Capsular Contracture Correction – San Diego
Capsular contracture is a condition that occurs in a small percentage (generally less than 10% worldwide) of patients who have breast implants placed. 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 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, Ideal Implant®, 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 biologic substances that can be introduced into the implant pocket during surgery or afterwards. 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.
Capsular contracture can range from very mild and hard-to-detect changes to the position of one or more implant 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). 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
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
- Ultrasound therapy and massage (appropriate for mild degrees of early contracture)
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.
Contact us today!
If you’re in the San Diego or Newport Beach areas and have any questions about Capsular Contracture Correction or wish to schedule a consultation on Capsular Contracture Correction with Dr. Sayed, please contact our office.
Capsular Contracture 101
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.
Treatment of capsular contracture is usually done through an existing scar on the breast, but 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.
Capsular Contracture 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 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 at around 14 days 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 and with 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 have improvement of mild capsular contracture with nonsurgical methods or minor surgical releases. Others require a much more comprehensive surgical approach including removal of the capsule and implants, creation of a new pocket, and 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 capsule may occur. This does not mean a full capsulectomy and implant exchange operation is needed again, but it really depends on your body biology.
With regard to 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 need to have implants changed out 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 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 MRI’s 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 20′s 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 breast 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. While there is some scientific literature suggesting a mild affect on capsules with the use of these medications, Dr. Sayed has not found them helpful in the rare cases we have prescribed them to test their value. Some patients wish to try these medications to be sure they have “done all that can be done” before moving on to surgical correction. However, there are small risks including liver failure as a serious complication which may occur in rare cases with the use of these meds, so Dr. Sayed does not strongly encourage their use for this purpose.