Dr. Jejurikar's Blog

Capsular contracture is a condition that can occur after breast augmentation or reconstruction with implants. It is one of the most misunderstood complications among patients, yet it’s also one of the most talked about. Simply put, capsular contracture refers to the hardening of the tissue surrounding a breast implant, known as the capsule. This hardening can distort the appearance of the breast and, in some cases, cause discomfort or pain. To fully understand what capsular contracture is, why it happens, and how it’s treated, it’s essential to delve into the factors that contribute to its occurrence and explore the range of treatment options available.

Why Does Capsular Contracture Occur?

When a breast implant is placed, the body naturally forms a capsule of scar tissue around it. This is a normal part of the healing process. In most cases, the capsule remains soft and pliable. However, in some patients, the capsule tightens and thickens, causing the implant to feel firm or even painful. This process is known as capsular contracture.

The exact causes of capsular contracture are not entirely understood, but several factors are believed to contribute:

  1. Infection or Contamination: Even low-grade bacterial contamination can trigger an exaggerated immune response, leading to capsular contracture.
  2. Hematoma or Seroma: The accumulation of blood or fluid around the implant can increase the risk.
  3. Trauma: Physical trauma to the implant area can contribute to the development of capsular contracture.
  4. Implant Placement and Incision Type: The pocket in which the implant is placed and the type of incision used during surgery may influence the risk.
  5. Implant Characteristics: Factors such as the texture, size, and type of implant (saline vs. silicone) can play a role.
  6. Patient-Specific Factors: Individual biology, smoking, or autoimmune conditions can increase susceptibility.

Symptoms and Diagnosis

Patients with capsular contracture may notice symptoms such as:

  • Increased firmness or hardness in the breast.
  • A distorted or misshapen breast appearance.
  • Discomfort or pain, particularly in advanced cases.

Capsular contracture is classified using the Baker grading system:

  • Grade I: Breast is soft and appears normal.
  • Grade II: Breast is slightly firm but appears normal.
  • Grade III: Breast is firm and has an abnormal appearance.
  • Grade IV: Breast is hard, painful, and visibly distorted.

Treatment Options for Capsular Contracture

Nonoperative Treatments

Nonoperative treatments are generally more effective for mild cases of capsular contracture (Grade II or early Grade III):

  1. Medications: Anti-inflammatory medications and leukotriene inhibitors, such as Singulair, may help soften the capsule in some cases.
  2. Massage and Compression: These techniques are occasionally recommended but should be done cautiously and under professional guidance.
  3. Hyperbaric Oxygen Therapy: At our office, Dr. Sam Jejurikar often incorporates advanced therapies like hyperbaric oxygen to promote healing and reduce inflammation after surgery.

Surgical Treatments

In more severe cases, surgery is often the best solution:

  1. Capsulectomy: The removal of the capsule along with the implant.
  2. Capsulotomy: Cutting into the capsule to release tension and allow the implant to expand.
  3. Implant Replacement: In many cases, the implant is replaced with a new one to reduce recurrence.
  4. Pocket Change: Moving the implant to a different plane (e.g., from subglandular to submuscular) can significantly lower recurrence risk.

Incision Types and Their Impact on Capsular Contracture

The type of incision used during breast augmentation plays a role in capsular contracture risk:

  1. Inframammary Incision:
    • Located in the natural crease under the breast.
    • Offers excellent visibility and precision during implant placement.
    • Lowest risk of bacterial contamination, making it the preferred choice to reduce capsular contracture risk.
  2. Periareolar Incision:
    • Made along the lower border of the areola.
    • Can introduce bacteria from breast ducts, slightly increasing the risk of capsular contracture compared to inframammary incisions. Studies suggest a moderate increase in capsular contracture rates with this approach.
  3. Transaxillary Incision:
    • Placed in the armpit.
    • Avoids scars on the breast but provides less direct access for precise implant placement, leading to a higher potential for implant malposition. Capsular contracture rates are similar to those of the periareolar approach, with some studies indicating an increased risk due to limited control over implant placement.

At Dr. Jejurikar’s office, we carefully evaluate each patient’s anatomy and goals to determine the most suitable incision type, prioritizing both aesthetic outcomes and minimizing complications.

Pocket Choices: Subglandular, Submuscular, and Subfascial

Where the implant is placed significantly impacts capsular contracture rates:

  1. Subglandular Pocket:
    • The implant is placed above the chest muscle but below the breast gland.
    • Reported capsular contracture rates are higher, with studies indicating rates of up to 10-15%.
    • This option may be preferred in select patients with adequate breast tissue to cover the implant.
  2. Submuscular Pocket:
    • The implant is placed beneath the chest muscle.
    • Lower capsular contracture rates, typically around 2-5%, due to reduced exposure to breast tissue bacteria and increased implant coverage.
  3. Subfascial Pocket:
    • The implant is placed below the fascia of the chest muscle but above the muscle itself.
    • Emerging as a promising option, subfascial placement combines the benefits of reduced capsular contracture risk with a more natural aesthetic. Recent studies suggest capsular contracture rates of 5-7%, offering a balanced approach for certain patients.
    • Subfascial placement paired with Motiva implants, known for their SilkSurface™ technology, shows encouraging results with capsular contracture rates as low as 1-2% in preliminary studies. This combination is an exciting option for patients seeking both safety and natural-looking outcomes.

At our practice, submuscular placement has long been considered the gold standard, but subfascial placement is increasingly being utilized for its advantages, especially when combined with Motiva implants.

Capsular Contracture Rates Among Implant Brands

The choice of implant brand also affects capsular contracture rates:

  1. Mentor:
    • Known for consistent quality and smooth and textured options.
    • Capsular contracture rates for smooth implants are around 2-3%, while textured implants may further lower rates but carry other risks.
  2. Allergan:
    • Natrelle implants are versatile with varied profiles and sizes.
    • Smooth implants report capsular contracture rates similar to Mentor, around 2-3%.
    • Textured implants have been linked to lower capsular contracture rates but are less commonly used due to concerns about BIA-ALCL.
  3. Sientra:
    • Offers high-strength cohesive gel implants with low reported capsular contracture rates, generally under 2% for smooth implants.
    • Exclusive distribution to board-certified plastic surgeons ensures stringent quality control.
  4. Motiva:
    • Features advanced smooth SilkSurface™ implants with capsular contracture rates as low as 1-2% in preliminary studies.
    • Especially appealing to patients seeking a natural look and feel.

Dr. Jejurikar works closely with each patient to choose the most appropriate implant brand, ensuring optimal outcomes with minimal risk of complications.

The Keller Funnel: Reducing Capsular Contracture Risk

The Keller Funnel is an advanced surgical tool designed to minimize bacterial contamination during implant placement. This sterile, cone-shaped device allows for “no-touch” delivery of the implant into the breast pocket, reducing the risk of capsular contracture and improving patient outcomes. Dr. Jejurikar routinely uses the Keller Funnel for its proven benefits in enhancing safety and precision during surgery.

Why Choose Dr. Sam Jejurikar?

Dr. Sam Jejurikar is a board-certified plastic surgeon recognized as one of Dallas’ best. With extensive expertise in breast surgery, he combines technical skill with a patient-centered approach to deliver exceptional results. At our practice, we prioritize patient education, ensuring you understand every aspect of your procedure, including potential risks like capsular contracture. From consultation to recovery, you’ll receive personalized care designed to help you achieve your aesthetic goals safely and effectively.

Conclusion

Capsular contracture is a challenging complication, but with proper surgical techniques, advanced tools like the Keller Funnel, and a personalized approach, the risk can be minimized, and treatment options are highly effective. If you have concerns about capsular contracture or are considering breast augmentation, contact our office today. Let us guide you through your journey with expertise and compassion.

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9101 N. Central Expwy.
Suite 600, Dallas, TX 75231
Tel: 214-827-2814
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