Capsular Contracture - Breast Implant Problems

The most frequent revision that is required after breast augmentation is capsular contracture.  The most common cause is thought to be due to bacterial contamination or the presence of blood around the implant.  While there is evidence to justify these theories, the true nature of capsular contracture still remains an enigma.  Surgeons can reduce the chances of a capsular contracture with good technique, but even when everything is done right, contracture can still occasionally happen.  The critical components to minimize the chances of occurrence are: precise and bloodless surgery, avoiding any bacterial contamination of the implant , avoiding the nipples incision, encouraging early activity, and using the proper type of antibiotic and irrigation.

Should capsular contracture occur, the treatment is invariably surgical.  The procedure is called a “complete capsulectomy;” it involves removing all of the scar tissue in an exact and bloodless manner, using a brand new implant (since the contracture may be related to bacteria it is important to never reuse the old implant), and placing a drain.  Some surgeons have spoken about using asthma medicines such as Accolate or Singulair to treat contracture, but not only are the evidence for these proposed treatments very tenuous, these medicines have significant side effects as well.  Motrin, massage, ultrasound, Vitamin E, and many other remedies have been tried with mixed or minimal success.

With proper technique the rates of revision contracture are very low, but they are not zero.

In cases of recurrent contracture, recent reports suggest that the use of an “acellular dermal matrix” product such as Alloderm or Strattice can be beneficial.  Dr. Teitelbaum has used both Alloderm and Strattice for this purpose with great success, but cautions that these products are not specifically FDA approved for this purpose and follow-up has not been long enough to know for sure how effective they are.

For more information about treating capsular contracture from Los Angeles plastic surgeon Steven Teitelbaum call 310.315.1121

Before and After Breast Augmentation Photos

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  1. Capsular Contracture, Drooping

    Ruptured and contracted 30 year-old implants in front of the muscle. She had complete capsulectomy, placement implants behind the muscle, and a donut lift. A full lift would have given a better shape, but she didn't want the scars.

  2. Drooping After Augmentation

    She did not want to have a lift when she had her augmentation. So a big saline implant was used and she drooped even more. She was replaced with a smaller silicone implant and given an anchor scar lift.

  3. Capsular Contracture

    This woman had severe capsular contracture, which made her implants high, hard, painful, and round. The scar tissue was removed, and new teardrop gummy bear implants were placed behind the muscle.

  4. Capsular Contracture (Right), Implant removed (Left)

    This patient had multiple attacks of capsular contracture. The right implant became infected and was removed. Scar tissue was removed from both breasts, and new, larger implants were placed.

  5. Capsular Contracture (Left), Lateral Malposition (R)

    The right implant is low and outside. Strattice was used to strenghten the weak tissues in that area and move the impalnt inwards. The left had recurrent contractures, and Strattice was used to reduce the chance it would happen again.

  6. Capsular Contracture, Drooping, Wants Larger Implants

    The scar tissue made her implants high, hard, and round. Scar tissue was removed and Strattice used to reduce chances of contracture. Larger implants were placed. Her tissue is droopy, but she did not want a lift.

  7. Capsular Contracture, Severe Tissue Deformity

    This patient has had multiple operations through the nipple for capsular contracture, resulting in a horrendous deformity. She was treated with removal of all the scar tissue and careful sculpting and repositioning of her breast tissue.

  8. Capsular Contracture

    A very typical before and after of a capsular contracture. The round appearance with the upper bulge and downpointing nipple is corrected by complete capsulectomy and placement of a new implant.

  9. Capsular Contracture

    Her contracture returned three times after surgery for capsular contracture. The problem is that she needed all of her scar tissue removed. Dr. Teitelbaum removed all of her scar tissue and put in new implants.

  10. Capsular Contracture

    The scar tissue makes the breasts look very round. Patients will call it a "rock in a sock." Note that her nipples were pointing down, but with release of the scar tissue their position improved. Such patients sometimes think they need a lift.

  11. Capsular Contracture, Drooping

    She has contracted 35 year-old implants. The breasts are very hard, distorted, and painful. Her goal was to elminate the pain and become soft. She said, "At my age I don't care about drooping." But if she did, she could have a lift.

  12. Capsular Contracture, Wants Larger

    Scar tissue around her breast implants hard, round, and unnatural looking. She wanted more cleavage, soft breasts, and prettier breasts. Removing the scar tissue and placing larger implants improved her cleavage and her shape.

  13. Capsular Contracture, Nipple Distortion

    She has had multiple occurences of capsular contracture, so Strattice was used to prevent it from recurring. It was also used to fix the defect on her areola. This is a very disfiguring complication of that incision.

  14. Inferior Malposition, Capsular Contracture

    Her implants were too low and were contracted. The scar tissue was removed, the implants raised, and new smaller implatns were placed behind the muscle.

  15. Capsular Contracture

    She had severe and painful capsular contracture around her ruptured implants from the 1980's (that was a period of very fragile implants.) All the scar tissue was removed, and newer silicone implants were placed behind the muscle.

  16. Capsular Contracture (Left)

    She was happy with her right breast, but the left had grown hard, high, and painful. She had a complete capsulectomy on that side and replacement wiht a new implant.

  17. Capsular Contracture, Strattice

    Her left breast was always soft and pretty, but the right kept geting hard after multiple surgeries. The scar tissue was removed and Strattice was placed. The breast has remained soft.

  18. Capsular Contracture, Drooping

    Capsular contracture can mask the true degree of droopiness. After the scar tissue was removed, the implant filled out the lower breast and it looked more droopy. But the upper bulge went away and the breasts became more attractive.

  19. Contracture, Rippling, Strattice

    Her implants were supposed to be behind the muscle, but the muscle was damaged which caused the upper inner rippling. Strattice reinforced the muscle and created enough coverage to stop the rippling.

  20. Capsular Contracture

    This patient had capsular contracture. Because she wanted a very smooth transition of her upper breast, and because she was so thin that any implant fold would be felt, she was treated with a highly cohesive anatomic implant.

  21. Capsular Contracture

    Capsular contracture narrows an implant, but her implants were also too narrow and high projecting to begin with. She had a complete capsulectomy and placement of silicone behind the muscle, and a donut lift. Her new implants are actually larger.

  22. Capsular Contract

    Her breasts were very round, hard, far apart, and painful. The scar tissue was removed. Though she looks smaller, the new implants are actually bigger. Note the improvement of cleavage and overall balance of the breasts.