The Prevention and Treatment of Capsular Contracture after Breast Augmentation

July 9, 2009

Prevention

How can we prevent capsular contracture? There is some evidence that bacteria may play a role in capsular contracture. Proper surgical technique, placement of breast implants behind the muscle, using saline instead of silicone filled implants, minimal handling of the implants, and irrigation of the surgical pocket with antibiotics can minimize the formation of capsular contracture. Postoperative massage may also help prevent contracture formation.

Treatment

How is capsular contracture treated? Many non-operative treatments exist and none are perfect. Massage, ultrasound, vitamin E, antibiotics, steroids and the latest leukotriene inhibitors (Accolate) have been tried with occasional anecdotal improvement.

Breast Augmentation Revision Surgery

Before and after pictures of breast augmentation revision for capsular contracture of right breast. Both implants were also replaced with larger breast implants.

Operative treatments are the most effective, and are usually reserved for Grade III and IV capsules. Open procedures include opening the scar (capsulotomy) or removing part or all of the scar (capsulectomy) to make more room for the implant. Sometimes changing the implant or the location of the implant with respect to the pectoralis muscle is recommended. Before and after pictures and a description of breast augmentation revision surgery can be found in part 1 of this three part mini-series about capsular contracture.

Closed capsulotomies, vigorous manual compression to disrupt the capsule, have fallen out of favor as the procedure can also disrupt (break) the implant. This procedure nullifies the current warranties offered by Allergan and Mentor.

Recurrence

Capsular Contracture can recur after release, but my Walnut Creek breast augmentation revision patients are happy to find out that having a previous contracture does not seem to increase the risk of subsequent capsular contracture. The reported rates of capsular contracture range widely from 10% to 50% in some studies. The most common capsular contractures are Grade I and Grade II which do not normally require additional surgery. Grade III and IV are less common and are more commonly treated operatively.