Capsular Contracture | Breast Revision Surgery – Dr. Kevin Brenner

Capsular Contracture & Breast Revision Surgery

Breast revision surgery may occur for several reasons, including altering the size or shape of the implants, correcting implant malposition, removing and/or replacing old or ruptured implants and correcting a condition known as capsular contracture.

Dr. Brenner is a double board certified plastic surgeon specializing in breast & body contouring with an emphasis on breast revision surgery. His extensive training in general, reconstructive and aesthetic surgery has helped him to develop advanced techniques for natural, lasting results.

Capsulectomy to correct capsular contracture is amongst one of the most common breast revision procedures performed by Dr. Brenner.

What is Capsular Contracture?

Breast capsules are formed as the body’s natural response to wall off the breast implant from the surrounding tissues. This process occurs any time a foreign device is placed into the body whether it is a pacemaker, artificial joint or breast implant.

During breast augmentation, a pocket is created either over or under the muscle for the implant to sit. A breast capsule consisting of fibrous tissue is formed along the outside border of the pocket to allow for natural movement of the implant. In some instances, an exaggerated response by the body may cause the breast capsule to develop excess tissue and tighten around the implant. This is a condition known as capsular contracture.

Although capsular contracture may occur anytime after breast augmentation, most instances occur in the first few months following the procedure. Common indications of capsular contracture include hardening and distortion of the breasts experienced with moderate to severe discomfort. Overdevelopment of the breast capsule cannot be predicted prior to surgery and is amongst the most common complications of breast augmentation.

The degree of capsular contracture varies from person to person and is explained using the Baker Grading System

Baker Grading System – 4 Grades of Capsule Contracture

  • Baker Grade I – The breast is normally soft, and looks natural.
  • Baker Grade II – The breast feels a little firm, but appears natural.
  • Baker Grade III – The breast feels firm, and is beginning to appear distorted in shape.
  • Baker Grade IV – The breast is hard, and has become distorted in shape. Pain or discomfort may be associated.

How to Prevent Capsular Contracture

Placement of Breast Implants

Although capsular contracture may occur whether the implant is placed above or below the muscle, studies have shown that breast implants placed over the muscle have a 10%-25% higher instance of developing excess tissue in the breast capsule. For this reason, Dr. Brenner prefers to place breast implants under the muscle. His no-touch technique for placement of silicone implants using the Keller Funnel also decreases the instance of capsular contracture by decreasing the likelihood of contamination.

Using Drains After Revision Breast Surgery

A condition where fluid accumulates in the breast capsule, known as a seroma, has also be linked to the occurrence of capsular contracture. This most often occurs during secondary or breast revision surgery. For this reason, Dr. Brenner utilizes small surgical drains after revision surgery to remove any excess fluid.

Breast Augmentation Massage

Whether after a primary or breast revision surgery, it is important to perform breast massage at least twice a day for about 10 minutes beginning two weeks after surgery. During your post-operative appointment, Dr. Brenner will discuss and demonstrate how to properly perform a breast massage to help drop the implants into place and keep them soft. Displacement of the implant inside the breast capsule will help break up any excess tissue which may form around the implant, reducing the chance of capsular contracture.

Accolate to Help Treat Capsular Contracture

Accolate is a popular prescription used by plastic surgeons to help treat capsular contracture. Used primarily as an asthma medication, doctors have found that its anti-inflammatory properties have helped reduce the severity of capsular contracture in up to 50% of cases according to several studies.

Accolate typically works best for patients in the early stages of capsular contracture and is often recommended as the first stage of treatment before breast revision surgery is considered.

Breast Revision Surgery for Capsular Contracture

If capsular contracture does not improve with massage or the use of Accolate, breast revision surgery, known as a capsulectomy, is performed release the hold of the breast capsule around the implant.

Some surgeons will perform what is called a closed capsulectomy where the implant is squeezed tightly to forcibly “pop” the implant out of the breast capsule. This can be performed as a quick office procedure without the use of anesthetics, but is not recommended by most board certified plastic surgeons and implant manufacturers. Closed capsulectomy has demonstrated a low rate of success and a high rate of implant rupture.

Dr. Brenner only performs open capsulectomy for patients seeking breast revision surgery for capsular contracture. Open capsulectomy is a safe and effective procedure with lasting results. An incision is made, usually in the same location as the initial breast augmentation scar, and the fibrous tissue that creates the capsule is scored to release its grasp on the implant. The implant is then removed along with the breast capsule and excess fibrous tissue.

During capsulectomy, patients may choose to remove the implant entirely or to replace the implant after the breast capsule has been removed. Depending on the age and condition of the implant, Dr. Brenner may recommend removing the existing implant and replacing it with a new one. If the implants were originally placed over the muscle during primary breast augmentation, while performing breast revision surgery Dr. Brenner will often revise the pocket and relocate the breast implants under the muscle for a more natural appearance and reduced chance of recurrent capsular contracture. Occasionally, Dr. Brenner will place an acellular dermal matrix graft (such as Alloderm, Strattice, or Flex HD) into the pocket around the implant. Some studies have shown a decreased incidence of recurrent contracture with the use of these products.