Capsular Contracture

Dr. William Umansky and Dr. Jeffery Umansky know that complications can occur with any surgery. Capsular contracture (CC) is a breast augmentation problem that can develop when internal scar tissue forms a tight or constricting capsule around a breast implant, causing it to become misshaped and hard. The breast may become painful, and the capsule may affect the appearance or shape of the breast. At Umansky Medical Center, La Jolla – San Diego, our first priority is to assure all procedures are done to meet all safety requirements, using only state-of-the-art techniques and materials to assure optimum Breast Augmentation Surgery outcome.

What is Capsular Contracture of the Breast?

A capsule is basically scar tissue. A capsule actually forms around every breast implant, silicone or saline. Scar tissue is the body’s natural response to the placement of any foreign object. It is only when this scar tissue thickens or contracts and restricts the movement of the implant, that the breast is said to have a contracture.
Symptoms of capsular contracture often begin within weeks of the original breast augmentation surgery, but capsular contracture can occur at any time. There are a range of signs and symptoms. The main sign of capsular contracture is increasing firmness of the effected breast. This can lead to upward displacement of the breast implant, altered size and shape of the effected breast, and pain. At its worst, the breast can become hard, painful, and distorted into a round and superiorly displaced position.

The majority of capsules occur within the first two years following surgery. Symptomatic capsular contracture rates appear to be lower with saline implants than with silicone gel implants. If a capsular contracture occurs around a gel implant many years after augmentation, it could be a sign of an implant rupture.
The technical definitions of capsular contracture are as follows:

• Grade I — the breast is normally soft and appears natural in size and shape.
• Grade II — the breast is a little firm, but appears normal.
• Grade III — the breast is firm and appears abnormal.
• Grade IV — the breast is hard, painful to the touch and appears abnormal.

Who’s at Risk of Developing Capsular Contracture?
Predicting who will develop capsular contracture and when it will happen is not possible. It occurs in about 10 percent of women who undergo breast augmentation with implants.

The cause of a “silent” capsular contracture — that is, one without an obvious precipitating event such as trauma, hematoma or radiation — is unknown. Many theories about capsular contracture have been proposed over the years, but currently the most widely accepted cause is a low-grade infection.
Other factors that may increase the risk of developing capsular contracture include:

• Postsurgical complications like hematoma (bleeding into the implant space), seroma (collection of fluid) and bacterial infection
• Severe breast trauma
• Radiation therapy
• Inadequate soft tissue coverage or using too large an implant for the amount of tissue coverage
• Silicone molecules that “bleed” into the implant space (primarily an issue with older silicone gel implants)

How can Capsular Contracture be Avoided?
Decreasing the risk of developing capsular contracture is the best way to avoid this complication. Most surgeons recommend placing the breast implants behind the pectoral muscles. The theory is that the constant movement provided by the pectoral muscles will discourage the growth of scar tissue around the implants.

Other techniques that have been used to reduce risk for capsular contracture include antibiotics during the surgery. Some surgeons promote gentle implant massage beginning shortly after surgery. Exercises that involve squeezing the implant to keep it flexible and loose may also be recommended. As well, antibiotics, anti-inflammatories, or Vitamin E may be recommended after surgery.

Dr. William Umansky and Dr. Jeffery Umansky always discuss these and other options for avoiding capsular contracture with patients prior to breast augmentation surgery.

Treating Capsular Contracture

Capsular contracture may happen despite the best efforts to avoid it. Implant studies of how often capsular contracture occurs will vary depending on type of procedure (above or below muscle implant placement) and the type of implant (silicone or saline). Women who undergo breast reconstruction after Cancer, who have radiation treatment, tend to be on the higher end of the statistics.

MEDICATIONS like Singulair, which is an anti-allergy/anti-asthma drug, has shown some benefit in a small percentage of patients. It actively reduces the inflammatory process in asthma and has shown some benefit in helping to prevent hardening or in softening an already contracted implant. Vitamin E appears to have some benefit in preventing capsular contraction. Dr. William Umansky and Dr. Jeffery Umansky will discuss with patients the use of medication for preventing Capsular Contracture.

MASSAGING and stretching exercises may help prevent or reduce the severity of contracture once it starts. As discussed above, the goal is to not allow the fibrous capsule to reach a state of excessive hardness or allow the implant to stay stuck in an upward position.

CAPSULE SURGERY, often known as open capsulectomy or capsulotomy, can be done to release, cut, and allow for opening of the contracture. The goal is to release the tightness and allow for return of softness. This type of surgery may require placement of a new implant. An alternate method is called a closed capsulotomy. This is where a surgeon physically breaks the capsule by forcibly squeezing the breast from the outside to break the scar and allow for softening. This method is not recommended as it is painful, unpredictable, and may compromise the implant itself.

It is also important to understand that despite initial improvement after surgery, a repeated contracture may occur. Drs. Umansky will of course discuss the best option per each situation.

ASPEN —At Umansky Medical Center, Aspen ultrasound treatment is provided. We are one of the only offices in the surrounding areas to offer this beneficial modality to aid in healing and minimizing your risk for future corrective surgery, removal or replacement surgery. This was developed by Aspen Rehabilitation, a post-plastic surgery treatment facility in Coral Springs, Florida. Ultrasound therapy is used along with massage and compression bandaging to help soften an early contraction. While this approach is not always successful, we have found that it has reversed hardening in a subset of patients and has helped avoid repeat surgery in some patients. Aspen can also be used to help treat: Bruising, scarring and hematomas to assist in healing from (liposuction, tummy tuck and facelift procedures). Depending upon the degree of the contracture, scarring or hematoma, multiple treatments may be necessary to address the effected area. Aspen is not a guarantee of correction and future surgery may still be necessary.

 

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