It is the natural response of the body to form scar tissue around implanted foreign objects. Referred to as capsular contracture (CC), this process squeezes and tightens the implant, making it firm. The range of firmness will vary from person to person, as will the degree of discomfort and pain experienced. It is also important to note that capsular contracture can result in just one breast or both.
Nobody really knows the cause for this problem but there are many theories and known issues that contribute. Infection, inflammation, smoking, vaping, and bleeding after surgery may all contribute to CC. Many steps have been taken over the years to lessen this occurrence. While statistics of 20% or 25% of all breast patients were common 30 years ago published numbers are closer to 9-11% in primary breast augmentation patients. We see a lower number in our practice.
Prevention is the first step. Choosing the correct implant size, shape and texture as well as placement will help. Irrigation with appropriate antibiotic solution and prevention of bleeding during surgery is necessary. Implants both saline, structured (Ideal) and silicone are all improved over the last 30 years and have better results.
When CC occurs there are several treatment options. Massage may help by mechanically stretching the pocket. The use of Singulair or Accolate, both medications used for asthma, have been advocated for early CC with a 50% success rate. Aspen Medical has developed an ultrasound machine, used initially for physically therapy, that has shown some success with treatment.
Surgical treatment becomes more complex. Most surgeons advocate removal (en block) as a complete Capsulectomy. Generally a new implant is place as the old one may harbor come bacteria on the surface (called slime). Capsulotomy, or incisions within the capsule can allow an expansion of the space. Changing the placement of the implant from submammary to submuscular can be beneficial. Lastly, new products which are biologic meshes can be used. These include Stratice, Alloderm, Belladerm, Galaflex, and Seri to name a few. There are not enough studies to show the differences in long-term results but they all have different properties and they all seem to help.
It’s important to choose a surgeon well experienced with Implant Revision Surgery, as these operations can be complex and take several hours. The costs for treating CC will depend upon the operation chosen, the use of new implants and mesh as well as time for the OR and Anesthesia. It is not uncommon for the costs to range between $10,000 and $20,000 dollars in most major cities and the recurrence rate is higher, between 25-40%. Choose your Board Certified experienced surgeon carefully.
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