Breast Augmentation Gone Wrong: Capsule Contracture; What Can Be Done?

A special guest article by Brian Windle, MD, a board certified plastic surgeon practicing in Kirkland, WA.
Breast Augmentation Gone Wrong Picture - LocateADocBreast augmentation can result in a breast implant problem called capsule contracture. This is when a capsule or scar forms around the breast implant and then tightens much like a balloon full of water being squeezed. The more it tightens, the harder and more round the breast implant or balloon becomes and the more distorted the result the breast augmentation becomes. Capsule contracture is the most frequent cause of breast implant revision that is required after breast augmentation.
A review of the literature shows that there is no consensus on the cause of breast implant capsule contracture. It could be the presence of blood around the breast implant after surgery, contamination of the surface of the breast implant with bacteria leading to a problem called a biofilm, or it could be some other as yet unrecognized cause. Most surgeons feel that the most likely cause is a biofilm and are taking special precautions to prevent the problem including:  
  • Intravenous antibiotics given just before the operation.
  • Thoroughly washing the operative site and the breast implant with antibiotics.
  • Using a no touch technique for the implants by using a special device called a Keller funnel.
  • Using implants that allow for tissue ingrowth like the Mentor Memory Shape breast implants, Natrelle 410 breast implants and Sientra breast implants.  All are gummy bear implants.  Sientra also has a 2 year warrantee to help defray the cost of reoperation of a capsule contracture occurs.
  • Early activity has also been shown to speed recovery and reduce the incidence of many risks of which the literature suggests one risk that may be reduced is capsule contracture. This came from research done on the 24 hour rapid breast augmentation recovery postoperative regime.
Brian Windle, M.D.Breast augmentation capsular contracture treatment is almost always surgical. Either a procedure called a neo-pocket creation is used or a complete capsule removal with the placement of a special internal sling to help stop any further capsule contracture formation.  Some physicians use asthma medicines such as Accolate or Singulair to try to treat contracture, but there is no good evidence that this works and these medicines have can significant serious side effects.  Anti-inflammatories, massage, ultrasound, Vitamin E, and many other remedies have been tried with mixed or minimal success.
With proper technique and breast implants, the rates of contracture revision in breast augmentation are very low, but they are not zero. In Seattle, we are working hard at solving the problem.
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