I have been getting a lot of questions about breast capsule contracture lately. People are asking about it on Real Self. They are calling in to ask about it and we are seeing a number of patients who have the problem from previous surgery and want to know how to correct it. The reason I think that we are seeing this is that the new textured, gummy bear implants feel so natural and are so devoid of contractures that when someone who has a breast implant capsule meets someone with a new style implant, they immediately want the better result and start asking questions that they were not asking before. In other words, they get breast envy!! I am not sure but that is certainly my sense of why we are seeing and hearing from more patients now than before.
What is a breast implant capsule contracture?
If you have ever seen or hugged a woman who has round hard breast implants, you know what breast capsule contracture looks like or feels like; a soft ball on a chest (or two soft balls!). This is due to breast implant capsule contracture.
Whenever any foreign body, like a breast implant, is placed in your body, your body immediately recognizes the foreign body and starts to wall it off from the normal cells of the body. It does this by forming a scar around the implant. All scars tend to shrink and in the case of a breast implant, when the balloon like scar around the implant shrinks it will make the implant go round and hard just like a rubber ball will go more firm if you squeeze it.
What Causes Breast Implant Capsule Contracture?
We are not sure. It may be the presence of excess blood around the implant at the time of surgery. It may also be that some bacteria get introduced to the pocket and this irritates the scar to start contracting. It may also be that some people just make heavy scars.
How common is Breast Capsule Contracture with Breast Augmentation?
Capsule contracture has been reported to happen in up to 45% of breast augmentation cases (which is very high). Most studies show that it happens in 4 to 20% of cases with smooth breast implants (saline or silicone). The new gummy bear implants have a much lower capsule contracture rate that has been reported in the 2% range.
What can be done to Treat Breast Capsule Contracture?
Some surgeons will prescribe medication in the hopes of softening the breast capsule contracture. Unfortunately, the evidence that medication, specifically Singulair, when used treat capsule contracture, is rather weak and at best it has been reported to soften the capsule only slightly or about one grade of firmness, when it works. It does not work for everyone.
The definitive way to treat capsule contracture is to remove the implants and then do something to replace them. This is where there is a lot of debate, conjecture and opinions among surgeons. Some of the alternatives include:
- A capsulotomy. This is a surgery where the implant is removed and the balloon like scar is simply cut or scored in multiple places to make it loose again. The implant is sometimes put back in and sometimes a new one is placed.
- A capsulectomy. This is a surgery that removes part or all of the capsule or scar around the breast implant. The old implant is may be placed back in the fresh, scarless pocket but usually a new breast implant is placed. With this procedure an acellular dermal matrix or scaffold may be placed to try to prevent a new capsule. Other matrices include FlexHD®, AlloDerm®, Neoform™, DermaMatrix™, Permacol™, and Strattice®.
- A neo-pocket surgery is a surgery where the old breast implant is removed and the old capsule is left in place. The incision in the capsule to remove the old breast implant is sutured closed, and a new pocket above or below the old one is created. A new breast implant is placed.
Breast Capsule Contracture is not quite this bad!!
The neo-pocket procedure seems to be gaining in support among surgeon since it is a less disruptive surgery. In addition, when a new textured implant is used, the recurrence rate seems to be in the same 2% range as a first time breast augmentation with a textured implant. It also avoids the cost of the scaffold material.
Unfortunately, there is no good alternative to surgery if you have capsules that are so bad that they need to be redone. Some women have chosen to live with their firm breast implants and some have chosen to abandon their breast augmentation all together and just get their breast implants removed.
All of the implant companies now provide a breast implant capsule contracture warrantee for primary breast augmentation with textured breast implants but that warrantee does not help the woman who has the problem.
As always, if you have this problem or know someone who does, please contact us to set up a strategy session so that we can help you.