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What Is Breast Capsular Contracture and How Is It Treated?

Breast Implant Revision in San Francisco by Miguel Delgado, M.D.

The #1 plastic surgeon in the Bay Area to treat capsular contracture following breast implant surgery. Reclaim confidence in your body with us.

What Is Breast Augmentation and How Common Is It?

Breast augmentation is a common cosmetic surgical procedure. It involves placing saline or silicone implants into the breasts to enhance shape, size, and volume.

In 2019, 300,000 breast augmentations were carried out in the United States. This makes breast augmentation more popular for American women than other types of cosmetic surgery. For example, it is more popular than liposuction (265,000 in 2019), eyelid surgery (211,00), nose reshaping (207,000), and face-lifts (123,000).

Breast implants are FDA-approved for patients who are healthy and meet the minimum age requirements. Healthy patients 18 years or older are eligible for saline implants; for silicone implants, the age eligibility increases to 22.

Breast augmentation surgery produces a range of desired effects. This includes an increased fullness and projection of breasts. It also consists of an improved balance of breast and hip contours and enhanced self-image and self-confidence.

1. Saline Implants

Saline implants contain a silicone outer shell filled with sterile salt water (saline) solution. Some are pre-filled while others are filled during the implant operation. Saline implants are often used in revision surgeries as well as use in breast augmentation and reconstruction surgeries.

2. Silicone Implants

Silicone gel-filled implants have a silicone outer shell that is filled with silicone gel. They are used in breast augmentation and reconstruction surgeries, as well as in revision surgeries.

What is Capsular Contracture?

Capsular contracture is a complication resulting from breast augmentation surgery. It occurs when internal scar tissue develops a constricting capsule around a breast implant. The scar tissue contracts the breast implant until it becomes inflexible and misshapen. Capsular contracture may cause the breast to feel painful and stiff, and the capsule may affect the breast’s appearance or shape.

Breast implant capsular contracture, after either saline or silicone breast implant surgery, is very common. Capsular contracture may affect one or both breasts. Capsular contracture may occur at any time following breast augmentation surgery. In some cases, contracture has been known to occur shortly after surgery. In other cases, it maybe 15 years or longer following augmentation surgery.

Capsular contracture is known to range in severity, ranging from minor to severe. Distortion of the breast and general discomfort can be measured on a scale. There are four grades of capsular contracture – Baker Grades I to IV.

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1. Baker I
The breast is usually soft and looks normal.

2. Baker II
The breast is a little firm but looks normal.

3. Baker III
The breast is firm and abnormal-looking, with visible distortion.

4. Baker IV
The breast is hard, painful, and abnormal-looking, with more significant distortion.
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Breast fibrous capsule formation is normal following breast augmentation surgery. This is a similar process that occurs with other foreign body placement. For example, hip or knee replacements, rods or pins, or even a bullet in the body. The body will form a scar capsule around – walling off – the foreign body.

breast capsular contracture - San Francisco Breast Revision

Causes of Capsular Contracture

The exact cause of capsular contracture is not currently known. Various factors may increase their likelihood. These include rupture of the breast implant shell, bacterial contamination, leakage of the silicone-gel filling, and hematoma.

In the scientific world, the two most common theories are the infectious hypothesis and the hypertrophic scar hypothesis. Despite this, we know neither the actual cause nor how to prevent capsular contracture.

Reducing the Incidence of Capsular Contracture

A variety of techniques can be employed to attempt to reduce the likelihood of capsular contracture. One such method is known as the ‘no-touch technique.’ In this practice, the idea is that nothing comes in contact with the implant, reducing the likelihood of future contracture. Another approach is known as the Keller Funnel technique. In essence, this method allows for the implant’s transfer into the breast pocket without any physical touching.

Other methods of reducing the likelihood of capsular contracture include the use of antibiotics. Antibiotics can be used both as an oral pill and as a solution to bathe the implants. Other measures to reduce its likelihood include breast massage and administering vitamin E.
Despite these precautions, capsular contracture may still occur in a percentage of cases. While many believe that today’s modern breast implant devices decrease the likelihood of capsular contracture, there remains the possibility of contracture.

According to the FDA, studies have shown that some 7.7% of patients receiving saline implants developed Baker III or IV contracture. For patients who received cohesive silicone gel implants, the figure rose to 9.8%. These findings were made over six years.

The Use of Drugs to Treat Capsular Contracture

A variety of medication that is used is to treat instances of capsular contracture. These include Accolate and Singulair. Neither of these drugs has been approved by the FDA to treat capsular contracture. However, research has found positive results in the treatment of Baker I and Baker II conditions using these medications.

Another drug that has shown positive results while also displaying a few side effects is Singulair, making it a good option for treating capsular contracture. This is especially the case in instances of Baker I and Baker II. Due to their nature, Singulair is not recommended for use in cases of Baker III or Baker IV, the two most advanced instances of contracture. The use of this medication is unlikely to result in a significant reversal of the condition in these instances.

The use of medication to treat capsular contracture must be carefully and professionally considered before being administered to a patient.

Corrective Surgery Options for Capsular Contracture

There are several surgical options for the correction of breast capsular contracture. The best option for you can be determined by Miguel Delgado, M.D., during a consultation.

Options include capsulectomy, open capsulotomy, and autologous reconstruction.

1. Capsulectomy
During a capsulectomy, the existing implant and the surrounding tissue capsule will be removed. A new implant, wrapped in a sheet of the dermal matrix material, will then be inserted. The dermal matrix is a skin substitute made mostly of collagen. It provides an extra protective layer. The body will then form a new capsule of scar tissue around it.

2. Open Capsulotomy
Scar tissue is released or partially removed following an incision within the breast area during an open capsulotomy. The goal is for the capsule to pop open, giving the implant more room to move around. In some cases, for an open capsulotomy, the existing implant may be removed and replaced with a new one.

3. Autologous reconstruction
Also known as ‘flap’ reconstruction, this type of surgery is a more complex procedure performed on the breast. During this surgery, the existing implant will be removed. The surgeon will reconstruct your breast with a ‘flap’ of tissue transplanted from another area of your body. This tissue may be transplanted from your buttocks or stomach. Flap reconstructions
This type of surgery ensures that capsular contracture will not reoccur due to the fact that tissue capsule will not form. As it is more complex, there is a longer recovery time for your procedure.

4. Use of Acellular Dermal Matrix
Acellular dermal matrices (ADMs) are an increasingly common component of implant-based breast procedures. The introduction of ADMs in revision surgery has led to a decrease in the recurrence of capsular contracture. ADMs may be used at the primary aesthetic implant surgery or during revisionary surgery.

5. En-Bloc Implant Removal
Another option for either saline implants or silicone gel implants is en-bloc implant removal. This procedure involves the complete removal of the implants and the intact capsule. We will discuss this and all other options with you during your free consultation to determine the best recourse for you.

Corrective Surgery Options for Capsular Contracture

There are several surgical options for the correction of breast capsular contracture. The best option for you can be determined by Miguel Delgado, M.D., during a consultation.

Options include capsulectomy, open capsulotomy, and autologous reconstruction.

1. Capsulectomy
During a capsulectomy, the existing implant and the surrounding tissue capsule will be removed. A new implant, wrapped in a sheet of the dermal matrix material, will then be inserted. The dermal matrix is a skin substitute made mostly of collagen. It provides an extra protective layer. The body will then form a new capsule of scar tissue around it.

2. Open Capsulotomy
Scar tissue is released or partially removed following an incision within the breast area during an open capsulotomy. The goal is for the capsule to pop open, giving the implant more room to move around. In some cases, for an open capsulotomy, the existing implant may be removed and replaced with a new one.

3. Autologous reconstruction
Also known as ‘flap’ reconstruction, this type of surgery is a more complex procedure performed on the breast. During this surgery, the existing implant will be removed. The surgeon will reconstruct your breast with a ‘flap’ of tissue transplanted from another area of your body. This tissue may be transplanted from your buttocks or stomach. Flap reconstructions
This type of surgery ensures that capsular contracture will not reoccur due to the fact that tissue capsule will not form. As it is more complex, there is a longer recovery time for your procedure.

4. Use of Acellular Dermal Matrix
Acellular dermal matrices (ADMs) are an increasingly common component of implant-based breast procedures. The introduction of ADMs in revision surgery has led to a decrease in the recurrence of capsular contracture. ADMs may be used at the primary aesthetic implant surgery or during revisionary surgery.

5. En-Bloc Implant Removal
Another option for either saline implants or silicone gel implants is en-bloc implant removal. This procedure involves the complete removal of the implants and the intact capsule. We will discuss this and all other options with you during your free consultation to determine the best recourse for you.

Virtual Consultation Available

If you are concerned about complications following your breast augmentation or considering revision surgery to correct capsular contracture, you are welcome to schedule a free consultation with our team in person. Alternatively, you can send us your photos and description through email. We will then contact for a follow-up conversation about your options.[Submit Your Photos]

Miguel Delgado, M.D.

Miguel Delgado, M.D.’s credentials include membership in the American Society of Plastic Surgery and certification by the American Board of Plastic Surgery. Alongside Miguel is a highly-experienced and qualified team with decades of experience in breast revision and capsular contracture surgery.

Reclaim Your Confidence | Contact Miguel Delgado, M.D. and His Team

We offer the best options for those seeking breast revision surgery due to capsular contracture in the San Francisco Bay Area. Contact our dedicated, friendly, and experienced team today for more information. Put your trust in us and reclaim your confidence today!