Surgical Treatment of Capsular Contracture: Removing Constriction and Regaining Freedom

What is capsular contracture?

Whenever your skin is broken, your body’s defense system rushes to the area to repair the damage. New tissue is created to cover the opening, and any foreign material that may have entered the body through the opening gets encased in tissue to protect the body from infection. The inside of your body works the same way. Regardless of the type of implant, any type of foreign material that’s placed into the body triggers your immune system to encase the material in scar tissue. In breast augmentation this scar tissue is known as a capsule and serves as an anchor, holding the implant in place in the pocket. Unfortunately, for some, the capsule around the implant begins to shrink until the sack is smaller than the implant creating an implant that feel firm or hard also know as a capsular contracture.

What causes capsular contracture?

Doctors do not exactly what causes capsular contracture, but they do know that certain factors tend to make certain people more prone to having this problem develop.

• Hemorrhaging at the time the implants are put in can increase the likelihood of capsular contracture. To help decrease the chances of this happening, Dr. Tolson has patients stop taking aspirin, anti-inflammatories, and any vitamins or herbs that tend to thin the blood and increase their risks of developing blood clots two weeks prior to their augmentation procedure.
• When bacteria somehow manage to enter the chest cavity of the patient, a bacterial film forms around the implant, eventually creating thick scar tissue called biofilm. Bacteria lives on everyone’s skin and can easily enter the body through any open wound. Dr. Tolson takes extra measures to ensure that the implants and the wound remain free of bacteria when doing the original augmentation.

When does capsular contracture need to be treated?

Every person’s body responds differently to surgery. The one consistent factor is that a capsule of scar tissue will form around the implant. Capsular contracture is relatively common, with one in six patients having some form of contracture. Not every patient needs to be treated, though. The amount of contracture is broken down into varying grades, and if a patient is going to need treatment, that will generally be seen within the first two years of the augmentation.

• Grade 1 – The breasts both look and feel soft and normal. No symptoms present themselves to the patient.
• Grade 2 – Although the breasts look normal, they feel firm to the touch.
• Grade 3 – The breasts are firm to the touch, may appear overly round and hard, and have misshapen nipples. Little to no pain is experienced at this stage.
• Grade 4 – The breasts are hard and misshapen and are painful and tender to the touch.

Late onset of capsular contracture is not unheard of but it can occur. Eighty percent of the patients that develop capsular contracture do so in the first four to six months after their surgery.

How can capsular contracture be treated?

The most effective way to treat capsular contracture at this time is through removal of a portion of the contracted capsule and placement of a sheet of acellular dermal matrix and consideration of exchanging the implants for a form stable implant. Dr. Tolson will perform this procedure in his state-of-the-art, AAAASF-certified operating room in Cumming, Georgia. He is certified by the American Board of Plastic Surgeons and is a member of the American Society for Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, so he stays abreast of what really works in the field of cosmetic surgery.

Consultation

At your consultation, Dr. Tolson will examine your breasts and breast tissue and take pictures for your medical records. He will discuss

• Your previous breast augmentation.
• Your cosmetic goals.
• Your medical history, including current medications, allergies, vitamins, and supplements.
• Your family’s history of breast cancer.
• Your current mammogram results.

Preparation

You will need to stop taking aspirin, anti-inflammatories, vitamins, and herbs that thin the blood two weeks prior to your implant revision. Although this is an outpatient procedure, you will want to arrange to have someone drive you home afterwards and stay with you the first night. Be sure to wear soft, comfortable clothing that opens in the front and slip-on shoes so that you don’t have to bend over after the surgery. Because nicotine inhibits healing, you will need to stop using tobacco products six weeks prior to your surgery date.

Procedure

Capsular contraction treatment is an outpatient procedure that uses general anesthesia. Dr. Tolson will go in through a peri areolar  incision and remove both the capsule and the implant. He will then place the sheet acellular matrix.  After the surgery is complete, you will be taken to recovery where one of Dr. Tolson’s staff will monitor you before releasing you to go home.

Recovery

You may be released wearing a surgical bra or gauze and a bandage. You may notice that your range of motion is limited at first, but that should improve as the swelling decreases and your body heals. You should not do any driving, lifting, laundry, or cleaning for the first two weeks, giving your body a chance to heal without added strain. Plan on sleeping on your back at a 25- to 45-degree angle until the swelling goes down. If you tend to sleep on your side or stomach, invest in some extra pillows to keep from rolling over.

Capsular contractor doesn’t have to mean the end of your new look. Dr. Tolson can usually treat the hardened capsule and restore your look once again, allowing you to walk with confidence while wearing your bathing suit or formal gown.