Capsular Contracture Correction in La Jolla and Newport Beach, CA
Capsular contracture is a condition that occurs in a small percentage (generally less than 10% worldwide) of patients who have breast implants.
The condition was much more common in the early generations of breast augmentation when most implants were placed on top of the pectoralis major muscle (subglandular breast augmentation) and using the older generations of silicone implants. Capsular contracture is typically characterized by a tightening of the tissue that the body develops around an implant, which can increase asymmetry, cause some distortion, or, in severe cases, cause pain.
Today, plastic surgeons have better ways to lower the risk of capsular contracture at the time of the first breast augmentation, but unfortunately, even in the most skilled hands, we still occasionally see patients with capsular contracture of varying degrees. The move to subpectoral and dual-plane breast augmentation, in addition to innovations in breast implant technologies like cohesive gel, the Keller Funnel, saline devices, and better silicone fabrication, have all helped to reduce the overall incidence of capsular contracture. We have learned that one risk factor for this complication is the exposure of implants to “biofilms” – thin layers of protein, bacteria, and other biological substances that can be introduced into the implant pocket during surgery or afterward. To reduce biofilm exposure, Dr. Sayed uses an antiseptic regimen that includes antibiotics in the pocket, special handling of the implants, Keller funnels where indicated, and a general “no-touch technique” on the skin.
Of course, many patients with capsular contracture or other breast implant-related complications are at a crossroads in deciding if continuing with breast implants makes sense for them. Dr. Sayed is an internationally-recognized expert in explant surgery, with complete en bloc removal of the implant along with the entire capsule, and this is available to patients with capsular contracture who wish to be done with implants altogether. Many patients report significant quality of life and health improvements after explant surgery, and Dr. Sayed is happy to discuss the pros and cons of different approaches with each individual patient.
Continue reading or contact Tim Sayed MD to learn more about capsular contracture correction in San Diego (La Jolla) and Newport Beach, CA with leading capsular contracture surgeon Tim Sayed, MD, MBA, FACS.
Capsular Contracture 101 – What is Capsular Contracture?
Every patient with breast implants forms a thin layer of tissue around the implant. This is your body’s way of handling foreign permanent materials. Even though implants are sterile, and the body is not “rejecting” them per se, a foreign body reaction leading to a thin capsule is the natural, expected process. That is to say, every patient gets a capsule. However, not every patient gets a capsular contracture.
Capsular contracture may be improved by creating relaxing incisions in the capsule internally, which creates more “breathing room” for the implant. Sometimes this is enough, but in many cases, partial or complete removal of the old capsule with the implant is required. Most patients can have a new implant inserted in the same operation. Some patients unfortunately have a tendency to have capsular contractures come back (recurrence), but most patients get a significant improvement with treatment.
options for capsular contracture correction in San Diego
Patients with capsular contracture from prior augmentation have more options for correction than ever before. Some options for treatment of capsular contracture include:
- Capsulectomy — removal of the capsule and implant) with replacement of the implant(s) and possible pocket change to the so-called “neosubpectoral pocket”. Capsulotomy — scoring or otherwise partially releasing the capsule to allow the implant to settle better
- Implant exchange
- Implant and capsule removal without replacement of the implant
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One approach occasionally prescribed by plastic surgeons — though not FDA approved for this purpose and therefore “off-label” — is the use of medications called leukotriene inhibitors. These are medications usually prescribed for treatment of asthma and other respiratory conditions, which have found to potentially have modest beneficial effects on capsular contracture.
When surgery is required, Dr. Sayed can evaluate your specific condition, type of implant, and make recommendations for the next step. He has a high success record in correcting and improving capsular contracture for patients who have had surgery.
How Do I Know If I Have Capsular Contracture?
Capsular contracture can range from very mild and hard-to-detect changes to the position of one or more implants all the way to a painful hardening of the breast (much less common and often related to secondary issues like radiation treatment, infection, or a leak of an older generation silicone implant).Â
The Baker classification is most commonly used to describe the extent of capsular contracture:​
- Baker Grade 1 – The breast is normally soft and appears natural in shape and size (not really a contracture)
- Baker Grade 2 – The breast is slightly firm but normal in appearance
- Baker Grade 3 – The breast is firm and abnormal in appearance
- Baker Grade 4 – The breast is hard, painful to the touch, and appears abnormal
Why Choose Dr. Sayed for Capsular Contracture Treatment in La Jolla and Newport Beach, CA?
Dr. Sayed is a highly skilled expert in breast revision surgery, specializing in procedures like en bloc breast implant removal and treatment for breast implant illness. His extensive experience and expertise ensure that patients receive the maximum standard of care. Dr. Sayed adopts a holistic approach, offering a comprehensive range of services that include both surgical and nonsurgical options tailored to each patient’s needs. This includes weight loss management, vitamin infusions to boost the immune system and promote healing, and advanced skincare treatments to enhance overall skin health and appearance. His commitment to personalized patient care and optimal outcomes makes Dr. Sayed the premier choice for capsular contracture treatment in La Jolla, Newport Beach, and Southern California.
Meet Tim Sayed, MD, MBA, FACS
Double board-certified plastic surgeon | Breast Explant Expert
Dr. Tim Sayed and his staff believe that the commitment to undergoing cosmetic treatment is a momentous decision that needs to be approached with kindness and compassion, and this starts by offering a comprehensive, detailed consultation process with an emphasis on educating the patient about plastic surgery procedures and options. Dr. Sayed uses sophisticated drawing tools, the patient’s images, and anatomic education tools that he helped develop himself to inform the patient of every aspect of the procedure. Dr Sayed’s signature procedures include breast implant removal, breast lift and tummy tuck.
Surgical Approach to Capsular Contracture in San Diego
Treatment of capsular contracture is usually done through an existing scar on the breast. However, in some cases, depending on the original incision performed for breast augmentation, a new incision may be required. For example, if your original implant was placed through the transaxillary approach (armpit) or TUBA (trans-umbilical breast augmentation through the belly button) technique, an incision in the inframammary fold may be needed to remove or release the capsule. This may also be true if the original incision was around the nipple.
What’s the difference between capsular contracture and breast implant illness (BII)?
Capsular contracture is the tightening and hardening of scar tissue around a breast implant, causing discomfort and changes in breast shape, often requiring surgical treatment. Breast Implant Illness (BII) is a collection of systemic symptoms such as fatigue, joint pain, and cognitive issues that some women attribute to their implants. Dr. Sayed has developed a profound understanding of the condition through his practice in La Jolla and Newport Beach, CA.
Biofilm Exposure Risk in Capsular Contracture
One risk factor for this complication is the exposure of implants to “biofilms” – thin layers of protein, bacteria, and other biologic substances that can be introduced into the implant pocket during surgery or afterward. To reduce biofilm exposure, Dr. Sayed uses an antiseptic regimen that includes antibiotics in the pocket, special handling of the implants, Keller funnels where indicated, and a general “no-touch technique” on the skin.
Off-Label Capsular Contracture Treatments
One approach occasionally prescribed by plastic surgeons, though not FDA-approved for this purpose and therefore “off-label,” is the use of medications called leukotriene inhibitors. These are medications usually prescribed for treatment of asthma and other respiratory conditions, which have been found to potentially have modest beneficial effects on capsular contracture.
When surgery is required, Dr. Sayed can evaluate your specific condition and type of implant to make recommendations for the next step. He has a high success record in correcting and improving capsular contracture for patients who have had surgery.
Schedule Your Consultation Today
Double board-certified plastic surgeon, Tim Sayed, MD, MBA,FACS, has helped countless women achieve the results and confidence they desire. Dr. Sayed and his expert team are committed to providing the best results and experience possible. To start your journey in Newport Beach or San Diego, CA please call us at (858) 247-2933 or complete our online form.Â
Capsular Contracture in Newport Beach FAQ’s
Some of our selection criteria to include you as a capsular contracture surgery candidate include:​
- Visibly noticeable or painful capsular contracture as determined by physical examination and symptoms
- A previous history of breast augmentation with implants still in place
- General good health, meaning you do not have major uncorrected cardiovascular, respiratory, kidney or other major organ conditions
- Age 18 or older for saline implants, 22 or older for silicone (FDA recommendations) if you are considering implant replacement
- No masses on breast examination – if you have a significant family history of breast cancer or are over 30 we will request a preoperative mammogram if you have not had one within a year
- Nonsmoker or willing to commit to NO NICOTINE IN ANY FORM for at least 3 weeks preop and for the duration of your recovery
- Available support system of friends, family, caregivers or others who can help you to keep your appointments, complete your preop and postop tasks, and emotionally bolster you through this exciting journey
- Reasonable expectations of how much breast enhancement is possible with specific techniques
- Willingness to accept a potential shape change in the breast, especially if you elect to have your implants removed
- Awareness that for some patients, capsular contracture may occur again even after thorough efforts to treat and correct
Most capsular contracture correction procedures are about 2 hours in duration, depending on the incision approach, type of implants, degree of contracture, type of capsulectomy or other approach being performed, and other factors. The process of taking out an entire capsule on one breast may take 15 to 30 minutes or even more if the capsule is very adherent, the implant is ruptured, or other findings are encountered. The process of putting new implants in can take 20 to 40 minutes more per side, again depending on the situation.
Most capsular contracture procedures are performed on an outpatient basis in a AAAASF-certified operating room, meaning the facility is up to very high standards of accreditation. Patients usually spend up to a couple of hours in the postoperative suite before being discharged in the care of a companion, family member, or friend. Dr. Sayed gives a 24-hour phone number to all patients who can reach him for urgent questions, and we also issue access to a patient engagement application that allows the patient or companion/caregiver to send SMS messages, photos, video, and other content to our team in a secure, private digital format. This keeps us mutually informed on your recovery and allows us to update your instructions while requiring a respectful number of face-to-face visits in the office.
Early postop recovery findings can include bruising and swelling, mild discomfort, the implants riding in a slightly high position (if new implants were placed or a capsule release was performed), numbness or diminished sensation in nipples, and some mental adjustment to the process of healing which most patients undergo. Most patients are advised to take a few days out of social circulation, and we’d prefer that you not drive yourself in the first 10 days or as long as you are taking any prescription pain medication. Most sutures are dissolvable, but there may be a few that need to be removed within 14 days’ time postop.
We ask that you abstain from exercise for 2 weeks and then return to light fitness routines after that. You will be asked to wear a surgical bra and avoid underwires for a few weeks, and it will be easiest for you if you wear tops that button down in the front in the first 10 days or so. Dr. Sayed and his team provide close postop care in the office using our remote engagement tools. You will be asked to take some supplement medications to aid in your recovery, which may include medications for pain, bruising, swelling, and dietary optimization.
We’re going to repeat some information found on our primary breast augmentation page here. Before we do so, we want to say that capsular contracture correction is a very complex process. Some patients are able to improve mild capsular contracture with nonsurgical methods or minor surgical releases. Others require a much more comprehensive surgical approach, including the removal of the capsule and implants, the creation of a new pocket, and the placement of new breast implants. In about 90 to 95% of patients, good, lasting correction occurs, which means the breasts look better and continue to look better than they would have if no correction had been offered. In the rest, some degree of return of the capsule may occur. This does not mean a full capsulectomy and implant exchange operation is needed again, but it really depends on your body’s biology.
Concerning implant longevity, there seems to be a lot of confusion out there about breast implants and how long they “last.” There is a common misconception that patients must have implants changed every 10-15 years. The reality is that breast implants are man-made devices, and although they are safe, well-tested, and regulated by the FDA, they are subject to some wear and tear over the years. There is a small risk of implant failure/leakage – if your implants are saline, the device will deflate and likely be noticeable; if the implants are silicone, you might not be aware of any changes in the device as the new generation of cohesive gel implants are made of a next-generation silicone that has better integrity. For this reason, the FDA recommends screening MRIs every few years in patients who undergo silicone implant breast augmentation, although the choice to comply with this is the patient’s. The implant companies offer warranty programs that protect your investment in certain circumstances.
Many women have breast implants placed in their early 20s, and some go on to have children, breastfeed, gain or lose weight, or have other changes that impact breast shape and size, so redoing breast augmentation after such events may make sense. Many women also have changes to their breasts that accompany menopause. It should be emphasized that many women who undergo breast augmentation never choose to have their implants removed or replaced or their breasts otherwise modified – “if it ain’t broke, don’t fix it.”
- Have a reasonable expectation of what surgery can accomplish
- Look at before and after photos and understand what kinds of techniques you are interested in
- Bring in photos of ideal results that can help inform us of your goals
- Don’t smoke or take nicotine in any form for at least 3 weeks and ideally longer before (and after) surgery
- Stay well rested and well hydrated and eat a nutritious diet balanced with plenty of protein
- If your diet is lacking in vitamins, take vitamin C and zinc supplementation but ask Dr. Sayed about other supplements. We have a list of ingredients we ask you to avoid in the immediate preop phase to optimize healing and minimize bleeding risk.
- Designate a caretaker who can help you through the first 5 to 7 days after your breast augmentation.
- Identify whether any female relatives in your immediate family have any history of breast cancer
We don’t like to publish pricing as it is subject to market changes and dependent on the types of procedures you consider. Review our Pricing page to build a “wishlist” and get estimated pricing on capsular contracture correction or a combination of procedures. We also have a fee schedule available in the office after your consultation. Feel free to contact our San Diego office for a pre-consultation and we are happy to provide more information. The cost of your surgery will partly depend on where you have it, the brand and style of implants, and whether a capsulectomy, capsulotomy, implant replacement or just removal are being performed.
One approach occasionally prescribed by plastic surgeons — though not FDA approved for this purpose and therefore “off-label” — is the use of medications called leukotriene inhibitors. These are medications usually prescribed for treatment of asthma and other respiratory conditions, which have found to potentially have modest beneficial effects on capsular contracture. Commonly prescribed medications include Accolate and Singulair.
Capsular contracture occurs when the scar tissue that naturally forms around a breast implant after breast augmentation surgery tightens and hardens, causing discomfort and changes in the appearance of the breast.
The risk of capsular contracture can be influenced by several factors, including the type of implant used (saline or silicone gel implants), surgical techniques, and post-operative care.
To help prevent capsular contracture, surgeons may use techniques such as the subpectoral (under muscle) implant placement, textured implants, and an antiseptic regimen during surgery to reduce biofilm exposure.
Treatment options include capsulectomy (removal of the capsule and implant), capsulotomy (releasing the capsule), implant exchange, and sometimes the use of off-label medications like leukotriene inhibitors.
If you suspect you are experiencing capsular contracture, consult your surgeon. They can evaluate your condition and recommend appropriate treatment options, which may include revision surgery.
Yes, there is a possibility of recurrent capsular contracture even after treatment. However, many patients experience significant improvement with appropriate surgical intervention.
Non-surgical treatments, such as precisely controlled ultrasound waves or ultrasound therapy, are being explored, but their efficacy may vary and they are not widely adopted as standard treatments.
The type of implant (saline or silicone gel) and its placement (under or over the muscle) can impact the risk of developing capsular contracture. Textured implants and subpectoral placement are often used to reduce this risk.
Yes, many breast augmentation patients who have developed capsular contracture can undergo revision surgery to replace the implants and address the issue. Your surgeon will provide the best recommendations based on your specific case.
A breast capsule is the scar tissue that forms around a breast implant. In some cases, this tissue can become excessively thick and hard, leading to capsular contracture.
