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Capsular Contracture
What is it???


Capsular Contracture, sometimes casually re-named “Capsular Contraction”, is a condition that may affect those who undergo breast augmentation, either electively or after breast reconstruction. It is a hardening and constriction of the breast implant capsule and causes breast firmness. In the most severe cases, it can create a painful, distorted, misshaped, or oddly positioned implant.


The truth is that a capsule is natural, and forms around any foreign object in our bodies, in this case, the breast implant. This “capsule” or implant shell is similar to the thin opaque membrane that one may see when you break open a hard boiled egg. It’s the flimsy/ rubbery covering inside the shell but outside covering of the egg.


A capsule normally occurs to anything “foreign” object inside the body, like hip replacement prosthesis, metal fragments, or even a thorn deeply lodged inside the body. It becomes a problem, or Capsular Contracture, when the natural capsule is triggered to constrict or fibrose, which ultimately causes hardening of the breast implant shell and possibly other problems.


CAPSULAR CONTRACTURE VIDEO
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LEFT BREAST WITH IMPLANT CAPSULAR CONTRACTURE:

Notice how the Left breast is higher, firmer, more balloon-like in fullness, and misshapen versus the normal Right side breast.





AN IMPLANT CAPSULE:

The capsule is represented by the white opaque inner lining of the skin resection above. The opening represents the space where the implant sits and has been removed.

Photo courtesy of Dr. Hilton Becker, Boca Raton, FL.


Causes of Capsular Contracture:
The origin of Capsular Contracture is speculated to be from a number of causes that are still up for review. The following are generally well accepted as possible causes:

  • Trauma
  • Bacterial Infection
  • Hematoma (Excessive blood that collects in an area)
  • Seroma (Non-blood type watery liquid that collects in an area)
  • Smoking
  • Radiation treatment for breast cancer

Signs of capsular contracture:

  • PAIN
  • FIRMNESS
    Capsular Contracture firmness is graded using the Baker Grading System:
    • Grade I: Breast looks and feels normal           
    • Grade II: Breast feels a little firm but looks normal
    • Grade III: Breast is more firm and is visually distorted (shape change or mal-positioned)
    • Grade IV: Breast is hard and greatly distorted in shape and position
  • IMPLANT NOT DROPPING OR IN HIGH POSITION
  • DISTORTED SHAPE OR APPEARANCE
 

PREVENTION:

TYPES OF SURGICAL PROCEDURES may help prevent capsular contracture. Some recommend that certain types of implants or placement of the implant may reduce contracture. The fact is that even the “perfect” surgery under the best conditions can result in a breast implant encapsulation. It is important to talk to your surgeon about what these options are before having your procedure.

Antibiotics, Papaverine, ANTI-inflammatories, or even Vitamin E may be recommended after surgery. It important to discuss this with your surgeon as these substances are not always indicated and may have possible adverse side effects.  Antibiotics may be especially important for future dental procedure as it may help prevent a late onset of contracture from possible infection.

MASSAGING and/or wearing a compression garment/ bandage may help reduce the incidence of contracture with the goal of not allowing the fibrous capsule to reach a state of excessive hardness. Aspen Rehabilitation, a post-plastic surgery treatment facility in Coral Springs, Florida specializes in this type of training and education. One of their clinically licensed therapists can show you how to properly perform the right type of massages, wear the right type of compression bandage, and even show you exercises to help prevent capsular hardening.

EXTERNAL ULTRASOUND Treatment (Not to be confused with Diagnostic Ultrasound or Ultrasound Assisted Liposuction-UAL) has been researched internationally for quite a number of years and shows promise in assisting prevention of capsular hardening. Aspen Rehabilitation in Coral Springs, Florida specializes in this type of treatment for prevention of capsular contracture and has been achieving excellent results using External Ultrasound as part of their Capsular Contracture Treatment Program. External Ultrasound can be applied after surgery and before a capsular hardening begins. This is especially important for those who have had encapsulation in the past and have undergone a corrective surgery. The best treatment is prevention and waiting till contracture occurs, lessens the effectiveness of this type of treatment.

 

TREATMENT:

Despite the best efforts, capsular contracture may happen. The American Society of Plastic Surgeons (ASPS) of how often capsular contracture occurs will vary depending on type of procedure (above or below muscle implant placement) and the type of implant (silicone or saline). On average, 9-33% of women may encounter a breast encapsulation sometime in their life after breast implant surgery. Women who undergo breast reconstruction after Cancer, who have radiation treatment, tend to be on the higher end of the statistics. 

MEDICATIONS like Accolate or Singulair, which are anti-asthma drugs, have shown some promise. They actively reduce the inflammatory process in Asthma and have shown some benefit to helping prevent, even soften, already contracted implants. Using these medications for the purpose of Capsular Contracture is considered an off-label use so it is very important to speak with your surgeon if these medications are right for you.

EXTERNAL ULTRASOUND(Not to be confused with Diagnostic Ultrasound  or Ultrasound Assisted Liposuction-UAL) treatment as discussed above, also shows promise in treating implants that have already begun capsular hardening. Aspen Rehabilitation in Coral Springs, Florida specializes in this type of treatment for capsular contracture and has been achieving excellent results using External Ultrasound as part of their Capsular Contracture Treatment Program.

External Ultrasound is a painless electronic modality. It is applied to the outside of the affected breast and can be used after a contracture has started.  It must be initiated immediately or results will be lessened. Aspen Rehabilitation utilizes a very unique, computer controlled Ultrasound machine that is unlike traditional ultrasound machines used in doctor’s offices, therapy clinics, chiropractic, or massage offices.

MASSAGING and/or wearing a compression garment/ bandage may help reduce the severity of contracture once it starts. As discussed above, the goal is to not allow the fibrous capsule to reach a state of excessive hardness or allow the implant to stay stuck in an upward position. Aspen Rehabilitation, a post-plastic surgery treatment facility in Coral Springs, Florida specializes in this type of training and education. One of their clinically licensed therapists can show you how to properly perform the right type of massages, wear the right type of compression bandage, and even show you exercises to help prevent capsular hardening.

CAPSULE SURGERY, often known as open capsulectomy or capsulotomy, can be done to release, cut, and allow for opening of the contracture. The goal is to release the tightness and allow for return of softness. An alternate method is called a closed capsulotomy. This is where the surgeon physically breaks the capsule forcibly by squeezing the breast from the outside to allow for release and softening. This method is not widely used as it is painful, voids the implant warranty, may create instability in the position of the implant, and may compromise the implant itself. It is also worth mentioning that both the above open and closed capsulotomy procedures may result in a repeated contracture occurring, so discuss the best option with your surgeon.









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