Capsular Contracture of the Breast
Boca Raton, Palm Beach Florida
Capsular contracture is the most common complication that occurs after breast augmentation surgery. Capsular contracture occurs as the body builds scar tissue around the implant. The scar tissue tightens and causes the implant to feel hard. The implant does not actually harden, only the surrounding scar tissue capsule. This can be seen in breast asymmetry and felt as a hardened breast.
Breast Capsular Constracture. Q&A with Dr. Ennis
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How a Capsular Contracture Forms
Most instances of capsular contracture develop within two years of a breast augmentation procedure. The causes for capsular contracture are not fully understood but there are several theories as to why it may occur. Common causes of capsular contracture can include trauma or bleeding around the implant from surgery, bacterial infection, ruptured implants or the patient’s own immunologic reaction to a foreign material from the implant.
The body normally produces a capsule of scar tissue around the breast implant, as the implant is a foreign material in the body. However, this naturally occurring capsule is typically very thin and even almost transparent. The capsule that is normally formed is larger than the implant, allowing both the capsule and implant to move naturally and maintain a soft feel and appearance. However, in the case of capsular contracture, the capsule becomes thicker and constricts. This makes the capsule smaller, not allowing enough space for the implant to move within the breast.
When scar tissue tightens around the breast implant, it squeezes the implant and causes it to feel firm. The patient may notice that one or both breasts do not feel as soft and supple as they used to feel. Additionally, the breast may begin to harden or look different from the other. There may be some discomfort present. These signs should alert an individual to schedule a consultation with an experienced plastic surgeon for further evaluation.
Capsular Contracture Before and After Photos
Actual Patients of Dr. Ennis
Breast Implant Capsular Contracture
Capsulectomy for correction of breast implant contracture
Capsular Contracture Before and After by Dr. Ennis
Capsulectomy for correction of breast implant contracture
Signs of capsular contracture can include:
- Implant rising to a higher position in the breast
- Breast looks oddly tight
- Breast looks artificially round, with a ball like appearance
- The implant feels abnormally firm
- The implant feels and looks hard
- The breast is uncomfortable or even painful
Experience a Breast Consultation with Plastic Surgeon, Dr. Ennis
Diagnosis of Capsular Contracture
A capsular contracture is diagnosed with a physical examination by a skilled plastic surgeon. The plastic surgeon will examine the breasts to determine if there is indeed a capsular contracture. A capsular contracture can be appreciated through imaging studies such as a mammogram, ultrasound or MRI, but typically this is not necessary for a diagnosis to be made. Physical examination is sufficient. The breast is classified using the Baker scale, with a I-IV grading scale, in regards to feel and appearance.
- Grade I: The breast feels soft and is considered normal.
- Grade II: The breast is less soft than normal and the implant can be palpated.
- Grade III: The breast feels firm and the implant can be easily palpated. There is a noted asymmetry in breast shape.
- Grade IV: The breast feels hard and is tender. The breast shape is significantly distorted.
Treatment of Breast Capsular Contracture
The first step in addressing a capsular contracture is a thorough evaluation with the plastic surgeon. Here, the surgeon will identify the reason for breast abnormality and the appropriate treatment plan for correction. For many women, the initial consultation with the surgeon brings great relief for a surgical solution.
The most common solution for a capsular contracture is a complete capsulectomy procedure. In this procedure, the scar tissue surrounding the implant is released and then removed. The surgeon will remove the existing implant, since the contracture may be related to a bacterial infection or poor acceptance of the old implant.
Next, the surgeon will insert a new breast implant. If the existing implant was positioned beneath the chest wall muscle, then a new implant pocket will not need to be created. However, if the existing implant was positioned above the chest wall muscle, then a new implant pocket will need to be made below the chest wall muscle. When the implant is placed below the chest wall muscle there is a much lower rate of capsular restriction. For this reason, breast revision due to capsular contracture is performed with positioning of the implant below the chest muscle, using a submuscular approach.
In addition to reduced risk of capsular contractures, the submuscular approach offers greater protection of the breast implant. The implant is positioned underneath the skin, glandular tissue, and musculature. These layers offer natural padding over the breast implant, reducing likelihood of rippling and trauma. Additionally, this approach yields a more natural appearance with more natural breast movement.
With the improved breast implant position, the rates of contracture after revision are low. However, there is still a risk for developing a new capsular contracture. The only treatment intervention that guarantees the condition will not return is a permanent removal of the implants and surrounding capsule. For some women, capsular contracture is a reason for permanent breast implant removal. With a permanent breast implant removal, without implant replacement, the surgeon makes an incision through a previously existing scar. Then, the surgeon removes the implant and closes the incision. Some women choose to also undergo a breast lift, in order to reshape the smaller breast after implant removal.
The Ennis Plastic Surgery Difference
Ennis Plastic Surgery in Palm Beach offers a comprehensive, caring and compassionate approach to cosmetic and esthetic intervention. We understand that the appearance of a woman’s breasts greatly impact her self-esteem and confidence. The clinical staff at Ennis Plastic Surgery take the time to listen to each woman’s needs, concerns and goals. We understand what an impact a breast procedure can have on a woman’s outlook and self-impression.
We are excited to have the opportunity to contribute to that outcome. If you are interested in discussing how a breast enhancement surgery can impact your physical appearance, please contact us to set up a consultation.