Capsular Contracture of the Breast Implant A.K.A. Capsular Contraction ~ Capsular Contracture Repair Capsular Contracture - Prevention - Treatments - Capsulectomy	Thanks to Board Certified Plastic Surgeon, Dr. Revis, of South Florida Plastic Surgery Associates in Ft. Lauderdale, FL for the capsulectomy explanation and capsular contracture photos.

What is Capsular Contracture?

After breast augmentation with breast implants, excessive scar tissue may form around the breast implant which causes the breast implants to harden (similar to what a contracted muscle feels like) as the naturally forming scar tissue around the breast implant tightens and squeezes it. Every patient will have some scar tissue form around the breast implant, however if it forms a lot the implant will feel firmer or even harder depending on the "grade" of capuslar contraction the patien has. Capsular contracture grades from 1-4 with for being the worst. While capsular contracture is an unpredictable complication of breast surgery, it is also the most common complication of breast augmentation.

How can Capsular Contracture be prevented?

1. Textured implants help deter contracture because of their rough surface which is intended to discourage a hard capsule from forming.
2. Under the muscle (sub-pectoral or 'partial sub-muscular') placement of the implant reduces risk of capsular contracture by an average of 8 - 10%. Whereas over the muscle (in front of the muscle or 'sub-mammary') has 10 - 25% or more chance of capsule contracture. Complete unders (total sub-musculofascial) provide even more protection.
3. Massage and or compression. This is usually only done with smooth implants and may be suggested for a period between a few weeks to as long as you have your implants. Do not massage bruises! More can be found on Dr. DeWire's massage page. 
4. The "no-touch" technique. This method includes meticulously re-washing surgical gloves before handling any instrument and implants. Only the head surgeon touches the implant, using a unique Teflon cutting board and immediately inserting the implant underneath the muscle. All of these measures help ensure that no foreign substance attach themselves to the implant, which could inflame the surrounding tissue and cause complications such as capsular contracture.
5. Vitamin E -- Is rumored to help, it can't hurt and it also beneficial to the skin. However, it may cause bleeding so don't take 2 weeks before & after surgery.
   

What treatment methods are available for Capsular Contracture?

1. Antibiotics - Surgeons use antibiotic for treatment of capsular contracture.
2. Zafirlukast (Brand Name: Accolate)
3. Capsulectomy

Preventing and Treating Capsular Contracture with Zafirlukast

40 randomly chosen patients with stiffening of the breast were given Zafirlukast with vitamin E experienced dramatic improvement over 3-6 months. In another study, 30 patients with recognized capsules used Zafirlukast for 12 months and 50% experienced softening or have become candidates for closed compression. 100 other patients were given Zafirlukast 2 weeks prior to surgery, which decreased the incidence of early capsules. Zafirlukast also decreased recurrence in patients undergoing capsulotomy.

Suggested dose: 20mg Zafirlukast twice daily for 3 months. The same dose is used for preventive treatment 2 weeks prior to surgery.

Risks: Allergic rashes. Long term effects are unknown as Zafirlukast has only been available in the US since 1999.

Other benefits: Zafirlukast is used chronic rhinitis so patients may notice improved breathing which also may lead to decreased snoring.

Capsulectomy (removal of the capsule)

The most appropriate treatment for capsular contracture is complete capsulectomy, or removal of the entire thickened capsule surrounding the breast implant such as in the specimen shown above. This is the most likely procedure to prevent future recurrent capsular contractures from forming. Capsulotomy, or merely cutting the capsule to release the scar formation, is much more likely to lead to a recurrence of the problem. The specimen to the right is shown immediately following removal, and the breast implant is still contained within the intact capsule.

The capsule has now been incised without removing any of the capsule. This demonstrates the considerable compressive forces exerted on the implant by the thickened capsule. This is why capsular contractures often lead to increased firmness of the breast.

A close-up view of the cut edge of the capsule, demonstrating the thickening that occurs during capsule formation. A normal capsule is a flimsy, transparent structure. As thickening occurs, collagen is laid down in layer upon layer, ultimately becoming apparent as a change in the shape of the breasts, a change in the softness of the breasts, and in some cases causing pain.

The final photo in this series showing the capsule fully opened with the implant removed.