Breast Implant Capsular Contracture from A to Z

Everything you need to know about Capsular Contracture:

The single most frustrating and difficult complication for Breast Implants is the formation of a tight envelope that surrounds and squeezes the implant causing pain and displacement of the implant. Sometimes the squeeze can be so powerful that the implant begins to look smaller compared to the other side.

This problem of capsule formation and contracture has been happening ever since implants were used in breast surgery but even today we do not fully understand why this happens and continue to have a hard time predicting who will develop contracture. The current theory of capsule formation is based on a unregulated immune response to bacteria surrounding the implant causing the formation of a thick tight capsule.

There are some risk factors for contracture that help us to know who may be at higher risk such as a history of prior contracture or damage to the breast tissue from radiation treatment. It was also thought that textured implant devices could help protect against contracture, but these devices have mostly been removed from the market.

How is capsular contracture diagnosed? Do I need a blood test or expensive breast imaging? No, there are no specific diagnostic tests to determine capsule formation, but you will notice some changes. At first you may notice the implant start to move upwards, higher onto the chest compared to the opposite side. This gives the appearance that the “normal’ side is falling lower when in a capsule is tightening around the implant bringing it closer and higher back onto the chest. Changes may be hard to see at first, but overtime there can be a tremendous difference in the breast heights.

Other major signs to look for are pain and limited movement of the implant in the breast pocket. A normal capsule will let the implant glide underneath the breast tissue for a centimeter or 2 in any direction, however, a tightening capsule will result in restrictive movement. Pain is not normal to have and can start off as occasional and mild to more severe and constant.

I often make the diagnosis based on my clinical suspicion but often there is value for breast imaging to determine the integrity of the breast implant prior to final treatment decisions. I like to use ultrasound first and then if needed MRI for implant evaluation.

What happens after you are diagnosed with capsular contracture? What are the treatment options to help with the pain and the tight look around the implant?

If you don’t want to undergo revision surgery first, I think it is totally reasonable to try using a medication that can minimize inflammation, we have been using montelukast in our practice with some degree of success. Montelukast is a special type of anti-inflammation medicine often used for people with breathing issues but it seems to also have some benefit in treating capsular contracture. I have seen improvement in my patients, but usually its only a partial result, but just enough to avoid a surgery. The scientific studies regarding montelukast therapy are mixed without a clear benefit. That said, side effects a fairly minimal, but they can occur such as sinus infections and irritability.

Sometimes I will recommend surgery to remove the implant and capsule altogether. This provides an immediate cure because the capsule is cut out and removed. This approach we refer to as the “Back to Breast Beautiful” procedure. Not only does it alleviate pain but also helps to restore the breast shape to a more aesthetic natural appearance.

Do I have to put back the implants or can I keep them out? What I love about the Back to Breast Beautiful procedure for capsular contracture is that you can not only cut of the painful capsule but also leave the implant out as well. I like to try and work with the remaining natural breast tissue and recreate a breast shape. But if you desire, a new implant can always be put back in.

For patients that have had implant based breast reconstruction, I like to remove the capsule and implant and thoroughly was out the implant cavity with antibiotics and dilute betadine. Once the cavity is clean and sterilized, the mastectomy pocket is tailored to create a improved contour for a better breast result. Small strips of a biologic matrix are then placed against the mastectomy flaps to prevent fibrosis and contracture recurrence. All of these techniques are helpful but the risk of recurrence remains unfortunately high.

Who pays for capsular contracture surgery? If you have had breast reconstruction then we will submit for your insurance company to cover the procedure. Cosmetic breast augmentation patients will often have to cover the entire expense or part of the expense if the insurance company is willing to cover removal of the capsule and implant.

Finally, I get asked if capsular contracture is such a frustrating part of breast implants, why do you like to treat patients with this problem? I think fundamentally, because I like complexity and challenge but the satisfaction and benefits of helping my patients both feel and look better is tremendously gratifying.