Capsular Contracture occurs when the scar that normally forms around a breast implant becomes symptomatic.
The Normal Capsule: It is normal and desirable that a scar forms around the breast implant. The scar forms a pocket surrounding your implant. The capsule secures the breast implant and keeps it from migrating around under the skin. The capsule is very important to prevent mal-position and bottoming-out of the breast implants. A normal capsule is soft and cannot usually be felt.
What is Capsular Contracture?
Capsular Contracture occurs when the capsule is too tight or too thick. It is most likely an exaggerated normal response. If the capsule is tight all around the breast implant, it can make the breasts feel hard and immobile. If the capsule is tight on just one side, it can push the implant. For example, when the scar is tight on the bottom, it moves the implant up. The result is the opposite of bottoming out.
Contractures rate from super-mild to highly deforming and even painful.
• Grade I – Naturally soft. Not palpable
• Grade II – Increased firmness. Scar is palpable. No visual distortion.
• Grade III – Firm to touch. Immobile causing visual distortion.
• Grade IV – Same as Grade III and painful.
•Grades II and I are the most frequently seen capsular grades and are not normally treated. Grades III and IV are less frequent, and are often treated with a Breast Augmentation Revision Surgery.
Capsular Contracture Treatment
· Many non-operative treatments exist and none have been proven to be clinically effective. Massage, ultrasound, vitamin-E, antibiotics, steroids and the latest leukotriene inhibitors (Accolate) have been tried with occasional anecdotal improvement, but there are no large studies proving any of these techniques safe and effective for treating capsular contracture. They are frequently employed with grade II and early grade III capsular contracture in an attempt to reverse the progression to a tighter scar capsule.
· The best method of treatment remains breast implant replacement with revision surgery. For grade III and IV capsular contractures, capsulotomy and capsulectomy are the mainstay of treatment. Capsulotomy is a surgical technique during which the capsule is incised to allow for expansion. This is most effective when the scar is thin and soft. Capsulectomy is the surgical removal of the scar. This is used when the scar is thick. There is a slightly greater risk of bleeding with the capsulectomy.
Recent developments in Capsular Contracture:
Bio-film: This concept involves the formation of a microbiological membrane covering your implant resulting in an exaggerated normal response. Microbiological flora native to your breast tissue may be the cause for most capsules. This is the reason that most surgeons now replace the initial implant with a new one.
Protection plans against the cost of capsular contracture surgery. Some of the better implant manufactures now offer plans that protect you from the cost of revision surgery. They offer new implants and money to offset the cost of surgery.
Modern placement techniques are now used to decrease capsular contracture rates such as Keller Funnel, total coverage and pocket treatments.
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