Breast Capsular Contracture

Capsular contracture is a serious breast augmentation complication. After an implant is placed, your body recognizes that it is a foreign material, similar to a pacemaker, heart valve or any other prosthesis, and therefore forms scar tissue around it also known as a capsule. In other words, your body attempts to isolate the implant in order to protect you.

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Capsule formation is totally normal and all women who have breast implants develop them. They are thin and soft and imperceptible to the patient. However, in some cases the capsule will abnormally thicken and contract around the implant, causing the breast to appear deformed and displaced.

This is what’s known as capsular contracture. If you do a thorough job of researching the right surgeon, you will have the confidence that you have chosen one of the best breast augmentation surgeons Beverly Hills can lay claim to because of his low rate of capsular contracture or other complications.

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Understanding the severity of your condition

Not all cases of capsular contracture are created equal. In fact, the severity of the complication can vary quite a bit, and is graded on the following scale:

Grade I – Your breasts are soft and appear natural.
Grade II – Your breasts feel slightly firm, but appear normal to the eye.
Grade III – Your breasts are firm and appear abnormal, but there isn’t any pain or discomfort.
Grade IV – Your breasts are hard, painful and appear abnormal.

Capsular contracture typically develops within the first few months after breast surgery. However, it can appear at any time and can only be fully corrected with revision surgery.

What causes capsular contracture?

No one knows! It is one area of plastic surgery that is still unclear. We have several good theories, but the evidence is still being studied. Below are some of those theories:

The placement of your breast implants

When breast implants are placed above the chest muscle, rather than underneath, there is an increased risk of capsular contracture. The rate can vary significantly. Above the muscle can be as much as 50% contracture rate where as below is 5-10%.

Complications after surgery

In some cases, complications after your breast augmentation, such as bleeding or an accumulation of fluid within the breast pocket can cause capsular contracture to develop.

Using saline implants

While it was initially thought that capsular contracture rates were higher with silicone implants, that is no longer true. That information was due to the fact that older generations of silicone implants used to ooze and hence create a lot of inflammation. Currently, many surgeons would argue that silicone may actually have a slightly lower rate than saline. That being said, it can occur with any and all implants.

Using smooth implants

While the evidence is still weak, there is some suggestion that smooth implants are associated with a slightly higher rate of capsular contracture when compared with textured implants.

An infection

Capsular contracture is more likely to occur if the patient acquires an infection in the breast pocket after surgery. As such, it’s important for both the surgeon and patient to take the steps necessary to prevent an infection from developing. Currently, one of the leading theories of capsular contracture is notion of biofilm. It is thought that all implants can develop a microscopic film around them in which a small of bacteria resides and create kind of a low grade infection. The body does not recognize it as such but it causes the capsule to become inflamed and thicken. Much research is currently being done to elucidate the facts around biofilm and its connection to contracture formation.

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When Dr. Rahban does a consultation with a prospective patient, he wants it to be two things above all others: thorough and honest. He will find out from you just what you want from cosmetic surgery. And he will tell you honestly if you can get the result you want, and how he can best help you do so.

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Dr. Rahban’s approach to preventing capsular contracture

Patients of Dr. Rahban can rest assured that they are in highly capable hands, as he goes to great lengths before, during and after surgery to prevent capsular contracture. Prior to your procedure, he’ll offer personalized guidance on how you can improve your health to ensure a smooth recovery. For example, he’ll talk to you about your smoking history, lifestyle, diet and exercise regimen and any chronic conditions you may have, as all of these factors can influence the healing process. As there is a lot of evidence that capsular contracture is related to a low grade infection found in biofilm, he will have you wash your breasts the night before and the morning of surgery with a very powerful antibacterial soap called Hibiclens.

During surgery, he’ll take a number of important steps to further decrease your risk. To begin, he’ll ensure a sterile environment in the operating room and your chest, as this is critical to preventing an infection that may result in capsular contracture.

He will make certain that you have received your dose of antibiotics prior to his first incision, as this has been proven to reduce the risk of infection. From there, his technique for creating your breast pocket where the implant will sit is incredibly meticulous and accurate. He takes about twice as long as most surgeons to perform your surgery—this is because he is addressing any bleeding that occurs immediately, preventing late onset blood formation in the pocket. The more accurate the pocket, the less unnecessary breast tissue is exposed to the implant. Breast tissue is not sterile and has lots of bacteria within it.

He will in almost all instances place the implant below the muscle as this will significantly reduce the contracture rate. After the pocket is dissected, he irrigates with a very specific formula of antibiotics, that has been shown to reduce the capsule rate, prior to placing the final implant. And finally he uses a new device that few surgeons use called the Keller Funnel. This device allows him to insert the implant without it touching the surgeon’s gloves or the breast tissue, hence reducing contamination and capsular contracture. He firmly believes that all surgeons should be using the device.

After surgery, he’ll provide you with guidelines on how to care for your breast and incisions. Many women are told by their surgeons and friends that they must vigorously massage their breasts, but after many years of research there is no proof that it helps. Many surgeons hastily perform surgery and then rely on massages to prevent contractures. Then when it occurs, they tell patients they simply didn’t massage enough. While this complication is not preventable, it is reducible and the most crucial element is performing surgery with rigorous surgical technique.

How is capsular contracture treated?

Although Dr. Rahban prefers to prevent capsular contracture, he is also very skilled in treating the condition. He has performed countless revision procedures for patients who have come to him for help, and has mastered the techniques that are most effective in fixing this complication and preventing a recurrence.

In most cases, capsular contracture can be successfully resolved with an open complete capsulectomy. During the procedure, Dr. Rahban will use your previous incisions to gain access to the capsule and remove the entirety of the problematic scar tissue, allowing the implant to expand naturally in your breast pocket. While this sounds straightforward, it is incredibly challenging when performed correctly. Most surgeons will simply remove strips or just parts of the diseased capsule, enough to allow the implant to temporarily sit smoothly. The problem is that the recurrence rate is quite high if the entire capsule is not removed. Removing all of it is surgically difficult and time consuming, hence why it is not often done.

You need to meticulously remove the capsule from all its attachments such as the muscle. The other issue is when a surgeon decides to remove all of it, often the pocket left behind is significantly larger than the previous one, leading to malposition of the implant. This procedure requires time and patience.

If your implants were placed above the muscle during your primary surgery, Dr. Rahban will reposition them underneath the muscle. This is known as a conversion technique and is also very challenging in order to be performed correctly. The muscle has to be re-secured to the breast tissue in just the right location in order to create a natural and round shape.

In all cases, when Dr. Rahban performs contracture work, he will replace the implants as they will have biofilm on them, which is resistant to antibiotics and will lead to recurrence.