What is Capsular Contracture in Breast Implants? Treating Pita Pockets and Raviolis

A woman in white shirt is giving herself a breast exam. (Model)

Breast Augmentation surgery is typically an extremely satisfying procedure for my patients—and for me as your surgeon! Most of my breast augmentation patients have a smooth aesthetic journey, and their final results are precisely what they were hoping for—be it returning to their previous size and contour or achieving a new, larger “wish pic” size. However, on rare occurrences, there is what we call a capsular contracture. You may wonder, what is capsular contracture? In general, it’s a thickening and tightening of the normally smooth and pliable scar tissue around the breast implant. This causes the implant to feel firm and assume a rounded ball shape, potentially leading to physical symptoms of achiness or pain.

Fortunately, the treatment options range from oral medications to corrective breast augmentation revision surgery. In this blog, I will cover the current theory about why capsular contracture happens and the grading system and treatment options based on its severity. Again, while most patients are relieved not to have this happen, capsular contracture is a known complication that is important to understand before undergoing breast surgery for the first time.

Breast Augmentation Revision Case 605 Before & After Front | Columbus, OH | Aesthetica Surgery & Spa
Before and After Breast Augmentation Revision

What is a Biofilm?

The current theory about the cause of capsular contracture is something called a biofilm. This is a low-grade bacterial colonization of the implant that causes inflammation but not an outright infection. The inflammation causes the body to react by building up thicker scar tissue, and when it starts to be noticeable, we call this capsular contracture, or “Cap-Con” for short!

How Common is Capsular Contracture?

Fortunately, the data ranges from about 1 to 3 percent, making capsular contracture a rare complication. But if you are among the unlucky one percent, it is natural to feel like something went wrong in surgery. However, I can assure you that we utilize the same surgical approach each time and take every precaution available to prevent capsular contracture from occurring. To make matters even more challenging, it’s a condition that is not visible immediately after surgery, taking many months or even years to become noticeable. While the implants are initially perfect and soft, one (usually not both) will gradually tighten, get rounded in shape, and then start to ache. Later, the patient calls the office to report this odd finding, and we explore how to address it with a treatment such as breast revision surgery.

Grade 1: Early Capsular Contracture

There are different levels, or grades, of capsular contracture that help us judge its severity. For very mild cases, the first step is to begin oral antihistamines to turn down the inflammatory response. The two most common drugs are Singulair and Accolate. The patient takes the med for about 3 months and then is re-evaluated. This can halt the progression of the scar tissue. But in cases where medication does not do the trick, the next step is surgery.

Surgical Treatment of Capsular Contracture

No specific surgical treatment is the answer, but we employ a range of techniques depending on the severity, and if it is recurrent—yes, it can strike again! The surgical approach involves removing all the scar tissue and the old implant and then replacing the implant. This probably sounds easy enough, and often, this is the only treatment needed. But in some cases, the capsular contracture returns, and the patient is more frustrated than ever.

If there is a recurrence, another tactic must be used to prevent capsular contracture from recurring—again!  This tactic is to use another layer of product wrapped around the new implant—like a pita pocket or ravioli—to keep the scar tissue formation at bay. The product that is used can vary, but all have an additional cost. Currently, this treatment has the best outcome. In other words, the new implant that is placed remains soft, and no capsular contracture returns. To help patients who face this problem, implant manufacturers offer a warranty for the first 2 years. They will supply a monetary stipend to help defray the cost of surgery, but there are still out-of-pocket costs for the patient, as it does not cover all the fees.

Treating Capsular Contracture: The Takeaway

Fortunately, capsular contracture is a rare occurrence and, as such, should not be a big worry for prospective breast augmentation patients. However, having a baseline knowledge of capsular contracture before surgery is crucial. The good news is that there are varying treatment options available, including breast augmentation revision surgery, depending on the severity of your symptoms. Overall, breast augmentation surgery is typically very positive for the vast majority of patients, but it is essential to be prepared for the unexpected. “Breast assured” that the entire team at Aesthetica will help guide you during each stage of your breast augmentation journey. If you have questions or concerns about any of our cosmetic surgery procedures, please request a consultation online or call us at (614) 350-4722.

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