Thomas G. Crabtree, MD, FACS | Capsular Contracture Treatment
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Capsular Contracture Treatment

What is Capsular Contracture?

One of the most common complications from breast augmentation is capsular contracture or capsular contraction, a condition that results in distorted and sometimes even painful, hard breasts. Read on to learn more about the signs of capsular contracture, your capsular contracture treatment options.

 

A capsule is the normal tissue that the body produces surrounding a breast implant. Usually, it is pretty thin, sometimes almost transparent. The capsule is larger than the implant, allowing them both to move around and feel soft. In capsular contracture, the capsule becomes thicker and tightens which makes the space for the implant smaller and smaller. Some Signs of capsular contracture can be the implant rising to a higher position on the chest or the breast looking oddly constricted and artificially round, like a baseball. The capsule can get so small that the implant feels firm (grade 3 capsular contracture) or can even feel hard and be painful (grade 4 capsular contracture).

Studies show that up to 26.9% of women who receive breast implant surgery will develop Capsular Contracture.

 

If you have capsular contracture, the typical solution employed by plastic surgeons is a capsulectomy (removal of the tissue surrounding the implant), unfortunately the failure rate of capsulectomy is 80%, and the capsular contracture recurs within a few months after the breast implant revision surgery.

Treating Capsular Contracture

Dr. Crabtree typically uses the en bloc technique to correct capsular contracture. The en bloc removal is when you remove the capsule and the implant in one piece, with the implant still within the balloon of capsule. To do this, Dr. Crabtree gently dissects it free from surrounding tissue.  During the surgery, the implant is not visible at all.  He keeps the entire capsule intact to prevent any leaking implant material to get into the surrounding tissue.

 

Not all implants can be removed en bloc though. For Dr. Crabtree, en bloc is always the preference, but there are some circumstances which makes him change course.

  • Occasionally the hardened capsule will not be able to fit through the tiny incision intact. Rather than making a larger scar, Dr. Crabtree will open the capsule carefully with sterile towels nearby, remove the contents within the balloon of capsule onto the towel, clamp the capsule closed again, and then get it out through the incision.
  • The second reason has to do with capsule variability. Sometimes the capsule is thin and adherent to the nearby tissue too tightly. To remove the capsule would involve risk. The most common example of this is in a subpectoral implant where the posterior capsule is thin and adherent to the underlying ribcage. The lung lies just below this.  Another example would be when your skin is very thin, and to remove capsule would cause the overlying skin to be injured. Again, as with the example above, Dr. Crabtree dissects as much as possible en bloc, empty the contents within the balloon of capsule, and then finish the dissection of the capsule.

Preventing Capsular Contracture from Reoccurring

  • Remove the implant and capsule
  • Employ no touch surgical technique with new implants
  • Use evidence based antibiotics