While breast augmentation is a safe procedure that has improved the appearance of thousands of women, complications can accompany this procedure on occasion. One of the most painful is capsular contracture, a situation in which scar tissue forms and tightens around the implant, resulting in firmness in the breast. In the most severe cases, the breast may become distorted and painful to the touch.
The optimal way to minimize the chance of capsular contracture is to choose a plastic surgeon for your breast augmentation that is experienced in the procedure and knowledgeable about steps that will lower the likelihood it will develop. However, even in the ideal surgical situation, there is no way to eliminate the risk. The team at Umansky Medical Center for Plastic Surgery have the basic facts about capsular contracture you need to know to ensure your best odds of a complication-free breast procedure and how to treat it if it does begin to develop.
The Lowdown on Capsular Contracture
Scar tissue is a natural byproduct of any surgical procedure, including breast augmentation. The formation of the tissue is not a problem unless the tissue contracts and forms a tight capsule around the implant that restricts movement and causes the breast to become hard. The tightening often occurs in the weeks following surgery, with most contractures developing within the first two years after breast augmentation. If the breast becomes hard later, it could be an indication the implant has ruptured.
There are varying degrees of capsular contracture, based on the Baker grading system:
- Grade 1: breast is soft and natural with no signs of distortion
- Grade 2: breast has some firmness, but no distortion is detected
- Grade 3: breast has more firmness and begins to look abnormal
- Grade 4: breast is hard and painful to the touch, significantly distorted
Are you at risk?
Capsular contracture occurs in about 10 percent of the women that undergo breast augmentation. While there is no way to predict with certainty who will develop this condition, there are some factors that might heighten your risk:
- Complications after surgery, such as excessive bleeding, fluid buildup or infection
- Severe trauma or injury to the breast
- Insufficient skin to cover the implant
- Selecting an implant that is too large for the breast
- Leaking of silicone molecules from the implant into the breast tissue
- Radiation therapy
While these risks can be somewhat straightforward to identify, the cause of a “silent” contracture (one that cannot be attributed to these events) is unknown. Most physicians believe a low-grade infection is the most likely culprit; however, that theory has not been proven currently. Despite the lack of solid information on the causes of capsular contracture, experienced physicians will take steps to lower the risk for their patients.
Since prevention is the most efficient way to treat the problem before it occurs, Drs. William and Jeffrey Umansky take steps before and during all breast augmentation procedures to lower the risk of capsular contracture. While not all these options are appropriate for every patient, our surgeons will take whatever precautions they can without compromising the results of your procedure. Some of the steps we consider include:
- Placing the implant underneath the pectoral (chest) muscle
- Administering antibiotics before surgery to lower the risk of infection
- Massage and compression exercises to keep the implant soft and pliable
- Choosing textured over smooth implants
- Taking vitamin E, anti-inflammatories and antibiotics after surgery
Treating the Problem
If capsular contracture does begin to develop, earlier treatment may help you avoid the need for additional surgery. Umansky Medical Center for Plastic Surgery is one of the only plastic surgery offices in the San Diego area to offer a revolutionary ultrasound treatment developed by Aspen Rehabilitation. The procedure delivers ultrasound energy into the breast tissue, which can soften the early signs of contraction when combined with massage and compression therapy. While the treatment does not work on every patient, we have seen a substantial number of women respond favorably to this therapy and see relief from contracture without the need for surgery.
If this treatment is not effective, other treatment options may be used, including:
- Medications like Singulair, typically used to reduce inflammation in people with asthma, may also provide some softening when the contraction begins to occur.
- Vitamin E taken after surgery or at the first sign of contracture might also be helpful.
- Massage and stretching may prevent the condition or minimize contracture if it does occur.
- Capsule surgery, known as a capsulectomy, releases the contracture and returns softness to the breast. The implant may need to be replaced if it has been damaged from the contraction, which can be handled during this procedure as well.
No matter which treatment is used to address your capsular contracture, there is a possibility the condition could recur. Drs. William and Jeffrey Umansky will discuss your risks with you before treatment and monitor you afterward to ensure hardening does not begin to develop again.
There may be no way to completely avoid capsular contracture, but educating yourself about the condition and seeing your plastic surgeon at the first sign of a problem will go far in minimizing the effects of this condition. To learn more, contact Umansky Medical Center for Plastic Surgery today at 858-281-4560.