The most frequent revision that is required after breast augmentation is capsular contracture treatment. 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 during his Los Angeles capsular contracture treatment, 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.