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    Capsular Contracture

    A scar tissue capsule forms around every breast implant placed for breast augmentation. However, the thickness and overall size of the scar tissue capsule depends on many factors including heredity, inflammation and post-operative care and prevention. Depending on all of these factors, the scar tissue capsule can either be thin and soft or thick and hard. It is the body’s normal response to wall off or form scar tissue around any foreign body (including a breast implant) but no one is certain why sometimes the body will form a soft thin capsule while other times it will form a thick, firm capsule. If the capsule becomes very severe it can even lead to deformity of the implant and tenderness in the breast area. For this reason, capsular scar tissue has been classified from being mild to severe depending on the thickness of the capsule and whether deformity or symptoms of pain or tenderness are present.

    When the scar tissue capsule begins to thicken and contract the condition is called “Capsular contracture.” The exact cause and mechanism of capsular contracture is not entirely understood but most surgeons agree that is related to inflammation within the breast implant pocket. Capsular contracture can occur as soon as 4-6 weeks after surgery and is uncommon to begin developing later than six months after surgery unless some sort of trauma has occurred to the augmented breast. Dr Motykie has seen many capsular contracture patients from around the world and he has developed many different protocols to help treat and prevent the development of capsular contracture in patients that are already prone to its development. The development of capsular contracture can be very frustrating for the patient and surgeon alike. Sometimes the perfect patient and the perfect surgery can still randomly lead to the development of a capsular contracture. It is also unknown why only one breast may develop a capsular contracture while the other breast remains perfectly soft and natural.

    The first step in trying to solve the mystery of capsular contracture development is to determine the specifics of the breast surgery that lead to its initial development.  Many times a revision surgery that simply changes variables of the previous surgery can have a great impact on preventing the recurrence of a capsular contracture. One of the first variables to consider is the implant position within the breast pocket because capsular contracture occurs significantly more frequently when the implants are placed above the chest muscle as compared to be placed underneath the muscle. In order to correct this problem and decrease the risk of capsular contracture recurrence, the revision surgery should place the breast implants underneath the chest muscle. In addition, the implants should not be left above the muscle because the removal of scar tissue may thin out the breast tissue itself leading to increased implant visibility (rippling) and palpability (feeling the bag through the breast). This is one of the reasons that Dr Motykie recommends the majority of his patients to have their implants placed underneath the muscle in the first place. A second variable is the type of breast implants used in the augmentation. Saline-filled implants seem to fare better than silicone gel-filled implants whether they are inserted above or underneath the chest muscle. Therefore, if a patient has developed capsular contracture with silicone breast implants, they may want to consider switching to saline breast implants during any corrective surgery in order to help lower their risk of capsular contracture recurrence. Thirdly, since many believe that inflammation may be the identifiable culprit in the formation of capsular contractures, any technique or intervention aimed at reducing post-operative inflammation should have an impact on possibly reducing the recurrence of capsular contracture formation.

    All surgeries to correct severe capsular contracture will involve some sort of interior scar tissue release that may include capsulotomies, capsulectomies, implant exchange and/or placement of dermal substitutes such as Alloderm or Belladerm.  A capsulotomy is a surgical procedure that releases scar tissue (but does not actually remove it from the pocket) that has formed inside of the breast. This allows for expansion of the breast pocket and relief of the scar tissue contraction that literally squeezes the breast implant. Dr Motykie performs this procedure in order to limit the amount of breast tissue removed during the surgery in order to decrease the risk of implant visibility and palpability after the procedure as well as to decrease the risk of bleeding which can lead to an increased risk of capsular contracture recurrence. A capsulectomy is a surgical procedure that is performed to completely remove the scar tissue surrounding a breast implant. This is a more aggressive approach to releasing capsular contracture and it is more often used in the cases of very thick, calcified scar tissue capsules and/or in the case of ruptured silicone breast implants. However, just because the capsule is removed in its entirety does not mean that it will not recur.  This is why Dr Motykie has developed specific protocols in order to help decrease the risk of capsular contracture recurrence. Dr Motykie has found that it is extremely important to evaluate every patient on an individual basis in order to determine the probable cause of the capsular contracture in order to reduce the risk of recurrence in each specific case. Most of the time, with longstanding capsular contracture, Dr Motykie recommends removal and replacement of your breast implants at the same time as your scar tissue release.

    After corrective surgery has been performed, Dr Motykie has learned that a combination of post-operative preventive modalities appears to work the best in combating capsular contracture. Therefore,  Dr Motykie usually recommends a combination of modalities in capsular contracture corrective surgery that includes compression therapy to reduce post-operative swelling and inflammation, possible placement of a drainage tube to remove any inflammatory fluid form the breast implant pocket during recovery, prophylactic use of Accolate or Singuliar, an aggressive post-operative breast massage routine, prescription of anti-inflammatory medications and possible placement of dermal material such as Alloderm or Belladerm in order to help camouflage the presence of the implant

    To find out more about breast surgery please contact us at 310-246-2355

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