Patients who develop severe scar tissue around the implant have capsular contracture. It can be classified in four scales with grade IV being the worst where a patient has severe painful, hard breasts with visible distortion. We treat patients with capsular contracture every week, both in Beverly Hills as well as seeing patients in Las Vegas, Nevada. Capsular contracture is one of the most common complications of breast augmentation surgery. Patients can present with scar tissue at any time from four weeks to 40 years later. Interestingly, capsular contracture may occur at any time in a woman's life. The etiology of scar tissue around the implant at one time was felt to be associated with a possible micro infection, which means a contaminant around the implant, not enough of an infection to cause an abscess, but enough to increase scar tissue formation; this has been an idea in the past as to the cause of capsular contracture, but at this time there is no specific guaranteed etiology for it.
Capsular contracture is associated with a thickened hard capsule that forms around an implant any prosthetic device in the body. It has three main components which include collagen, myofibroblast cells and capillaries or blood vessels. It is usually a white, thin, paper-like appearing entity that is found around the implant. There are classifications of capsular contracture associated with Baker classification. A Baker I capsular contracture is a soft breast without significant scar tissue. Baker II is a palpable scar tissue around the implant. There is no visibility and no severe pain. Baker III is capsular contracture where there is both palpable hardening, visible distortion of the implant, as well as some deformation of the breast due to the shape contortion associated with the scar tissue. Baker IV capsular contracture is the worst of all scar tissue contractures associated with palpable, visible, hard distorted cold breast which is painful even on mild to moderate palpation of the breast.
A Board Certified Plastic Surgeon will make a specific classification on a clinical examination of the patient's breast. Once the stage of capsular contracture has been determined, a regimen plan can be created by the Board Certified Plastic Surgeon. For early capsular contracture, significant tissue expansion exercises, massaging, and vitamin E orally, twice a day, will help to break up some of the scarring. This, however, may not be enough in order to prevent further progression to severe Baker IV capsular contracture.
Implants that are placed subpectorally, behind the muscle or within the dual plane technique, certainly have a reduced incidence of capsular contracture versus the implants in the older days, 80's and 90's, that were placed above the muscle either subglandular or in the retromammary plane. Capsular contracture may be associated with women who have increased risk of keloiding or hypertrophic scarring. However, there has not been a complete determination or correlation at this time.
Patients in Beverly Hills and Las Vegas can see Dr. Linder to repair the capsular contracture, reduce pain and create a normal shape and size to the breast without visible distortion and painful scar tissue contracture. Two different types of surgeries can be performed: capsulotomy versus capsulectomy. Capsulotomy simply means releasing the scar tissue in order to reduce the pain by increasing the volume space and allowing for more room for the implant to sit. Often, there is enfolding of the implant where the edges of the implants become folded in and they can actually be seen underneath the tissue or skin. This can be reduced by simply increasing the space around the implants by using electrocoagulation and releasing through scar tissue release the pocket and allowing for the implant to lay flat. Capsulotomies can be performed on a Las Vegas patient under general anesthesia and should be performed normally with patients who have minimal breast tissue or thin volume tissue or patients who have had multiple surgeries on the breasts where there is not a lot of tissue coverage. Removing tissue with a capsulectomy on a patient with thin tissue could leave the woman with minimal tissue and increased visibility of the bag and therefore it is very important to determine which patient should have capsulectomies and which should have capsulotomies.
Dr. Linder is a specialist in breast revision surgery who has patients flown in from throughout the country and the world for revision surgery. Our experience and judgment will help us to create a normal shape to the breast, and reduced incidents of visibility of the implant. Sometimes capsulotomies will be performed with implant removal or replacement. If the tissue is very thin, you may want to consider silicone gel implant replacement or cohesive silicone gel implants which will again reduce visibility and palpability of the bag.
Capsulectomies should be performed when women have a significant ample amount of breast tissue and by removing the scar tissue as well as releasing it, it will give a better softer breast appearance. However, if removing the scar tissue will increase visibility, then the tissue should be left intact and only released rather than removed. With capsulectomy, tissue is actually removed from the undersurface of the pectoralis major muscle. A total capsulectomy is associated with complete exenteration of scar tissue both along the undersurface of the pectoralis major muscle lateral breast tissue borders include the infraclavicular region along the parasternum, along the inframammary fold into the lateral anterior axillary line. There are patients who will require explantation of the implants if there is not enough coverage of breast tissue after multiple capsulectomies in order to prevent increased recurrent scar tissue which could lead to death of skin, nipple areolar complex or avascular necrosis.
A combination of capsulotomy and capsulectomy can be performed as well. Patients may require smaller areas of scar tissue released and removed while others only released in order to avoid visibility of the bag edges.
Stuart Linder, M.D., F.A.C.S. is a Beverly Hills and Las Vegas Breast Revision Surgeon who enjoys performing breast augmentations, breast revisions, breast lifts, breast reductions and breast reconstructive surgery. He is a Diplomate of the American Board of Plastic Surgery and a Fellow of the American College of Surgeons and a Member of the American Society of Plastic Surgeons.
Stuart A. Linder, M.D., F.A.C.S. Las Vegas Breast Revision Specialist
9167 W Flamingo Rd, Suite # 110, Las Vegas, NV 89147
Phone: (702) 434-7205