Capsular Contracture Revision

The causes of capsular contracture are unknown, although current research seems to indicate that a certain bacteria, staphylococcus epidermidis, which is present on our skin and also can be found in the milk ducts within the breast, may play a role in causing contracture. This bacteria can be found is as many as 70 percent of breast capsules with contracture.

There are four grades of capsular contracture:

• Grade 1: The breast looks and feels normal
• Grade 2: The breast feels slightly firm but looks normal
• Grade 3: The breast feels firm and looks abnormal
• Grade 4: The breast feels hard, painful to the touch and appears distorted

Some doctors further designate capsule contracture as “early” or “late” contracture. Early contracture occurs within the first year after augmentation and is more likely caused by bacteria, while late contracture can occur many years after implantation. In patients with silicone gel implants, late contracture may be caused by microscopic gel leakage which stimulates thickening of the scar tissue. Late capsule contracture is easier to treat than early.

Milder forms of capsular contracture may possibly be managed without surgery. Some surgeons recommend patients take vitamin E supplements to help soften the capsule, while others recommend taking milk thistle, an herbal supplement. However, there are no studies that prove or disprove these treatments’ effectiveness, and patients taking vitamin E need to stop at least 7-10 days before any surgical procedure due to risks of prolonged bleeding. Asthma drugs like Singulair have also been used to treat mild forms of capsular contracture, and have about a 50 percent success rate when taken daily for 90 days. While our surgeons may occasionally recommend these medications, at this point the research is not clear that the benefits outweigh the potential side effects of the medication.

If the breasts become markedly firmer, distorted in shape or feel painful, these symptoms indicate a Grade 3 or Grade 4 capsular contracture that could require surgery to correct.

As with many medical conditions, the best treatment for capsular contracture is prevention. Without knowing the precise cause, knowing how to prevent the occurrence of abnormal scar tissue growth is challenging. However, our surgeons take several precautions during breast augmentation surgery that have been known to decrease the likelihood of developing capsular contracture in the first place:

• Give intravenous antibiotics before surgery
• Perform not one but two full skin preps with surgical antiseptic: once prior to injection of local anesthesia, and another before surgical draping and incision
• Use submuscular implant placement whenever possible
• Minimize implant contact through the use of surgical powder-free gloves and use of the Keller Funnel
• Irrigate the implant pocket with an antibiotic solution, and ensure that no blood remains in the pocket

Implant type can also have an impact on capsular contracture. Silicone gel implants are most likely to become contracted and saline implants are the least likely, with gummy bear implants falling in between these two.