Question:
There are 10 years after my breast aumentation surgery with prothesis and stick out more. They feel somewhat harder, but is this the implant or capsular contracture? How does a doctor determine if a patient has this problem?
Answer:
Increased firmness 10 years after breast implant surgery is certainly a capsular contracture. The implants themselves do not get firm. Capsular contracture is when the tissue surrounding the implant gets more dense and tightens arounds the implant squeezing it. If it tightens enough, the implant will get very firm and become shaped like a ball. Remember that the smallest space an object can occupy is a perfect sphere, and if the scar tightens enough, the implant will become a sphere. And, further tightening can even become painful.
There are four grades of breast capsular contracture - The grading is as follows ( according to the Baker system ) :
• 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
If you are a Grade 2, I would do nothing. Grade 3, but only mildly distorted and you may need replacement of the implant and removal of the surrounding scar capsule(called a capsulectomy). Capsule contracture is the most common complication of an augmentation mammoplasty.
Some patients have had some softening of the encapsulation using the medication Singular, which is an anti-leucotriene. Add an anti-prostaglandin to that, such as Aleve, and you may have some relief natural Vitamin E complex
The following techniques have been employed to fight capsular contracture:
1. submuscular breast implant placement
2. using textured implants
3. limiting handling of the implants and skin contact prior to insertion
4. irrigation with triple-antibiotic solutions
the study examined saline vs. silicone capsular contracture rates , 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. However the most reliable and common way to treat capular contracture is to remove the capsule and replace the implant
The causes have not conclusively been determined although some things that increase capsular contracture are: 1) Infection, 2) Hematoma (collection of blood around the implant), 3) History of breast radiation, and 4) History of previous capsular contracture .It is believed that capsular contracture is primarily a response to the presence of low-virulence or non-virulent bacteria (i.e. not the kind that generally produce an actual infection, with redness/tenderness/fever etc) that adhere to the implant surface on the day of surgery, and which over weeks and months following surgery stimulate the cells that make collagen (called fibroblasts) to make more collagen - thickening the capsule and stimulating it to contract and tighten around the implant. It is not an actual infection; there are no symptoms that this is going on, and taking antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient's skin, or the ductal systems of the breast that lead to the nipple, as both are normally colonized with bacteria.
The older implants are known to have greater gel bleed which allows smaller particle size silicone molecules to bleed out from the implant shell over time. This is though to incite a low grade inflammatory reaction and potentially contribute to capsular contracture.
A capsular contracture is diagnosed by physical exam and symptoms – . If the implant is firm and does not move around or starts to ride up on the chest more so on one side than the other, then more than likely you have it. imaging can show scar but not contracture . Encapsulated implants will feel very distinct from the surrounding breast tissue, are usually firmly attached to the chest wall, and the breast tissue will sometimes hang off the implants. Often times they may feel painful to the touch as well, which can occur in more advanced forms of this condition. You can try to massage the implants to relieve some of these signs/symptoms
Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.
The more difficult decision is what to do. If the contracture does not bother you, it may be best to adopt a wait and see. Surgical options typically involve replacing the implants and either removing the capsule itself, or changing the position of the implant.
1. If it doesn't bother you, capsular contracture is not medically worrisome, and you could consider doing nothing if the process is stable.
2. If it is mild and early but bothers you, certain medications (Singulair, Accolate, Vitamin E) show promise in reducing or at least preventing progression of capsular contracture.
3. If it is moderate to severe, you may wish to consider surgery to loosen or remove part or all of the capsule (capsulectomy or capsulotomy) with implant replacement.
I would encourage you to perform breast implant excercises to prevent or minimize ongoing contracture.
