Capsulectomy for Capsular Contracture

Capsulectomy, for capsular contracture after breast augmentation, can be performed in several ways. Capsular contracture is a common complication after breast augmentation that causes symptoms such as discomfort, pain and hard or distorted breasts. When a foreign object such as an implant is placed into the body, the immune system tends to react by forming scar tissue or a capsule around the area designed to protect the body. Treatment usually consists of cutting or excising a portion of the capsule to relieve the restriction or binding on the breast tissue. In general, capsular contracture is caused by:

• A tightening or contracting of the scar tissue around the implant
• Excessive or internal bleeding during the procedure resulting in bacterial contamination
• Blood left in the breast pocket that was not cleaned out, prior to inserting the implant, which stimulated the inflammatory process
• A hematoma, or collection of blood that forms under the skin, after surgery
• Trauma to the breast

Am I a Good Candidate for Capsulectomy for Capsular Contracture?

GOOD CANDIDATES for capsulectomy for capsular contracture are:

• Patients whose breasts have become firm or hardened, after augmentation, and are distorted in some manner
• Women who have discomfort or even constant pain in the breast tissue
• Patients with misshapen breasts, or a displaced implant, generally in an upward position
• Patients with signs of a ruptured implant
• Women with severe inflammation that shows no improvement with medication
• Patients whose scar tissue has become so thick that it can be felt by others

The following patients are NOT GOOD CANDIDATES for capsulectomy of capsular contracture:

• Women with mild pain and firmness but no deformity to the breast tissue
• Patients who are ill at the time of surgery
• Patients with medical issues which may increase surgical risks or healing problems

How is Capsulectomy for Capsular Contracture Performed?

A capsulectomy procedure can take between 90 minutes and 3 hours depending on the amount of work that needs to be performed. It is typically performed on an outpatient basis and under general anesthesia. However, a patient may need to stay overnight for observation since this type of procedure is more complex than an initial breast augmentation procedure. Prior to surgery, the doctor will give the patient prophylactic intravenous antibiotics to help minimize the risk of a bacterial contamination.

The surgeon will re-open the incision and cut through the scar tissue to open the capsule. The surgeon will then remove either a portion of the capsule, or the entire capsule, to relieve tension. These techniques are referred to as a sub-total capsulectomy or a total capsulectomy. A sub-total capsulectomy can only be done if the implant has not shifted or ruptured. After the tension from the capsule is released, the implant may be re-inserted into the pocket or a new one will take its place. Depending on the circumstances, a new pocket may need to be created and/or the size of the implants may need to be changed. The surgeon will apply surgical dressing to cover the wound and will close the incision with sutures and tape.

Alternative Techniques

One variation may include the use of a synthetic tissue material, which has been biologically created, to reconstruct the breast. These products can be sutured into the inferior half of the breast after excising the breast capsule. ADMs, or acellular dermal matrix products, are known to reduce the chance of capsular contracture recurring and will be naturally absorbed by the body in about 6 months.

Sometimes, the surgeon may have to take out the implant and excise the capsule. However, the surgeon may not be able to insert a new implant until the breast tissue heals in about 3 to 6 months.

The patient may decide to have the implant and capsule completely removed and not replaced. A breast lift may be recommended to treat saggy breast tissue after the implants are removed. 

An alternative procedure may include a capsulorrhaphy which is a repair of a tear or surgical incision in a capsule. However, this procedure is only an option if the capsular contracture is due to bacterial contamination and bleeding from the scar tissue. With a capsulorrhaphy, the surgeon will only cut the capsule to weaken it.

A breast massage can lower the risk, recurrence or tightening of capsular contracture after breast augmentation.

Singulair, which is an anti-inflammatory medicine, can help minimize symptoms in patients who are beginning to experience firmness with the breast. Taking 10 mg of Singulair once a day has been observed to decrease the progression and potentially reverse abnormal capsular contraction in patients.

What is the Cost of Capsulectomy for Capsular Contracture?

The cost of capsulectomy for capsular contracture will be greater if the treatment is needed on both breasts. The cost will be higher if both breasts require replacement of both implants rather than just removing them. The cost will also vary according to the type of implants being used to replace the existing ones, the geographic location of the facility and any fees charged by the doctor. In general, the price goes from $4000 to $15,000.

Recovery and Downtime 

After capsulectomy for capsular contracture, the breasts will be sore, swollen and bruised during the initial RECOVERY period. Pain can be managed by medications. Antibiotics will also be prescribed for the first 5 to 7 days. A surgical bra or compression garment will be worn for several weeks to minimize swelling and pain and to support the breast tissue. Ice packs can be applied to help reduce swelling. Drainage tubes may be placed, within the incision, to excrete excess fluid and blood for 1 to 3 days.

Patients are advised to take it easy for the first few days of DOWNTIME but they are encouraged to take short walks starting the day of the surgery. It is recommended that the patient sleep with several pillows that are propped up to keep the chest elevated. It is common for patients to experience numbness or tingling around the incision. However, this should subside over a few weeks or months. Normal activities and work can resume after a few days but patients should avoid lifting their arms above the shoulders or bending over for the first 2 weeks. Exercise and heavy lifting should be avoided for approximately 4 to 6 weeks or until the surgeon states otherwise.

Results

The RESULTS from capsulectomy for capsular contracture can be noticed immediately but will continue to improve as the swelling and bruising subsides. The implants may sit higher than expected and this is especially true if a new pocket was created. However, the implants will eventually settle into a better position. Swelling can take several months to dissipate. Therefore, it can take 3 to 4 months to see the final results. Nevertheless, the breasts will be softer and more natural looking after the surgery. Scarring may appear pink and firm for several months but will fade over time.

Limitations of Capsulectomy for Capsular Contracture

Limitations of what can be accomplished by capsulectomy for capsular contracture can result from the patient’s current anatomy including:

• The severity of the capsular contracture
• The capsular around the implant may be too big to only remove a portion of it so the entire capsule and implant may need to be removed
• Patients may be required to have a new pocket created, especially if the original implant was placed above the muscle, and is now being placed below the muscle

Risks of Capsulectomy for Capsular Contracture

The risks involved with capsulectomy for capsular contracture may include:

• Bleeding
• Infection
• Reaction to anesthesia
• Blood clots
• Reduction or loss in nipple sensitivity
• Nerve injury
• Inability to breastfeed
• Asymmetry
• Wrinkling or deflation of implants
• Recurrence of capsular contracture

Consult with a Surgeon as Soon as Possible

Patients who suspect they have capsular contracture after breast augmentation should consult with their surgeon as soon as possible. Preventing capsular contracture with massages or medications, before it becomes a bigger issue, may save a patient from having a capsulectomy for capsular contracture. Pain, firmness of the breasts, distortion, shifting of the implant and a rupture are all signs of capsular contracture. A capsulectomy for capsular contracture can alleviate these symptoms and provide softer, natural looking breasts.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Robert Troell, MD of Beauty by Design in Las Vegas, NV