Breast Augmentation

Capsular contracture is something that I help my patients with frequently. One of the most common reasons for people with implants to have additional surgery is capsular contracture. There are four grades of breast capsular contracture. Grade I: The breast is normally soft and looks natural Grade II: The breast is a little firm but looks normal. Grade III: The breast is firm and looks abnormal. Grade IV: The breast is hard, painful, and looks abnormal. Some patients actually prefer the look of mild capsular contracture (Grade 1-2). many theories have been proposed about the formation of capsular contracture but current literature indicates that it is likely an immunologic response. The following techniques have been employed to fight capsular contracture: Submuscular breast implant placement - likely has a role in decreasing capsular contracture Using textured implants - many recent studies show this is not an effective method in preventing capsular contracture. Limiting handling of the implants and skin contact prior to insertion - follows the immunologic basis of capsular contracture indicatiing that less handling causes lower bacterial contamination and is likely an important concept in preventing capsular contracture. Irrigation with triple antibiotic solutions - Care about solution selection must be used as some solutions void the warranty of the breast implant In my practice I have found submuscular placement of breast implants, avoiding handling as much as possible of the implant and triple antibiotic irrigation of the implant and the pocket significantly reduces contracture numbers. A study in 1984 and in 1990 examined saline vs. silicone capsular contracture rates and actually found silicone to be higher, but this was likely secondary to the fact that a ruptured silicone implant causes much more of an immune response and is likely to cause capsular contracture. It is not clear that there is a large difference between intact implants and also not clear if the newer silicone implants - if they were to rupture - would have the same problem. Treatments for capsular contracture have included: Closed capsulotomy (disturbing the capsule via external manipulation), a once common method for treating hard capsules, has been discouraged as it can cause implant rupture, poor efficacy, reforming of the capsule and patient pain. Nonsurgical methods of treating capsules include massage, external ultrasound, and leukotriene pathway inhibitors. The most reliable and common way to treat capsular contracture is to remove the capsule and replace the implant. This is a relatively short outpatint procedure that patients tolerate well. Sometimes we recommend delaying replacing the implant to lower the risk of capsule reformation in extreme cases.