Treatment of capsular contracture after breast implant surgery

Capsular contracture after breast implant placement for breast enlargement occurs in a minority of patients undergoing breast augmentation. It’s occurrence, though, is disappointing for the cosmetic patient and frustrating to treat for the plastic surgeon. Two modalities exist for treatment of a breast implant capsule that has begun to harden: a medical treatment and a surgical one. Preventing capsular contracture is the best method all together, and though an inexact science involving massages after surgery, antibiotics and steroids during surgery, it is the best way to proceed. Breast augmentation implant capsule treatment can be challenging but the results are worth it.

Medical treatment of breast capsular contracture

A few years ago, quite by serendipity, some plastic surgeons noted that their patients who had developed breast capsule contractures began to have improvement of their contractures when they were placed on treatments for asthma.  In asthma, the smooth muscle cells around the bronchi (breathing tubes in the lungs) contract on stimulation by an allergen. This brings about an asthma attack: the tightening of the muscles decreases the amount of air passing through to the lungs and the “attack” is underway. Asthma drugs such as Accolate and Singulair decrease the reactivity of the smooth muscles and their contracting force. They do the same thing in breast implant capsules—they decrease the contracture of the cells and the breast capsule relaxes. This is the case in 80% of patients; the other 20% need surgery.

Surgical treatment of breast capsule contraction

When a patient is unresponsive to the medical treatment for capsular contracture, the surgical procedure of capsulectomy can be performed. In my practice, about 1% of patients need to have this surgery at some point.  This is a procedure whereby the capsule and the implant inside it are removed from the chest and a new implant is placed. The surgery can take anywhere from 1-2 hours depending on how tightly the capsule is attached to the surrounding tissues. In the best cases, such as the one below, the capsule is removed in its entirety with the implant still inside. The hard  and round shape of the capsule and implant mimics the shape of the breast with capsular contracture—hard and round.

Breast implant in capsule

breast implant capsular contracture


Obviously, the body will make another scar tissue capsule around the new breast implant, and yes, the capsular contracture can occur again, but this time, with the foreknowledge of the patient’s susceptibility, the drugs such as Accolate and Singulair can be started right away and the patient can be placed on a more aggressive massage regimen to ensure the largest possible breast implant pocket. For some reason, it seems to work.

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