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Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery |
Body Contouring |
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| Breast Augmentation Revision Surgery | |
| Breast Implant Capsule Contracture |
Breast Implant Capsule Contracture
| Capsule Contracture, a firm scar enveloping the implant , is the commonest complication of breast augmentation, yet the incidence of occurrence varies from surgeon to surgeon, and is very technique dependent. Treatment of capsular contracture may be as simple as forcefully squeezing the | breast and implant to fracture and release the scar (not usually successful long-term), or as complex as surgically removing the scar and replacing the implants in a different position, especially from over the muscle to under the muscle. | |
| Case 1: A 20 year old Asian woman was seen with a 2 yr history of submuscular breast augmentation with 175 cc Saline Breast Implants and bilateral grade IV capsule contractures. |  |
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Pre-op and Post-op photos show correction of capsule contractures by removal of implants, capsulectomy and development of an oversized submuscular pocket which was maintained by implant displacement massage. She also had redo of a previous mini-tummy tuck at the same time. She remains capsule free at 5 years post-op. Note marked improvement in the shape with a modest implant volume increase, and with maintenance of an oversized pocket, avoiding the visibility of the implant outline in a relatively thin patient. |
| Height:
4'
10"
Weight 85
lbs
Original Implants: McGhan
Volume: 175 cc Sm Saline Incision:
Crease
New Implants:
Mentor Volume: 225cc
Sm Saline Incision: Crease
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| Case 1 Problems | Analysis of Cause | Correction |
| Capsule Contracture | Though not absolutely certain, the cause of most instances of capsule contracture appears to be related to transient or long - term bacterial contamination of the implant surface, leading to the formation of an inflammatory scar around the implant, walling it off from the body. Occasionally formation of a capsule contracture is associated with intermittent or ongoing inflammation and fluid accumulation. Once established, a capsule contracture will not resolve unless it is treated surgically by removal, or breakup of the scar. External capsule contracture fracture by pressure is occasionally effective, but usually will result in recurrence. Other factors, including hematoma, and interference with blood or oxygen flow to the surgical area, as with smoking, may tend toward inflammatory scarring, and formation of implant scar capsule contracture, though those factors are less certainly involved. | Treatment
of capsule contracture usually
requires removal of the s
car around the implant, along
with the establishment and maintenance
of an oversized pocket to limit the tendency of recurrent
pocket closure and encroachment on the volume of the
implant itself. Additionally,
the oversized pocket prevents the phenomenon
of firmness of the implant associated with a pocket which may
be only marginally larger than the
implant, and then causes it to feel firm when minimal
pressure deforms the implant,
pressing it against the surrounding unstretchable
scar. Even non-contractured results can feel quite firm
if there is a nearby
surrounding scar. This is especially true
for textured implants with their
intimately attached surrounding scar,
despite claims that they limit risk of
capsule contracture. Post-op displacement massage is key in
maintaining the oversized pocket to prevent
this undue firmness.
See: Correction of Unfavorable Shape UNDER CONSTRUCTION |
| Prevention | ||
| Prevention of capsule contracture is favored by placement of implants under the muscle and via a route that avoids potential implant contamination with germs, including those that normally reside in the ducts of the breast tissue. Also irrigation of the surgical site and pocket with antibacterials, such as dilute Betadine solution, or antibiotic solution, is shown to limit the risk of capsule contracture formation. I personally prefer to insert implants via the transaxillary route to totally avoid implant contact with the breast tissues by keeping them totally submuscular in their position. |
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| Advanced Art of Cosmetic Surgery | ||
| 3974 Springfield Road | ||
| Glen Allen (Richmond), VA 23060 | ||
| 804-290-0200 |
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| ©Copyright 1997-2007 Advanced Art of Cosmetic Surgery: Thomas M. DeWire, Sr, MD, FACS Revised October 29, 2007 04:06:08 PM |