Case-11205 Gallery

Before and after bilateral breast revision in a 58 year old woman. She previously had bilateral nipple sparing mastectomies and immediate “prepectoral” implant reconstruction, with the implant placed on top of the muscle. Unfortunately, she developed left sided capsular contracture causing discomfort and deformity several months after surgery.

Contracture of scar tissue around implants is thought to be due to bacteria around the implant together with the body’s response to these foreign microorganisms, with the end result being excess scar tissue forming around the implant and then contracting.

We do not always know what the offending organism is, particularly when healing is complete and there are no active infections in the body. Some of the most common bacteria found around implants are Propionibacterium acnes (P. acnes, the acne bacterium which also lives in the gut and cannot be eradicated from the body) and Staphylococcus epidermidis from the skin.

Capsular contracture can be treated surgically, most commonly involving removal of the scar tissue via “capsulectomy” and implant exchange. At the time of capsulectomy surgery, a culture of the scar tissue is taken and sent for microbiological analysis. If any bacteria are detected, then antibiotic treatment can be targeted to that specific microorganism with the knowledge of antibiotic sensitivity for that particular bacterium.

If no bacteria are found, then we feel optimistic that capsular contracture will not recur. In either situation, ongoing implant massage is important to keep the breast implant pocket open and to monitor for any changes going forward.

Follow up photos are shown 10 days after capsulectomy and implant exchange. The implants were kept in the space on top of the muscle for the most natural results. Her cultures were negative. She is excited to resume exercise in another week. Her next follow up will be at three months to assess healing and again yearly for long term follow up.

Repeat surgery is NOT necessary every ten years after having breast implants! Revision surgery is necessary only if there is a problem (like capsular contracture), the desire for a size change or if patients no longer want their implants. We get to know our patients intimately and love seeing them routinely at one year, two years, five years, and every ten years after surgery to ensure they are still looking good and feeling great!