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Capsular Contracture & Breast Implant

What is Capsular Contracture?

Scar tissue forms around all nonabsorbable implanted materials in our bodies, as a natural part of healing. But scar tissue becomes troublesome when it tightens around an implant. As the capsule tightens, a flexible soft natural shaped implant can become a firm round ball and changes the shape of the breast. The capsule often becomes adherent to surrounding skin, breast tissue, muscle, or chest wall and can cause discomfort or pain with exercise, sexual activity, and normal everyday living.  Capsular contracture can occur after a Breast Augmentation with implants and causes the breast to feel firm, unnatural and often painful. The most severe cases can cause strange distorted breast shapes. These contractures can result in a cold feeling breast, affect sleep, contribute to muscle pain, shoulder pain neck and back pain, and in some women cause the feeling of difficulty in taking a deep breath. Capsular contracture can occur anytime but tends to do so in waves called either “early” or “late” capsular contracture. Removal of the capsule with or without and implant exchange usually involves a drain and most women return to work in 5-10 days.

Do I have a capsular contracture?

Contractures can occur any time after the placement of breast implants. There are several probable causes of contracture. Breast tissue naturally has bacteria. Breast implants over time appear to have bacteria that adhere to the implant shell, called a biofilm. This is not an infection, and does not respond to antibiotics, but can cause a slow inflammation, resulting in a gradual tightening of the capsule. Some studies suggest that blood in the pocket at the time of augmentation may increase your risk, and some contractures do not have any known causes. Most women never experience tightening or contracture.

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Before and After Photos

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Available Treatment Options

Some women may decide to have implants removed after developing a capsular contraction or may wish to have a revision and replacement of the implants. Current studies have shown that implants should be removed and replaced after capsule removal, and brand-new implants should be used. Keeping the original implants is not recommended since the implant surface has adherent bacteria called a biofilm. Most implant companies now provide a warranty for this condition. The implant companies we use DO warranty implants for contracture at this time.

A capsulectomy (the surgical removal of the capsule) is performed at the time of implant replacement to improve the likelihood of soft breast and potentially reduce the recurrence rate of the capsular contraction. Removal of the capsule generally results in a dramatic breast shape change. These options, however, do not ensure that a capsular contraction will not recur, and patients that have had a contraction are considered a significantly higher risk of subsequent capsular contractions.

A capsulectomy operation involves making an incision along the breast crease, regardless ow where your original incision was placed. The tissue is separated to expose the capsule that can be easily identified. The operation includes dissection (separation of the surrounding) tissue from the capsule. A contracted capsule can be very thin or thickened, can look normal or be covered with calcified areas that resemble tiny eggshells. These findings are identified during surgery and rarely show up on scans including MRIs. Most of the time, the surgery technique involves an en bloc approach which helps remove the capsule with implant inside as a single unit. This is an effective way to help reduce siligone spillage with ruptured implants but is not always advisable depending on the consistency of the capsule when it is very thin and adherent to rib or other structures. None the less, when a capsulectomy is complete, the goal is to have no remaining visible resectable lining left.

Most women find that following the operation they may need some pain relief for 24-48 hours, and most find that within 24 hours acetaminophen is effective. Driving can resume in 3-4 days, return to exercise in 3 weeks, and swimming and beach visits in 1 month.

The decision to re-implant should be carefully deliberated. If you have developed a capsular contracture once, you are at higher risk of a recurrence. If your implants were originally above the muscle, the option of replacing below the muscle may be considered. In some cases, the best option is to remove the implant and capsule, allow for healing, then consider options at a later date.

All tissue removed during surgery will be sent to pathology for evaluation. It is extremely rare to find any issue with the tissue. However, patients that have had textured implants have a very small risk over time of developing BIA ALCL (breast implant-associated anaplastic larger cell lymphoma) which in the overwhelming majority of cases is cured with a capsulectomy. These can develop to look like a contracture but often present with a fairly rapid size increase over weeks to a few months.

Capsular Contracture Classification

Correcting capsular contracture involves several factors including: the extent of the damage, how soon it occurred after implant placement, lifestyle, patient history and expectations. The most common classification system used by Board Certified Plastic Surgeons is the Baker Classification;

  • Baker I – Describes a breast that is soft and feels and looks normal.
  • Baker II – Involves a breast that is slightly firm, often feeling. different from the opposite breast, but with no visible changes.
  • Baker III – Capsular contracture is significantly firm, with visible changes in shape or contour.
  • Baker IV – The breast is very firm to hard, easily palpable implant, significant visible change, may feel cooler to the patient and is or may be painful with normal activity.

Receiving a Professional Consultation

Dr. Rudderman believes the consultation is critical for you and him. The consultation includes the following: full evaluation of your original surgical experience including implant type and location, placement and technique used. This information can yield insight into the contributing factors to the capsular contracture. During the consultation implant positioning, size, capsular contracture severity, and soft tissue characteristics will be assessed to estimate expected postoperative appearance. Many symptoms may resolve quickly after implant and capsule removal. Capsules removed are typically sent for pathologic evaluation, and patients receive a written report of findings from the pathologist.

All of your questions will be answered and your concerns addressed. Dr. Rudderman has done hundreds of breast surgeries and can project your likely outcomes. This is done in an embracing, relaxing environment. From the consultation evolves…trust, respect, mutual understanding and a personalized treatment plan.

These treatments are not an emergency, and plenty of time will be allowed to have a full conversation to consider options. Additional visits can be provided until you feel confident that you are making the best decision for yourself in health, safety, and outcome.

Dr. Rudderman has done hundreds of breast surgeries and can project your likely outcomes. From the consultation evolves…trust, respect, mutual understanding, and a personalized treatment plan.

After your first consultation with Dr. Rudderman, you will realize that there truly is a difference in how surgeons approach their profession. For Dr. Rudderman…that difference means understanding your goals and providing a level of service that places safety and comfort alongside predictable and pleasing outcomes.

Contact us at 678.566.7200 to meet with Dr. Rudderman in our Alpharetta or Midtown Atlanta offices.

Written and reviewed by:

This article was written by Dr. Randy Rudderman, who is board certified by the American Board of Plastic and Reconstructive Surgery (1994). He practices medicine at his offices in Alpharetta and Atlanta.
Learn more about Dr. Rudderman, his medical training, and credentials.

What to Expect After Surgery

  • You will wake up with a small dressing over the treated area and a surgical bra –
  • Mild swelling, & some discomfort is normal & to be expected – this resolve on its own and often requires some pain medication for 24 hours then only acetaminophen
  • You will be seen in the office 24 hours post-surgery and given a more comfortable bra
  • Swelling generally is mild and resolves in 2-3 weeks
  • Sutures are absorbable and do not need to be removed
  • You will have a type of brown paper tape on the incisions to protect the area and help with minimal scar formation
  • You will have a drain tube placed if you have had a capsule removed that needs to be checked several time a day, and we will speak with you daily during business hours to follow your progress and determine when to return to have drains removed.
  • Most patients have drains removed in 5-7 days.
  • Most patients who have surgery on Thursday can return to desk work Monday with drains or later without.
  • Avoid strenuous activity for 3 weeks…Dr. Rudderman will tell you when you can start to exercise again
  • Measurable results are typically visible immediately…but be patient…healing and stabilizing takes time. It can take months for the “new you” to be clearly seen.

Long-Term Results

The results of this procedure are long-lasting.  A good follow-up plan is necessary. Additional surgery to further improve the appearance is unlikely unless a contracture recurs. All breast need good long term follow-up for evaluation of breast disease by your practitioner of choice.

Procedures Frequently Asked Questions

Search our list of FAQs for the answers you are looking for.

All breast implants placed in the body become surrounded by a layer of tissue called a capsule. In breast in most women this capsule lining is thin and soft. However some women will find that one or both breast become firm or hard overtime. This is called a capsular contracture. As the capsule tightens, there is often an associated change in shape.

When a capsular contracture occurs, the tightening will gradually make your breast feel hard because of pressure on the implant. The hardness can occur quite rapidly and be noticeable over days or weeks or in some women the tightening of the capsules may be so gradual that they may not be able to remember when their breast first became firm, hard, or misshapen.

Many women will complain of pain, discomfort, soreness, or interference with physical or sexual activity when a capsular contraction occurs. You may experience discomfort in the chest, shoulder, rib, and back, numbness, tightness, heaviness, or non-specific irritation from capsular contractures. Some women will be generally embarrassed to give someone a hug because their breast just feel too hard. Clothing may become an issue because of the firmness and shape change of the breast.

Capsular contraction is believed to occur in some women as result of reaction to the natural bacteria within the breast tissue that stimulate response causing the capsule tissue to contract and tighten. These are not considered infections and treatment with antibiotics does not result in resolution.

Capsular contraction can be associated with ruptured implants, particularly when significant chronic inflammatory changes occur. However patients with intact implants, saline or gel, may develop capsular contractures. Capsules when tightened may become thickened or remain thin and still cause implant shape change. Capsular contraction can occur with saline or silicone implants, textured or smooth implants and with implants placed above or below the muscle.es, and other factors. Dr. Rudderman will explain which implants are most likely appropriate for your specific needs, and review their characteristics, warranty information, and general risks of use.

There are several medications that have been reported to reduce the potential for recurrence of capsular contracture following surgery. Some patients have noted a stabilization of their tightening. It is extremely unlikely that any significant capsular contracture will resolve without surgery. Some surgeons have used a technique called closed capsulotomy to treat contractures without surgery. This is an outdated technique where the breast is squeezed to tear the lining and release the tension. There is a high risk of implant rupture with this technique and unpredictable tissue damage that most always results in more, not less scar tissue.

There are several supplements that have anti-inflammatory properties that have been reported to help reduce recurrence.

A total capsulectomy is removal of the entire lining around the implant. This effectively removes the inflamed tissue, the scar tissue, and removes the biofilm (bacteria) that may have been present near the implant. The pockets are irrigated with antibiotic solution and a new implant can be placed. The original implants should NOT be reused if a capsular contracture has occurred and is being treated.

There is no way to accurately predict if you will have a recurrence. Women that have developed a contracture are definitely more likely to have a recurrence in the future.

There are patients that have had a second operation to remove the capsule with success. There are options as well to use a graft material called Acellular Dermal Matrix during surgery after a capsulectomy (the operation to remove the capsule). This is not foolproof, but some studies have demonstrated decreased contracture rates after use of this material. This does require drains for 5+ days, and there is additional cost associated with use of this material. This option should be carefully discussed before surgery.

Many women will decide not to replace implants. Your appearance after surgery will depend significantly on how much of your current breast volume is tissue vs. implant. Your cup size generally will be similar to your cup size before implants were placed. However, women who had had several pregnancies may have less OR more breast tissue than at the time of augmentation. Women who are near or through menopause may have experienced volume changes in breast, more commonly larger than smaller. Patients who have had gradual weight gain may as well have more native breast volume. And removal of implants placed above vs. below the muscle can impact the shape after surgery. All of these factors will be discussed during your consultation so that you can have a reasonable idea of possible outcomes before your breast implant removal surgery.

When a capsulectomy (surgical removal of the tissue lining around your implant) is performed in effectively all operations with implant removal. If implants are removed without removal of the capsule, the capsule will persist indefinitely, and may scar together, but will not disappear. Retained capsuled may occasionally become a site for seroma (fluid collection) if retained. All capsules removed during surgery are sent to the Northside Hospital Pathology department for microscopic evaluation, and a report is generated for your medical record with findings noted. It is very rare for any neoplasm (cancer) to be related with capsule removal.

Yes, he performs all of his patient’s surgeries. Many surgeons use assistants to suture or perform part of the operations. Dr. Rudderman performs the entire operation on every patient.

All surgeries involve some discomfort. Dr. Rudderman is highly skilled and uses advanced techniques and refined instruments that maximize comfort during his surgical procedures. Many patients will take either minimal pain medications for several days and then convert to Tylenol.

You will need to avoid all rigorous, strenuous activities for a few weeks until healing is adequate and Dr. Rudderman tells you it’s ok. We will see you frequently during your healing process to help you return to your normal activity as soon as possible. Exercise can be an important part or recovery, and we follow your recovery closely to help you reach your goals.

Dr. Rudderman’s patients most often return to desk jobs in about 2-4 days. Most operations for implant removal can be performed on Thursday with return to work on Monday. If drains are placed, they usually can be removed in 1-4 days as well. He can give you a time frame specific to you during your consultation.

Yes. All cases are supervised a Board Certified medical doctor who has specialized in anesthesiology.

All of our surgeries are performed in a fully accredited surgery facility using state of the art technologies and a world-class staff with all the comfort and safety factors as a hospital surgery suite.

Capsular contracture surgery is usually considered to be cosmetic procedures, especially when the original surgery was cosmetic in nature. Cosmetic procedures are not covered by insurance. However, there may be exceptions for removal of implants and capsulectomy, so you should check directly with your provider for this answer.

Yes. Financing through Care Credit is available for all the breast procedures Dr. Rudderman performs.

You will need someone to drive you to and from your surgery, stay during surgery and remain with your overnight (24 hrs) after you have had anesthesia. Your follow-up visit will usually be within 24 hours, and you should be able to drive to this appointment if you are not taking pain pills.