By Dr. Michael Somenek & Troy Pittman MD FACS
In my previous blog, I discussed the various grades of capsular contracture and the proposed causes of capsular contracture. Let’s now take a look at prevention and treatment of this condition.
Can capsular contracture be prevented?
In many cases, the formation of capsular contracture is random and could be considered “bad luck.” However, there are many steps that can be taken to reduce the risk of developing the condition.
- Careful patient selection. Patients that have a history of severe scar formation or adhesion formation after abdominal surgery should be counseled on the increased risk of developing capsular contracture. Additionally, patients at high-risk for developing hematomas such as those with bleeding disorders or patients that are actively smoking should be screened appropriately.
- Meticulous sterile technique in the OR. It is important to have minimal handling of the implant during the operation. Precautions are taken to assure that the pocket is irrigated with antibiotic solution to help decontaminate the pocket and minimize the amount of residual bleeding in the implant pocket. I use a device called the Keller Funnel which allows me to insert the implant through a tiny 3-cm incision without directly touching the implant.
- Textured Implants. It has been reported that there is a lower-incidence of capsular contracture when textured implants are used. The texturing on the implants (versus smooth implants) makes it more difficult for the body to form scar tissue around the implant.
- Sub-Muscular implant position. The breast gland is inherently non-sterile. Placing the implants under the muscle isolates the implant from the breast gland which theoretically can lead to a lower chance that the pocket becomes contaminated with bio-film. Having said that, there are some cases where placing the implant in from of the muscle is preferable. Every patient is different and the risks and benefits of each type of implant position should be discussed during a consult with a Board-Certified Plastic Surgeon.
How is capsular contracture treated?
In Grade 1 and 2 capsular contracture, no treatment is needed. If the implant pocket starts to feel firm and a smooth implant has been used, I recommend implant massage for two minutes a day. This can help with prevention of scar tissue formation. However, implant massage is not recommended for patients with textured implants.
With patients who have developed Grade 3 or 4 capsular contracture, revision breast surgery is recommended. In most cases, this involves removal of the implant and complete removal of the breast capsule. Removing the implant without removing the capsule is counterproductive. In some circumstances the patient may choose to her implants permanently removed. Most times a small mastopexy is necessary if implants are permanently removed.
It is important to note that once a patient has developed severe capsular contracture, her chances of developing a recurrent capsular contracture are doubled. So at 10-years, her chance of having another capsular contracture is close to 50%. There are certain things that can be done to help prevent another capsular contracture:
- Changing from a smooth to textured implant
- Changing the implant position, if it was on top of the muscle to under the muscle
- Use of some type of Acellular Dermal Matrix
It is also important to note that implants that are too large for the patient out stress on the breast gland and can lead to a capsular contracture. Many times, I recommend downsizing to a smaller implant in revision surgery.
If you are concerned about the development of capsular contracture or are experiencing symptoms please click here to schedule a consult with me.
