When any device is placed into the body, including breast implants, a very thin layer of scar tissue forms around the object. In breast augmentation, surgeons call this thin layer of scar tissue the breast capsule. Although scar tissue growth around implants is perfectly normal and expected, some patients’ bodies have an abnormal immune response that causes the scar tissue to become thick and tighten up around the implant in a process known as capsular contracture sometimes called implant encapsulation.
While mild cases of capsular contracture may go completely undetected, more severe cases can cause the breasts to look distorted in shape and they may even become painful to the touch. Breast implant revision surgery can remove the scar tissue capsule and restore a soft, natural look and feel to your augmented breasts again.
Recognized as a breast implant revision specialist and one of the top cosmetic surgeons in the Mobile-Pensacola metro area, Dr. James Koehler is a board certified cosmetic surgeon serving patients from Gulfport to Gulf Shores and beyond. Dr. Koehler offers a wide range of plastic surgery procedures for both men and women, and is known for his caring commitment to a patient-first approach.
Are You a Candidate?
Women who notice an unusual firmness around one or both breasts, a sudden change in breast shape or an increase in breast sensitivity may have capsular contracture, and could be candidates for breast implant revision. It’s also important to be in good overall physical and mental health, and to have realistic expectations about your results. During your consultation, Dr. Koehler will go over all your options to help ensure that you’re a good candidate for capsular contracture repair before proceeding with surgery.
About Capsular Contracture
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 Dr. Koehler 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, Dr. Koehler takes 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.
What to Expect
There are several surgical options surgeons may choose for treating capsule contracture:
- Capsulotomy: Your surgeon makes an incision (usually under the breast just above the inframammary fold) from which he or she can score or break apart the scar tissue by making small incisions in the capsule using cautery in the hopes that this will relieve the tightened capsule. However, capsulotomy is not very effective and has a high recurrence rate.
- Capsulectomy: Dr. Koehler prefers a full removal of the scar tissue capsule. He begins by making an incision, usually under the breast just above the inframammary fold. Next, he removes the entire capsule (or a good portion) and places a new implant. A drain tube is left in for several days to prevent fluid or blood from accumulating around the implant.
- Capsulectomy with Dermal Matrix: This is performed the same way as a capsulectomy, but the new implant is partially covered by acellular dermal matrix after being placed into the pocket.
Given the research that indicates the strong role bacteria seems to play in capsular contracture, Dr. Koehler feels that complete removal of the contaminated capsule is best, and typically recommends a complete capsulectomy.
The next decision is whether to replace the same implant or use a new implant. Since research has shown that bacteria can form an irremovable biofilm on the implant, reusing implants allows for the chance that the bacteria can create another capsule. For this reason, Dr. Koehler prefers using new implants whenever possible, and also lines the surgical pocket with acellular dermal matrix (usually Strattice) during surgery.
Risks and Complications
The risks of implant revision due to capsular contracture are similar to those associated with any breast enhancement surgery, with the primary concern being the possibility of scar tissue recurrence. With capsulotomy or capsulectomy and placing a new implant, the chance of recurrence is between 20 to 25 percent, although this percentage decreases significantly when acellular dermal matrix is used. Dr. Koehler will go over all the risks and benefits with you before your surgery so you’re fully informed about what to expect.
Your New Look
Recovery after your breast implant revision will likely feel similar to your first breast augmentation, although many women report the healing process as shorter and faster. You breasts should feel softer and more comfortable after surgery, with any contour irregularities resolved. Improvement is the goal of capsular contracture revision surgery rather than perfection, so it’s important to maintain realistic expectations about your new look.
The most significant benefit most women notice after capsular contracture revision is freedom from the issues that prevented you from fully enjoying the results of your initial augmentation, as well as the alleviation of discomfort and the reassurance of long-term positive results.