First of all, capsular contracture is a somewhat rare condition after breast augmentation that can be treated effectively, so don’t panic! Because my practice teaches patients to massage their breasts and to get to know what is normal for their body (and what is not), they are attuned to detecting a problem early-on if it is starting. If a breast starts to feel slightly firmer or is sitting differently on the chest (higher, projecting further, etc.), we advise patients to come in to see me right away. Often, by changing the method of implant massage, we can stretch out this scar tissue and avoid any other surgery.

In the event capsular contracture happens and cannot be alleviated by implant massage, I recommend surgical treatment only if the breast has deformity, if it is creating significant asymmetry or if it is painful (extremely rare). Surgery to treat capsular contracture is called “capsulectomy”. This describes surgical removal of constricting, tight or thick scar tissue that has formed around the breast implant. The implant itself does not get hard or change; rather, the scar tissue around the implant thickens and tightens, like a tight circumferential belt (or a thick grapefruit rind) that squeezes the implant, changing its softness or shape.

Capsulectomy is performed under general anesthesia in the operating room, and it takes a couple of hours. Drains are definitely required afterward, and downtime is usually a week off work and two to three weeks before a return to exercise. I always send a sample of the scar tissue around the implant (the “capsule”) for bacterial analysis (a culture) to determine whether bacteria are the culprit, as well as to best direct antibiotic therapy for around two weeks after surgery. If no bacteria are detected, we usually feel confident that whatever the cause of the scar tissue forming around the implant is now long-gone.

For severe capsular contractures where we suspect a bacterial cause (for instance, capsular contracture happening after a dental abscess, sinus infection or other severe infection that created fever, chills or required a lengthy course of antibiotics), the breast implant is usually changed. Thankfully, all the breast implant companies now have a 10-year warranty that protects patients against complications such as capsular contracture for the first 10 years after their breast augmentation surgery. Some insurance plans will cover capsular contracture as a complication after surgery and may pay some of the fees associated with this surgery, should it be required.

In all, capsular contracture is an important complication to be aware of and educated about, since a breast implant IS a foreign body, and just like a joint replacement or a prosthetic heart valve, bacteria in the bloodstream can potentially create problems with this implanted device. However, most patients do very well and never need to face additional surgery for this complication. Being educated and fully informed is empowering!

– Dr. Karen Horton, Board-Certified Plastic Surgeon