Capsulectomy for Scar Tissue From Breast Surgery

Removing Hardened Scar Tissue From Around a Breast Implant

Woman Gets Breast Implants Aged 83
Understanding breast capsulectomy to cope with scar tissue after breast augmentation. Credit: Barcroft / Contributor / Getty Images

If you have scar tissue or thickened and hardened areas in your breast after breast augmentation or breast reconstruction, your plastic surgeon may recommend a capsulectomy. When is this procedure done, how is it done, and how effective is it in resolving the problem?

What Is a Capsulectomy?

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 fibroblasts, collagen, and blood vessels and is known as capsular contracture. It is actually the body’s immune system's protective response against the presence of a foreign object that leads to the problem. 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 those who are having breast augmentation for the first time, those who have had breast reconstruction following breast cancer surgery, and in people who have previously been treated for capsular contracture.

Types of Capsular Contracture

There are several levels of capsular contracture that are categorized into stages based on the Baker Classification Scale. These stages 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. In other words, your breasts may feel uncomfortable and may be slightly hard to touch, but they will look normal.
  • 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 rounded or tilt upwards.
  • Baker Grade IV: The breasts are hard, cold and distorted in appearance and the patient experiences pain and discomfort.

Of course, there are many women who don't fit neatly into one of these categories. For example, your breasts may be soft yet painful, or your breasts may be hard and cold but not painful. One study found that 3.2 percent of women developed a grade III or IV contracture after breast augmentation requiring capsulectomy, and capsular contraction is the most common reason for additional surgery following the procedure.

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 saline breast implants. These are some reasons for the debate between silicone versus saline 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 such as prednisone or vitamin E may be prescribed for some women.
  • Placement of the implant in a submuscular position: Some surgeons use Alloderm as well to decrease the risk of scar tissue formation.
  • Type of implant: As noted, silicone implants are more likely to result in scar tissue formation than saline breast implants.
  • Not smoking before the procedure.
  • Postoperative massage (Note below under closed capsulotomy that vigorous massage is not recommended and may result in implant rupture or bleeding.)
  • External ultrasound treatment.

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

The Capsulectomy Procedure

For people experiencing Grade III or Grade IV capsular contracture, surgical treatment to remove the capsule of scar tissue surrounding the breast implant is often recommended. During a capsulectomy, the envelope which surrounds the implant is removed. The implants may be removed or reinserted during the procedure.

Capsulectomy vs Capsulotomy

A capsulotomy is a different procedure than a capsulectomy. In a capsulotomy, the capsule is opened (released and/or partially removed) to give the implants more room. A capsulotomy can either be an open capsulotomy, in which an incision is made in the breast, or a closed capsulotomy in which manual compression is used on the surface of the breast to break up scar tissue. While a closed capsulotomy sounds less invasive, there are many people who advise against the procedure due to the risk of implant rupture and hematoma formation. In contrast, an open capsulotomy may be a less invasive option for those considering capsulectomy surgery.

Recovery After Capsulectomy

Recovery will vary and will depend on the procedure performed and the patient’s ability to heal, but is often similar to the recovery after breast augmentation or reconstruction surgery.

Bottom Line on Capsulectomy for Capsular Contracture

Unfortunately, capsular contracture can lead to distortion and discomfort following breast augmentation or reconstructive surgery. Capsulectomy is one way to improve the appearance and increase your comfort if you're coping with this side effect.

As with any surgery, it's important to be your own advocate. Find a surgeon who has performed many of these surgeries. Ask to learn about the results or to see pictures if she has these. Your surgeon may also be able to put you in touch with other women who have had the procedure done who are willing to share their experience.

Sources:

Headon, H., Kasem, A., and K. Mokbel. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Archives of Plastic Surgery. 2015. 42(5):532-543.

McGuire, P., Reisman, N., and D. Murphy. Risk Factor Analysis for Capsular Contracture, Malposition, and Late Seroma in Subjects Receiving Natrelle 410 Form-Stable Silicone Breast Implants. Plastic and Reconstructive Surgery. 2017. 139(1):1-9.

Swanson, E. Open Capsulotomy: An Effective but Overlooked Treatment for Capsular Contracture after Breast Augmentation. Plastic and Reconstructive Surgery. Global Open. 2016. 4(10:e1096.

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