Dr. Brooke R. Seckel
A serious concern for many breast implant patients is the risk of the development of a breast implant capsular contracture. A breast implant capsular contracture can cause the breast implant to be hard, painful and the implant to be displaced upward. Fortunately, today we have a greater understanding of what causes breast implant capsular contracture and how to lessen the chance that this complication of Breast Augmentation with breast implants will occur.
A capsular contracture is the occurrence of excessive abnormal constricting scar tissue which forms around a breast implant. A normal breast implant capsule forms around all breast implants. However, a normal breast implant capsule is soft and flexible enough that it allows the breast implants to be soft and movable. When this normal capsule scars excessively and tightens around the implant making the implant hard and immovable a capsular contracture has occurred.
The clinical signs of a capsular contracture are firmness or tightening of the implant which can be painful and can cause upward displacement of the breast implant. Breast implant capsules are categorized according to a Baker classification as follows:
Baker I-the breast is soft, movable and appears normal
Baker II-the breast is slightly firm but looks normal
Baker III-the breast is significantly firm but still appears normal
Baker IV-The breast is hard, looks abnormal, is often displaced upward and is painful(see photos below)
Prior to the introduction of cohesive silicone gel or gummy bear breast implants in 2006 the rate of breast implant capsular contracture was often reported in as high as 30% of breast implant patients. However, the initial studies of the cohesive gel or gummy bear breast implants revealed a capsular contracture rate of 9.5% in Mentor breast implants and 14.8% of patients with Allergan breast implants.
More recently, with significant improvements in breast augmentation techniques including the no touch technique and the use of triple antibiotic irrigation the incidence of breast implant capsular contracture has been reduced to 1.8% in 1 study.
The most likely cause of capsular contracture around the breast implant is the occurrence of a bacterial biofilm which forms around the breast implant during surgical insertion. Bacteria that are normally present in the nipple and areola are accidentally shed during surgery and contaminate the implant.
In addition, a hematoma or excess bleeding if not treated with surgical removal of the blood, can increase the chances of a capsular contracture.
However, in some cases there is no obvious explanation of why excessive scar tissue and capsule formation occurs.
Currently recommended guidelines to reduce the risk of capsular contracture following breast augmentation are the following:
1. Intravenous prophylactic antibiotic at the start of surgery
2. Avoid the incision through the areola
3. Cover the nipple areola with Tegaderm™
4. Inframammary crease incision underneath the breast
5. Dual Plane breast augmentation-placement of breast implant underneath the chest muscle
6. Careful dissection to avoid bleeding–meticulous hemostasis
7. Avoid dissection into the breast gland
8. New surgeon’s gloves, patient drapes and instruments prior to implant insertion
9. Implant pocket, surgeon’s hands, the breast implant and surgical field irrigation with triple antibiotic solution
10. Implant introduction sleeve or Keller Funnel for insertion of implant
11. No touch technique, do not touch the implant before, during and after insertion
12. Close the incision with multiple layers and avoid the use of drains
13. Prophylactic antibiotics in the future for dental work and other surgical procedures
Treatment of Baker III and Baker IV capsular contracture requires surgical removal of the capsule and implant. Insertion of a new implant wrapped in a bio membrane called Acellular Dermal Matrix such as Belladerm™ can reduce the chance of recurrence. There is some evidence that the use of an oral Asthma medication called Singulair™ can reduce the recurrence of capsular contracture after revision surgery.
With the advances in Breast Augmentation techniques over the past ten years the chance of capsular contracture has been greatly reduced from over 30% to possibly as low as 1.8% under ideal circumstances. The use of the new cohesive silicone gel or Gummy Bear implants, the no touch technique, the use of the Keller Funnel™and triple antibiotic irrigation greatly increase your chances for a soft natural looking breast after Breast Augmentation.