Hard Implants (Capsular Contracture) Beverly Hills

What is capsular contracture?

When any device is placed inside the body, your body naturally forms a scar around it. A complication that can occur with breast implants is the development of a thick, tight scar around the implant; this is called capsular contracture. Sometimes, it may only occur in one breast, while in other cases, it affects both. Symptoms patients may experience with this complication range from mild discomfort and firmness of the implants to severe pain and distortion of the implant. The Baker Grade Scale classifies the degree of capsular contracture. Correction of this complication is most often achieved with surgical removal of the capsule (called a capsulectomy) and is of the most common reasons for reoperation for patients with breast implants (both cosmetic and reconstructive).

Baker Grade Scale for Capsular Contracture

Capsular contracture is graded on a scale of I to IV.

  • Grade I: Describes a normal, soft breast.
  • Grade II: The breast is somewhat harder and the implant can be felt.
  • Grade III: The entire breast is firm, and the implant is obvious to the touch. Asymmetry will often be present as well.
  • Grade IV: The breast is hard with severe distortion, and you may experience pain.

Why does capsular contracture happen, and is there anything that can be done to prevent it?

It is impossible to predict if capsular contracture will happen or to determine exactly what has caused it. One of the leading theories behind why capsular contracture occurs is from a bacterial biofilm that can form around the implant. From a physiology standpoint, if milk can get out of the breasts, then bacteria can get in – therefore, there are measures that are taken perioperatively to prevent infection:

  1. One week before your surgery, we ask that you start using Hibiclens, an antibacterial soap, as a body wash 1-2 times a day, concentrating on the areas of surgery.
  2. The day of surgery, the anesthesiologist will give you a dose of an antibiotic, called Ancef (cefazolin), through your IV prior to the start of surgery.
  3. During surgery, an antibiotic and a dilute betadine lavage is used to irrigate the breast pocket prior to placing the implant. Additionally, surgical dressings are placed in a sterile fashion and left on for a week after surgery.
  4. Following surgery, we prescribe an antibiotic called Duricef (cefadroxil) to be taken for 5 days after surgery, or, if applicable, as long as you have drains.

Other factors that may be associated with capsular contracture include subglandular implant placement (See Implant Placement) and having a personal history of capsular contracture.

Treating capsular contracture

In most cases, surgical removal of the capsule and implant, referred to as a capsulectomy, is the treatment of choice to correct the issue. This may or may not include placement of a new implant – this mainly depends on the patient’s preference.

In a few cases, a full capsulectomy is not necessary. Occasionally, a capsulotomy, where the scar tissue is just released, can correct the issue. In other situations, a partial capsulectomy, which removes only the anterior scar tissue, or a capsulorrhaphy, which simply scores the scar tissue rather than removing it, may be appropriate. However, both of these options have the downside of an increased rate of recurrence. In addition, some patients wish to remove the implants entirely at this time; in such cases, the scar tissue may, or may not, also need to be completely removed. Dr. Schwartz will be able to fully advise you on your options after he examines you.

Treatment of capsular contracture can also be directed by where your implants are currently placed and whether or not you have smooth or textured implants. Because bacteria can get into the breast tissue through the same pathway that milk leaves the breast, implants placed subglandular may have an increased risk of developing capsular contracture. Therefore, if you are undergoing restorative surgery to correct capsular contracture, the procedure may include converting your implants from a subglandular to a submuscular placement.

Textured implants are also associated with a decreased risk of capsular contracture when placing an implant subglandular, so utilizing a textured implant may be a consideration when planning a restorative surgery for the correction of capsular contracture if you strongly desire to keep you implants above the muscle. Of note, however, textured implants carry no advantage over smooth for decreasing risk of developing capsular contracture when submuscular.

While most cases require surgical correction, treating capsular contracture medically can also be an appropriate initial approach, especially for early postoperative presentations of capsular contracture.


CAPSULAR CONTRACTURE FAQS

What is capsular contracture?

When any device is placed inside the body, your body naturally forms a scar around it. A complication that can occur with breast implants is the development of a thick, tight scar around the implant; this is called capsular contracture. Sometimes, it may only occur in one breast, while in other cases, it affects both. Symptoms patients may experience with this complication range from mild discomfort and firmness of the implants to severe pain and distortion of the implant. The Baker Grade Scale classifies the degree of capsular contracture. Correction of this complication is most often achieved with surgical removal of the capsule (called a capsulectomy) and is of the most common reasons for reoperation for patients with breast implants (both cosmetic and reconstructive).

What is the Baker Grade Scale for Capsular Contracture?

Capsular contracture is graded on a scale of I to IV.

Grade I: Describes a normal, soft breast.
Grade II: The breast is somewhat harder and the implant can be felt.
Grade III: The entire breast is firm, and the implant is obvious to the touch. Asymmetry will often be present as well.
Grade IV: The breast is hard with severe distortion, and you may experience pain.

Why does capsular contracture happen, and is there anything that can be done to prevent it?

It is impossible to predict if capsular contracture will happen or to determine exactly what has caused it. One of the leading theories behind why capsular contracture occurs is from a bacterial biofilm that can form around the implant. From a physiology standpoint, if milk can get out of the breasts, then bacteria can get in – therefore, there are measures that are taken perioperatively to prevent infection:

  1. One week before your surgery, we ask that you start using Hibiclens, an antibacterial soap, as a body wash 1-2 times a day, concentrating on the areas of surgery.
  2. The day of surgery, the anesthesiologist will give you a dose of an antibiotic, called Ancef (cefazolin), through your IV prior to the start of surgery.
  3. During surgery, an antibiotic and a dilute betadine lavage is used to irrigate the breast pocket prior to placing the implant. Additionally, surgical dressings are placed in a sterile fashion and left on for a week after surgery.
  4. Following surgery, we prescribe an antibiotic called Duricef (cefadroxil) to be taken for 5 days after surgery, or, if applicable, as long as you have drains.

Other factors that may be associated with capsular contracture include subglandular implant placement (See Implant Placement) and having a personal history of capsular contracture.

How is Capsular Contracture Treated?

In most cases, surgical removal of the capsule and implant, referred to as a capsulectomy, is the treatment of choice to correct the issue. This may or may not include placement of a new implant – this mainly depends on the patient’s preference.

Treatment of capsular contracture can also be directed by where your implants are currently placed and whether or not you have smooth or textured implants. Because bacteria can get into the breast tissue through the same pathway that milk leaves the breast, implants placed subglandular may have an increased risk of developing capsular contracture. Therefore, if you are undergoing restorative surgery to correct capsular contracture, the procedure may include converting your implants from a subglandular to a submuscular placement.

Textured implants are also associated with a decreased risk of capsular contracture when placing an implant subglandular, so utilizing a textured implant may be a consideration when planning a restorative surgery for the correction of capsular contracture if you strongly desire to keep you implants above the muscle. Of note, however, textured implants carry no advantage over smooth for decreasing risk of developing capsular contracture when submuscular.

Our Location

Jaime S. Schwartz, MD, FACS

Board Certified Plastic Surgeon

310.340.6372