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Published on Sep 25, 2013
During a routine breast lift procedure, the surgeon encounters a case of extreme capsular contracture. What is it and how to deal with it? Dr. Caridi of Westlake Plastic Surgery in Austin, Texas removes the breast implants and describes this very extreme case of breast implants that have hardened. answers questions about the condition.
What are the symptoms of a breast contracture?
The breast becomes firmer and less mobile, distorted in shape, or painful. The breast implant usually moves upward. The breasts can appear “stuck on” and less natural in appearance. The worst outcome is a rock-hard, painful breast.
In my experience, it is more common in a patient with subglandular implants (implants placed above the muscle) and less common when active breast massage is performed to keep the breasts soft. Patients who develop a breast infection after surgery will almost always develop a contracture, as will those patients who develop a hematoma around a breast implant that is not treated by removing the blood. Implants older than 20 years often let you know they are worn out by developing a contracture.
All breast implants develop a thin layer of scar tissue around them called an “implant capsule.” In some cases, the scar tissue becomes thicker and tighter, and this results in a firm implant, or capsular contracture. This is believed to be the most common complication of a breast implant. An implant may become rigid, or the breast can be distorted and even painful at times. The cause of capsular contracture can be difficult to determine, but it is most likely the result of a low-grade infection, blood around the implant after surgery, or a patient who simply is a “hard healer” and makes firm scar tissue. It can occur at any time, but generally most cases will be seen within five years after surgery.
What is the best treatment for capsular contracture?
Treatment of a breast contracture usually involves implant change, pocket change, and capsulectomy. Removal of the implants is also an option. The use of Acellular Dermal Matrix, or ADM, has proven helpful in breast implant contracture, but more studies are needed to establish the effectiveness.
Which implants contract less—silicone or saline?
There is conflicting evidence regarding this issue. There probably isn’t much of a difference in the contracture rate between these implant types.
Do textured implants reduce the risk of capsular contracture?
There is conflicting evidence regarding this issue; however, I use mostly smooth-walled implants because they contract less in my hands.
Does the contracted capsule have to be removed?
It all depends on the individual case. If removal of the capsule is possible, it is a good idea to remove as much of it as possible. If the capsule is over 15 years old and calcified and brittle, removal is warranted, as it can be uncomfortable if it remains and may interfere with mammography.
How successful is surgical treatment for capsular contracture?
There is no guarantee that you will be contracture-free after surgery, but my experience shows that the success rate is very high (well over 80 percent).