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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.
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.
The 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.
The 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.
Thanks 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 Photos by Plastic Surgeon: Dr. Repta, Phoenix & Scottsdale, AZ
Breast Augmentation and Lift, Breast Revision, Capsule Contracture
Breast Revision, Capsule Contracture
Capsular Contracture Repair by Dr. Teitelbaum, CA
Capsule Contracture Repair Photos by Dr. Repta, AZ
Capsular Contracture Repair by Dr. DeWire, VA
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.
Capsular Contracture prior to repair surgery
Capsular Contracture shortly after repair surgery
Mamie's breast implants two years after her Capsular Contracture repair surgery
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