incidence of breast implant visibility or ripples. I read, "Strattice has been shown to decrease the recurrence of capsular contracture." But again, no case or study was cited so where was it shown to actually treat capsular contracture. Strattice is an acellular dermis made from bovine tissue and has been used extensively for other problems involcing breast implants and breast reconstruction. The extra tissue provides more implant coverage and support. This may suggest it could reduce the recurrence of capsular contraction.

Capsular Contracture Treatment

  1. Antibiotics - Surgeons use antibiotic for treatment of capsular contracture.
  2. Zafirlukast (Brand Name: Accolate)
  3. Capsulectomy
  4. Ultrasound - I am hearing about this but don't know what it does to treat capsular contracture.
  5. Singular - I am hearing about this to as treatment for capsular contracture. It is also an asthma treament drug like Accolate, so it could work for treatment of capsular contracture. However, I don't have any studies on it at this time for it's use in treatment of capsular contracture.
  6. Strattice - Which requires another surgery or breast implant redo. I have not seen studies on this or know anyone who has tried it for capsular contracture repair, but have according to the makers it can increase implant coverage and reduce the incidence of breast implant visibility or ripples. I also read, "Strattice has been shown to decrease the recurrence of capsular contracture." But again, no case or study was cited so where was it shown to treat capsular contracture? Strattice is an acellular dermis made from bovine tissue and has been used extensively for other problems involcing breast implants and breast reconstruction. The extra tissue provides more implant coverage and support. This may suggest it could reduce the recurrence of capsular contraction.
Preventing and Treating Capsular Contracture with Zafirlukast (Accolate)

40 randomly chosen patients with stiffening of the breast were given Zafirlukast with vitamin E experienced dramatic improvement over 3-6 months. In another study, 30 patients with recognized capsules used Zafirlukast for 12 months and 50% experienced softening or have become candidates for closed compression. 100 other patients were given Zafirlukast 2 weeks prior to surgery, which decreased the incidence of early capsules. Zafirlukast also decreased recurrence in patients undergoing capsulotomy.

Suggested dose: 20mg Zafirlukast twice daily for 3 months. The same dose is used for preventive treatment 2 weeks prior to surgery.

Risks: Allergic rashes. Long term effects are unknown as Zafirlukast has only been available in the US since 1999.

Other benefits: Zafirlukast is used chronic rhinitis so patients may notice improved breathing which also may lead to decreased snoring.

Capsulectomy
Removal of the capsule from the breast implant

Breast implant capsular contractureThe most appropriate treatment for capsular contracture is complete capsulectomy, or removal of the entire thickened capsule surrounding the breast implant such as in the specimen shown above. This is the most likely procedure to prevent future recurrent capsular contractures from forming. Capsulotomy, or merely cutting the capsule to release the scar formation, is much more likely to lead to a recurrence of the problem. The specimen to the right is shown immediately following removal, and the breast implant is still contained within the intact capsule.

Breast implant capsuleThe capsule has now been incised without removing any of the capsule. This demonstrates the considerable compressive forces exerted on the implant by the thickened capsule. This is why capsular contractures often lead to increased firmness of the breast.

A close-up view of the cut edge of the capsule, demonstrating the thickening that occurs during capsule formation. A normal capsule is a flimsy, transparent structure. As thickening occurs, collagen is laid down in layer upon layer, ultimately becoming apparent as a change in the shape of the breasts, a change in the softness of the breasts, and in some cases causing pain.

capsule fully opened with the implant removed

F.  Lauderdale Plastic Surgeon, Dr. Revis of South Florida Plastic Surgery AssociatesThanks to Board Certified Plastic Surgeon, Dr. Revis of South Florida Plastic Surgery Associates in Ft. Lauderdale, FL for the capsulectomy explanation and capsular contracture photos.

 

Capsule Contracture Before Surgery Repair
Capsule Contracture After Repair Treatment
Capsule Contracture Photos by Plastic Surgeon: Dr. Repta, Phoenix & Scottsdale, AZ

Breast Augmentation and Lift, Breast Revision, Capsule Contracture
by Plastic Surgeon, Dr. Repta of Advanced Aesthetic Associates in Scottsdale, AZ. She had breast implant surgery about 20 years previously by another plastic surgeon. She desired improved shape and symmetry to her breasts. They decided to remove the old breast implants, capsulectomy (removal of scar tissue), replaced with 460 ml silicone gel breast implants and a breast lift. Photos show improved symmetry, with soft, natural and proportional looking breast implants.

Capsular Contracture Revision
Capsule Contracture Photos by Plastic Surgeon:
Dr. Repta Phoenix & Scottsdale

Breast Revision, Capsule Contracture

This 53 year old female was seen at our Phoenix, AZ office for breast capsule contracture.  She had had breast augmentation performed by another plastic surgeon many years previously.  She complained of increasingly firm, painful, and distorted breasts.  Bilateral revision breast augmentation was performed by removing the previous saline breast implants along with full capsulectomies and replacement with 354 cc silicone breast implants.  Palpable masses were noted intra-operatively in both breasts which were biopsied and sent to pathology.  The post-operative photos show significant improvement in shape, contour, and feel of both breasts.  Her breast pain has stopped and her biopsies have come back negative.  A small lift of her left breast might be needed in the future to match the tissue stiffness of the right breast.


 

Capsular Contracture Repair by Dr. Teitelbaum, CA 

Capsule Contracture Repair Photos by Dr. Repta, AZ

Capsular Contracture Repair by Dr. DeWire, VA  

 

 

Capsular Contrature Experience Story - Mamies' Story

I researched for a year to find the right Plastic Surgeon. I knew all the risks, or so I thought.

I had read the pre-surgery paper work about Capsular Contracture, it sounded rare. Plus I had several surgeries before and always healed well. I didn't give it another thought.

Surgery went very well and I was so excited to finally have my new breast implants. As the days went by, I followed my doctor's instructions and massaged several times daily. The right breast was getting soft and dropping, but the left side didn't. When I returned for my 6 week checkup, I was told it would drop if I massaged more aggressively. Again I followed instructions. The morning of the 9th week I awoke feeling feverish. When I undressed to take a shower, I was shocked to see my left breast red and swollen. I called my doctor and saw her that morning. She wanted to send me to the hospital to do an ex-plant right then. I refused. She agreed to try and fight what ever infection I had with aggressive antibiotics. I was put on 3 different antibiotic simultaneously. They made me sick, but I was determined to not be hospitalized and go through what I knew was a hard surgery.

I didn't share this news with my husband at first. I just told him I needed to take antibiotics. I was then sent to a breast care clinic to have ultrasounds. Trying to see if it was blood that was causing the swelling. They didn't see any fluid, so no draining was possible.

After 2 weeks the swelling went down and fever was gone. By then the damage was done. I had stage 3 Capsular Contracture and would need to have more surgery to correct it. Not having the money right then, I had to wait 6 months to have my Capsular Contracture repair. I agreed to have the full breast implant removed and replaced with a new one. Not knowing what caused the infection in the first place we wanted to try and avoid it happening again.

I'm glad to say the repair surgery was a success and both my breasts are soft and natural. This experience I wouldn't wish on any one. But if I had to do it all again, I would.

Mamie's Capsular Contracture Pictures
capsular contracture capsular contracture immediately after surgery
Capsular Contracture prior to repair surgery
Capsular Contracture shortly after repair surgery
Capsular Contracture Corrected
Mamie's breast implants two years after her Capsular Contracture repair surgery

Capsular Contracture Repair by Dr. DeWire 

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