The Surgical Removal of Scar Tissue After a Breast Augmentation Procedure

Woman Gets Breast Implants Aged 83. Credit: Barcroft / Contributor / Getty Images

Definition: Capsulectomy is the surgical removal of scar tissue, or capsule that has become thickened and hardened around a breast implant. The capsule is composed of fibroblast, collagen and blood vessels and is known as capsular contracture. It is the body’s immune systems protective response against the presence of a foreign object.  The formation of a capsule is normal yet when it becomes thick or contracts, it squeezes the implant causing it to become distorted and painful.

Capsular contracture is the most common complication of breast augmentation procedures and occurs in first-time breast augmentation patients, breast reconstruction patients and patients who have previously been treated for capsular contracture.

Types of Capsular Contracture

There are several levels of capsular contracture and they are categorized into stages based on the Baker Classification Scale. They include:

  • Baker Grade I – a normal capsule forms around the breast after breast augmentation surgery and helps keep the breasts soft and natural looking.
  • Baker Grade II –a slightly firm capsule exists and may be firm to the touch yet the breasts still appear natural looking.
  • Baker Grade III – a firm capsule that distorts the appearance of the breasts can be seen and the breasts are hard to the touch. They may appear round or tilt upwards.
  • Baker Grade IV – the breasts are hard, cold and distorted in appearance and the patient experiences pain and discomfort.

    Causes of Capsular Contracture

    There is no way to predict how a body will heal or whether scar tissue will form before a surgical procedure is performed. It is believed that capsular contracture can be caused by the type of breast implant used in breast surgery. Silicone gel implants tend to have a higher rate than saline breast implants in developing scar tissue.

    Silicone can cause calcifications and result in a much thicker scar tissue than that seen with silicone breast implants.

    Capsular contracture may also be caused by how the breast implants are placed. Placing an implant above the muscle does not always provide the implant with enough coverage or lubrication, increasing the risk of scar formation.

    Another theory includes the bacterial contamination of the shell of the implant.

    Prevention of Capsular Contracture

    There are some ways to minimize the risk of developing capsular contracture and they include the following:

    • Prescription medication
    • Placement of the implant in a submuscular position
    • Type of implant
    • Not smoking before the procedure
    • Post-operative massage
    • External ultrasound treatment

    Patients who are not in good health, experience trauma, radiation treatment or post-operative complications, such as infection or bleeding, are more likely to develop capsular contracture than patients without these risks.

    The Capsulectomy Procedure

    For patients experiencing Grade III or Grade IV capsular contracture, surgical treatment to remove the capsule of scar tissue surrounding the breast implant is recommended. The implants may be removed or reinserted during the procedure.

    Recovery will vary and will depend on the procedure performed and the patient’s ability to heal.

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