Capsular Contracture After Breast Implants Treatment
Capsular contracture is the most serious and common problem of breast implants. Capsular contracture is a response of the body to the silicone component of the implant. This means that capsular contracture occurs with both saline-filled breast implants and silicone-filled breast implants. Both implant types are made of silicone and can cause an adverse reaction. Dr. John Anastasatos is a top breast plastic surgeon who offers capsular contracture (after breast implants) treatment at Los Angeles Plastic Surgery in Beverly Hills.
What Is Capsular Contracture?
In short, the body reacts against the silicone breast implant by creating and depositing extra collagen around the implant. This collagen is also called colloquially scar tissue. Capsular contracture is a frequent cause of breast pain in patients with breast implants. Other symptoms can include:
- Breasts are extremely firm to the touch
- The breast may look overly round
- Nipples may appear misshapen
- In severe cases, breasts become misshapen and tender to the touch
Capsular contracture occurs in about one out of six women who get breast implants. Plastic surgeons cannot predict who will get capsular contracture beforehand. This is why this remains a problem, as we do not know what exactly causes it. There is some research that indicates genetics can have an impact on who may experience capsular contracture after breast implant surgery and who will not.
Non-surgical treatment options are limited for capsular contracture, though it may be possible with lesser grades of the condition. In more severe cases, treatment is surgical and includes removing the capsule or scar tissue or breaking it. Removing the scar tissue is called capsulectomy, and breaking it is called a capsulotomy.
The Surgical Management of Capsular Contracture (En Bloc Capsulectomy)
The surgical management of capsular contracture in breast augmentation surgery.
The first breast augmentation with silicone gel breast implants was performed in the Spring of 1962 in Texas. The breast implants since then have evolved in that the gels inside the breast implants are cohesive instead of liquids. The saline-filled breast implants that exist today are also covered by a silicone shell. Finally, polyurethane-covered breast implants that do not yet have FDA approval in the US, but exist in Europe, also contain cohesive silicone gels inside.
The main problem of silicone breast implants is the formation of capsular contracture. A fibrous capsule always forms after a breast implant is placed in the chest. It is a normal and natural process. It is a pathological condition (a problem) in the majority of patients. The body does not recognize the breast implant as “its own tissue” and in return, it forms a capsule to completely cover the breast implant. The breast implant capsule consists of collagen which the body uses for healing and repair. This capsule is soft and remains soft over time. It also forms an important structural role as it keeps the breast implants in place.
In some persons, however, this capsule becomes thick and painful. As the capsule becomes thick it starts to close down on the breast implant. It can subsequently cause breast implant displacement and chest and breast pain. This condition is called “capsular contracture”.
We do not really know what causes capsular contracture. We do know that it is an exaggerated response of the body against the silicone. This means that if the breast implants were not made of silicone, but some other material, capsular contracture would not occur. We know for instance that when silicone great implants are covered by polyurethane the incidence of capsular contracture is extremely low. We have some theories about conditions that predispose to capsular contracture but we are not exactly sure as of this day.
How Does Dr. Anastasatos Surgically Manage Capsular Contracture?
He typically performs “en bloc” capsulectomy. This means that the whole pre-existing capsule is surgically removed together with the breast implants or ruptured silicone implants.
The other important aspect to lessen the chance of capsular contracture re-occurrence is to change something in the next breast augmentation. For example, if the previous breast augmentation was under the muscle or subpectoral then a sub-glandular breast implant placement should be strongly considered. If a saline-filled breast implant was previously used then consider a cohesive silicone gel breast implant. To lessen the chance of a new capsular contracture the plastic surgeon should ideally select a different surgical plan and perhaps a set of breast implants.
Not all cases of capsular contracture as the same. Many times, pregnancy and lactation can induce capsular contracture. This is a “kinder’ kind of capsular contracture with a lesser chance of re-occurrence. Therefore, if a woman developed capsular contracture after pregnancy then she may not get another occurrence if she does not get pregnant again.
Furthermore, if there is a continuum between capsular contracture and Breast Implant Illness (BIL). After a complete capsulectomy or en bloc capsulectomy, Dr. Anastasatos may often use a supportive mesh-like Galaflex if I place a new set of breast implants. Surgical meshes provide extra support for breast implants and can be useful when an internal breast lift is desired.
Dr. Anastasatos feels it is ethical to tell patients that despite a complete “en bloc” capsulectomy, or change of operative plan, they can still recurrence of capsular contracture as long as they still have silicone breast implants. These implants can be either cohesive silicone gels or saline-filled. The reason is that ultimately capsular contracture is a reaction of the body against the silicone component of the breast implants. That is why breast implants covered with polyurethane are better in reducing the incidence of capsular contracture. Such breast implants exist in Europe and can be placed at Dr. Anastasatos’s office in Athens Greece.
When patients feel that their breast implants are making them sick such as in cases of breast implant illness then the right treatment is to do “en bloc” capsulectomy and not place new implants. Such patients may need a mastopexy or breast lift at the same time, and fat transfer to the breasts.
Not all cases however of capsular contracture are the same and thus not all cases require surgery. Some milder cases or variations can respond positively to manual massage or Ultrasound therapy. Ultrasounds are used extensively in medicine and surgery to relax and soften scar tissue.
In summary, not all cases of capsular contracture are the same. Therefore, their management varies from person to person. The best results come from a very experienced plastic surgeon who has understands the special needs of removing and replacing breast implants, and breast capsule management. Capsular work may entail complete “en bloc capsulectomy, partial capsulectomies, capsulorrhaphies, and capsulotomies.
If you are experiencing symptoms of capsular contracture after breast implants, treatment is available at Los Angeles Plastic Surgery in Beverly Hills. Contact us to schedule a consultation with Dr. Anastasatos to discuss treatment options for symptom relief and improved breast appearance.