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| Top: Before Surgery with Capsules Bottom: After Surgery, Capsules Removed with Breast Lift |
Capsular contracture is a complication which can result after breast augmentation. All breast implants will get a capsule around them. The capsule is a soft scar which the body produces to "wall off" the implant from the rest of the body. If the capsule stays soft it will never cause a problem. However, if the capsule become thick and hard it can become painful and distort and harden the breast.
Preventing capsular contractions is a mainstay of breast augmentation surgery. Great care is taken in surgery to avoid and stop all bleeding and to prevent infection. It is also helpful to place the implant under the chest muscle which can decrease the incidence of capsular by fifty percent. After surgery, it is important for the patient to massage the implant as soon as cleared by her plastic surgeon and continue this massage indefinitely. I generally begin massage about a week after surgery and recommend massaging the implants three times per week.
I use a protocol where the patient is instructed to push the implant up, down, left, and right, and then press the implant firmly against the chest and then squeeze the base of the implant. We teach this massage technique on one of the first post-operative visits and monitor for capsular contracture on subsequent visits.
Because we are very meticulous to prevent capsular contracture and carefully monitor our patients, the incidence of capsular contracture in my practice is very small. However, I am frequently referred patients who have developed capsular contractures for a secondary revisional surgery. In these cases, I remove and replace the implant, remove the implant capsule, wash out the implant pocket with a steroid solution, and if necessary put the implant under the chest muscle to lower the incidence of recurrence. At the revisional surgery, many patients will want to change the size of their implants and often it is necessary to do a "lift" at the same time. We begin implant massage several days after surgery and continue frequently for the first several months. The above photograph is of a patient who was referred to my practice for this revisional surgery.
The best option is to avoid getting a capsular contracture by carefully choosing your plastic surgeon and following the instruction for implant massage after surgery. If, however, you have developed a capsular contracture then a revisional procedure can restore your breast to normal.
