Capsular Contracture

Capsular contracture is a known complication of breast augmentation and is covered by the implant manufacturer’s warranty. It is graded I through IV, with the first level being a soft, normal capsule and the fourth being a hard, painful capsule. We treat grade III and IV capsules with surgery. A grade II capsule is usually treated with massage and treatment with the Aspen external ultrasound system.

How Capsules Occur

Current thinking is that breast capsules are formed by biofilm – a type of low-level bacterial infection. This may occur from surgical contamination, or more likely from other infections in the body such as a sinus, tooth, or urinary tract infection. Antibiotics to treat the infection will not correct the capsular contracture.

infographic

Your Treatment

The most effective treatment of Grade III and IV capsular contracture is to remove the whole capsule (capsulectomy). Just scoring the capsule (capsulotomy) usually is ineffective. Other procedures — such as a closed capsulotomy, in which the breast is squeezed until the capsule is broken — are not recommended, as they may cause implant rupture and void the implant warranty.

Treatment for capsular contracture is a very common surgery at Sanctuary Plastic Surgery, and patients come from all over the world for treatment. We follow a protocol that we developed and our recurrence rate is under 5%.

Understanding Capsular Contracture

Procedure Details

The patient pictured here came to our surgery center in Boca Raton, Florida to address the complications from previous breast surgeries at another surgical center. She had multiple surgeries for capsule contracture and had multiple capsulectomies. She came to us with her implants already removed.

She underwent residual capsulectomies and reaugmentation with Mentor moderate plus profile 275cc implants and Strattice Tissue Matrix in our Boca Raton office. This after photo was taken two years post operstively. She has told Dr. Pozner that this surgery has been a “miracle cure” for her.

picture of breasts

Our Capsular Contracture Treatment Protocol

The treatment protocol is as follows:

Complete capsulectomy (the whole capsule is removed) incisions vary depending upon what was used previously and most of the time we use these previous incisions.
Wash the pocket with hypochlorous acid followed by triple antibiotic betadine solution.
If the previous pocket was over the muscle we convert to under the muscle.
The Strattice is placed.
A drain is placed.
Second washing.
The new implant is placed (we will not reuse a previous implant in patients with capsular contracture).
The other side of the Strattice is sewn in.
A breast lift is performed, if needed – otherwise the incisions are closed.
Capsules are sent to MicrogenDX in Texas for PCR and next-generation sequencing, to see if bacteria are present.
If bacteria are present, an extended course of antibiotics is prescribed.
If possible, Aspen treatment is scheduled for a few weeks

Schedule Your Consultation

We would love to talk more with you about your own personalized treatment at Sanctuary Plastic Surgery. With your own private consultation, our team of extraordinarily skilled and dedicated plastic surgeons will be able to recommend the right treatment plans for your unique goals and concerns. With offices in Boca Raton and Palm Beach Gardens, men and women in Florida can achieve the most natural and elegant results. Call today to schedule your consultation.

After Your Procedure

Capsule correction is done on an outpatient basis and you should arrange for someone to drive you home after your surgery and stay with you overnight. There will be some pain and swelling for a couple of days after surgery, and you will have prescription pain medication to help you stay comfortable in the early stages of healing. Soreness and swelling may last up to several weeks.

You will be seen the next day in the office and the surgical wrap will be removed. You will be placed in a soft bra that we'll provide. After you return, you may shower and replace the bra provided, but keep the drain entrance site protected. You will be seen a few days later for a follow-up to assess your healing. Wear the bra provided until our staff says otherwise, and avoid buying new bras until the swelling subsides, which may be a few weeks after surgery.

Details About Your Procedure

Operative times vary but usually are an hour and a half per side, though longer if a breast lift is also performed. A drain is used after capsulectomy and stays in for five to seven days. Recovery is similar to a primary augmentation.

Here is a general timeline of breast capsule recovery:

One week before you can return to work (depending on your job)
Four days or so to resume driving
Resume exercise as per individual instructions
No chest exercises for at least three months

With all of the above techniques, surgical and recovery times vary with the degree of difficulty. Post-operative taping and garments are essential to good outcomes.

Timing of return to work and exercise varies as well and will be discussed individually at consultation.