Capsular Contracture
Conveniently located to serve Atlanta and Sandy Springs
Capsular contracture is a condition that sometimes occurs after breast augmentation. According to research, roughly one in six breast augmentation surgeries result in minor, moderate, or severe capsular contracture. Capsular contracture can cause breasts to rise and to become distorted, and it can make them painful and hard to the touch. It can occur in one breast or in both breasts.
The body responds to any implant (medical or cosmetic) by forming scar tissue, or a “capsule,” around it as part of its normal healing process. This is the body’s immune system response to any foreign object it detects. In the case of a breast implant, this protective capsule of fibrous scar tissue is usually pretty thin, and it helps keep the breast implants in place.
In some patients, the capsule becomes thicker and contracts around the implant, which places the implant under pressure. As the capsule tightens, the implant can rise to a higher position on the chest, making the breast look tight and artificially round, like a baseball. In more advanced cases, the implant can feel firm or even painful.
75 percent of capsular contracture cases happen during the first two years after the surgery, and most happen during the first year. It often affects the breasts during the first six months following surgery and sometimes only takes weeks to occur.
In other cases, it can happen years after the implant-placement procedure. For these cases, implant ruptures are usually the culprit. A negative response from the immune system can also be a potential cause.
What Causes Capsular Contracture?
There are a number of theories on the exact cause of capsular contracture, though it does seem to vary from patient to patient. It is important to understand that capsular contracture is not caused by breast implants being toxic or dangerous. It can happen after any kind of medical implant is inserted into the body (i.e. hips, knees, etc.), and this condition is not unique to breast augmentation surgery.
Furthermore, capsular contracture is not generally dangerous to a patient’s health. It is, however, troubling secondary to the appearance of the breasts or if the patient experiences pain as a sequelae of advanced capsular contracture.
Though we do not know the exact cause of capsular contracture, we do know that certain things increase the risk of capsular contracture.
Biofilm
Biofilm is a thin layer of bacteria that develops around implants after bacteria has been introduced to the breast cavity during surgery. This bacteria can cause a chronic, low-grade infection that can result in increased scar tissue production, leading to capsular contracture.
It is important to note that this contamination does not necessarily result from a non-sterile working environment. It can occur from bacteria that is always present on the patient’s skin and does not usually cause symptoms. We use multiple methods of ensuring the most sterile skin environment for our patient during surgery to avoid development of these biofilms.
Hematoma and Seroma
Hematomas and seromas are rare complications of breast surgery. Specifically, these are collections of fluid that accumulate in the breast pocket. These fluid collections are thought to supply nutrients to bacteria, which encourage the growth of biofilm and increase the risk of capsular contracture. To avoid fluid collections, we perform meticulous surgery intraoperatively and may leave drains postoperatively.
Inflammation
Increase in inflammation in the breast pocket can cause capsular contracture. Generally, the thicker and more calcified the scar-tissue capsule, the more inflammation and cellular damage present. Causes of inflammation include bacterial infection or fluid collection. In addition, ruptured silicone or remnants of silicone from an old rupture can also stimulate inflammation in the breast pocket. Collagen is produced from the inflammation, causing the scar tissue to become thicker and more fibrous.
Smoking
Smoking is known to increase the risk of capsular contracture. We require that our patients be willing to stop smoking before and after surgery to reduce this risk.
Implant Placement
Placement of the implant under the chest muscle has been shown to lower the risk of capsular contracture by 4-8% compared with over the muscle placement of the implant.
Is There a Greater Risk of Capsular Contracture with Saline or Silicone Implants?
In the past, the incidence of capsular contracture seemed to be greater with silicone implants. Now, due to improved manufacturing practices, there is no longer a difference, and rates seem to be the same regardless of implant choice.
Is Capsular Contracture Dangerous?
No, capsular contracture is not typically dangerous but can cause unsightly surface abnormalities on the breast due to contracting scar tissue squeezing the breast implant. Capsular contracture can pose health risks when the capsule is so tight that it ruptures the breast implant.
How Does Capsular Contracture Feel? Does Capsular Contracture Hurt?
If you’re experiencing capsular contracture, your implant may feel hard. The tightening of the capsule may pull against nerves, ribs, or muscle tissue. This can result in restricted motion and discomfort. In extreme cases, capsular contracture can cause pain in the breasts.
What Is the Baker Scale?
Capsular contracture can increase in severity over time. Proposed in 1978, the Baker Scale is a system used to categorize the severity of a patient’s capsular contracture. There are four grades in this system.
At Grade I, the breast still has a natural appearance and feels normal. Note that even though no obvious symptoms are being experienced, capsular contracture is still present at this level.
At Grade II, there is still a natural appearance, but there is a slight degree of increased firmness in the breast.
At Grade III, there is more firmness and hardness, along with visible distortion of the breast. It may appear overly round or hard-looking, and there may be distortion in nipple shape.
At Grade IV, there is severe visible distortion, along with hardness, pain, soreness, and tenderness.
How Is Capsular Contracture Treated?
When mild cases of capsular contracture occur, surgeons can sometimes perform a capsulotomy. During this procedure, the scar-tissue capsule is carefully released, reducing tightness around the implant.
More often, and especially in more severe cases, capsular contracture requires surgery to remove the implant and the affected capsule. This procedure is known as a capsulectomy and is a form of breast explant surgery.
Several types of capsulectomies can be performed. A partial capsulectomy removes part of the scar-tissue capsule, whereas a total capsulectomy removes the entire capsule in sections. Another option is the en bloc capsulectomy, which removes the entire capsule as a single unit. Since the capsule encapsulates the entire implant, the implant is removed with the capsule.
A capsulectomy procedure in Atlanta usually takes two to three hours to complete, depending on the details of the surgery. First, general anesthesia is administered for patient comfort. Once it has taken effect, Dr. Kavali or Dr. Moak creates an incision. Whenever possible, the incisions used are the same ones that were utilized for the primary breast surgery.
Once the capsule is removed from the implant, a new implant can be replaced back into the breast pocket. Sometimes we will recommend the use of surgical mesh around the implant, which has been shown to significantly decrease the recurrence of capsular contracture.
After breast reconstruction patients have a capsulectomy, they may prefer to avoid a new implant and instead have flap-based reconstruction to restore the lost volume. This helps to avoid future capsular contracture.
After breast augmentation patients have a capsulectomy, they may prefer to have a smaller implant placed or to instead undergo fat transfer to the breast.
Other breast augmentation patients may prefer not to have a new breast implant inserted at all. After this form of breast explant surgery has been performed, the breasts may have loose skin. For certain patients, this loose skin may retract naturally. For many others, the skin will remain loose, which can necessitate a breast lift. This can either be performed during the same surgical session as the capsulectomy or during a subsequent session.
Once the surgery is complete, incisions will be closed with sutures. Drains may also be placed to prevent hematomas and seromas.
Why Choose Monarch Plastic Surgery for Capsulectomy Surgery?
At Monarch, our skilled Atlanta plastic surgeons have a great deal of experience with breast procedures, including breast revision procedures like capsulectomy surgery. They have performed revision surgery to correct numerous issues stemming from other surgeons’ work, such as contour imperfections, bottoming out, malposition, and capsular contracture.
Our plastic surgeons are also on staff at Northside Hospital and Atlanta Outpatient Surgery Center. All of our patients undergo their breast revision procedures at these locations.
Dr. Carmen Kavali, a board-certified plastic surgeon, has been a Castle Connolly Top Doctor since 2017, and she has also been recognized by Castle Connolly as an Exceptional Woman in Medicine since 2020. She has been named a Top Doctor by The Atlantan magazine and Atlanta Magazine. The Consumers’ Research Council of America has also honored her as one of America’s Top Plastic Surgeons.
Dr. Kavali graduated from Mercer University in Macon, Georgia, with a BSE in Biomedical Engineering and an MD. She then went on to a general surgery residency at the University of Illinois, followed by a specialized plastic surgery fellowship at Wayne State University in Michigan.
She is frequently quoted in magazines, podcasts, and radio shows as a trusted medical expert. Additionally, she has delivered presentations and lectures at medical conferences and has authored several articles for national medical journals.
Dr. Kavali is a member of medical associations like the Atlanta Women’s Medical Alliance, the Medical Association of Georgia, the American Society for Laser Medicine and Surgery, the Medical Association of Atlanta, and the American Society of Plastic Surgeons.
Board-eligible aesthetic plastic surgeon Dr. Teri N. Moak is an excellent option for your capsulectomy surgery. Dr. Moak has given lectures and presentations at national and international plastic surgery conferences, and she has taught medical students in clinical settings.
Dr. Moak has contributed chapters to medical textbooks, peer reviewed medical journal articles, and won awards for her writing. She is a member of medical associations like the Medical Association of Georgia, the International Society for Aesthetic Plastic Surgery, the Aesthetic Society, and the American Society of Plastic Surgeons.
Dr. Moak’s journey in medicine began at Mississippi College, where she graduated with a Master’s in Biological Medical Sciences. After studying Physical Therapy at the University of Mississippi Medical Center, she attended Little Rock’s University of Arkansas for Medical Sciences for her Doctorate.
She then attended the Washington University Plastic and Reconstructive Residency Training Program. After completing her residency, she received fellowship training from Dr. Grady Core. This fellowship was endorsed by the American Society of Aesthetic Plastic Surgery.
The staff at Monarch Plastic Surgery and Skin Renewal Center create a welcoming environment, ensuring that Atlanta patients feel safe and comfortable. For out-of-town capsular contracture patients, we’re conveniently located near the Hartsfield-Jackson Atlanta Airport. These patients are encouraged to take a trip to midtown Atlanta during their visit. Midtown Atlanta is home to such attractions as the High Museum of Art and the Atlanta Botanical Garden in Piedmont Park.
Am I a Good Candidate for Capsulectomy Surgery?
If you’re experiencing the symptoms of capsular contracture, particularly Baker Scale III or IV symptoms, you’re most likely a good candidate for a capsulectomy in Atlanta.
Patients who are currently pregnant or breastfeeding are not ideal candidates. Patients dealing with an active infection or untreated breast cancer will likely need to address these issues before considering capsulectomy surgery.
Candidates who have bleeding disorders, weaker immune systems, or a history of any treatments that cause blood-flow issues must discuss these with their surgeon during a consultation.
Capsulectomy candidates may need to undergo tests like chest X-rays, breast ultrasounds or MRIs, electrocardiograms (ECG), blood tests, a mammogram, and a pregnancy test.
The best way to determine whether your capsular contracture is best treated with capsulectomy surgery is by meeting with an experienced plastic surgeon at Monarch Plastic Surgery. For out-of-town patients, our Atlanta office isn’t far from a number of comfortable and convenient hotels, including Sheraton Atlanta Perimeter North Hotel, Crowne Plaza Hotel Atlanta Perimeter at Ravinia, and Hyatt Place Perimeter Center.
What Is a Consultation for Capsulectomy Surgery Like?
During a capsulectomy consultation, Dr. Kavali or Dr. Moak will ask you about the capsular contracture symptoms you’ve been experiencing. They will perform an examination of your breasts, evaluating where you fall on the Baker Scale by gauging the degree of firmness and distortion present.
Your plastic surgeon will also ask you about your medical history, including details about your initial breast procedure and other past procedures, current medications, and allergies. This will help them create the safest surgical plan possible for you.
If a capsulectomy is the ideal course of action, your surgeon will go over the capsulectomy process in great detail. This will include preparation steps, recovery directions, and your potential results. Patients are highly encouraged to ask questions at any time.
Once the consultation is complete, you will meet with a patient coordinator, who will discuss the next steps with you.
Capsular contracture patients visiting our Atlanta office are encouraged to consider a trip to downtown Atlanta, home of the Georgia Aquarium, the World of Coca-Cola, and the SkyView Atlanta ferris wheel. Many patients take in some art and culture at the ZuCot Gallery, Atlanta Contemporary Art Center, and MET Atlanta.
Downtown Atlanta also has several places that give visitors a better sense of Atlanta’s rich history, like the iconic Sundial Restaurant, the Curb Market, the National Center for Civil and Human Rights, and Centennial Olympic Park.
How Should I Prepare for Capsulectomy Surgery in Atlanta?
Preparation directions will be given to you by Dr. Kavali or Dr. Moak during your capsulectomy consultation.
For at least six weeks before the date of your capsulectomy, you’ll need to avoid smoking. Smoking negatively affects the health of the skin, which will need time to recover before surgery. Smoking can result in a prolonged healing process and an increased risk of post-surgical complications.
For at least ten days before the capsulectomy procedure, you’ll need to avoid taking any NSAIDs (non-steroidal anti-inflammatory drugs), along with certain herbal supplements. These can potentially result in increased bleeding during surgery.
It will be important to arrange for time off from work in advance. You’ll also need to contact a friend or family member and arrange for them to give you a ride home after the procedure. They should stay with you for the first day after the procedure to help out around the house as needed.
It will be important to gather all necessary healing aids before the procedure and to prepare your rest area appropriately. This means having plenty of pillows and towels on hand, along with bandages and ointments as directed.
The morning of the procedure, avoid applying makeup, lotions, creams, or hairsprays, and do not wear any jewelry. When you arrive at the Atlanta facility where your surgery is being performed, you will put on a hospital gown. Our facilities aren’t far from several Atlanta attractions, like Ponce City Market, the Fox Theatre, the Mercedes-Benz Stadium, and the LEGO Discovery Center.
What Is Recovery Like After Capsulectomy Surgery in Atlanta?
After undergoing your capsulectomy at Monarch Plastic Surgery and Skin Renewal Center, you will be transferred to a recovery area while still feeling the effects of the anesthesia. Temporary nausea and soreness are normal. A nurse will monitor your vitals, ensuring there are no complications. Pain-control medications will be given as needed.
After a period of rest, a friend or family member will drive you home. The details of your capsulectomy recovery process will depend on the specifics of your procedure. You will need to follow your plastic surgeon’s recovery directions as closely as possible to avoid post-surgical complications.
The recovery and healing process can take anywhere from four to six weeks. You’ll need to take time off from work, typically one to two weeks. You must avoid physically strenuous activities like sports, heavy lifting, and heavy exercise for a month or longer. Movements like elevating your arms and bending over should be avoided.
It will be important to wear a supportive surgical bra without underwire. Underwire could potentially damage the temporarily weakened breast tissues. Wearing this bra will help control post-surgical swelling and bruising. Applying ice packs can also aid in the reduction of these issues, as can sleeping on your back.
A degree of post-surgical pain is normal, and pain medication will be prescribed to address it. This must be taken as directed. You may also experience temporary numbness, burning, or tingling. A very gentle massage of the area can potentially help ease these nerve sensations.
You’ll need to avoid showering for 24 to 72 hours after capsulectomy surgery. Once you can shower again, it will be important to be extremely gentle when washing and drying your incision sites. Do not remove any adhesive strips from your incision sites.
You won’t be able to take baths or swim again until all sutures and drains have been taken out. After this point, you’ll need clearance from your surgeon before you can resume taking baths and swimming.
You’ll be able to take short walks very soon after your surgery. These are highly recommended, since they can help to prevent blood clots. Driving must be avoided until you’re no longer taking your pain medications and have been cleared to resume driving.
During capsulotomy recovery, capsular contracture patients must come to our Atlanta facility for regular follow-up appointments. Our facility is close to several coffee shops, including Just Love Coffee Cafe, Bagel Boys Café, and Zambawango. Follow-up appointments will involve removing sutures and drains, ensuring that healing is going as expected, and addressing any complications.
Follow all post-surgical scar care directions diligently to ensure that they fade properly. Avoid sun exposure, and apply petroleum jelly or a moisturizer to your scars as directed.
Is Capsulectomy Surgery Covered by Health Insurance Providers?
Typically, capsulectomy surgery’s cost is not covered by Atlanta patients’ health insurance providers. When capsular contracture occurs after breast augmentation, it is categorized as a complication of a cosmetic procedure, and these do not receive coverage. When Grade IV capsular contracture occurs, causing chronic pain, coverage may potentially be available.
When breast implants were placed as part of breast reconstruction, capsulectomy surgery’s price will likely be covered.
The best way to find out whether your capsulectomy surgery will receive insurance coverage is by contacting your health insurance provider.
Is There a Risk of Capsular Contracture Recurring After Treatment?
Many patients who have their implants replaced after a capsulectomy worry that the condition may recur. There is a chance of this, and studies have shown that after experiencing capsular contracture, patients are more likely to experience it again.
Find Out More About Capsular Contracture
If you’re worried that you may be experiencing capsular contracture, contact Monarch Plastic Surgery and Skin Renewal Center for a consultation. Patients can visit our Atlanta office, which isn’t far from dining options like Fleming’s Prime Steakhouse & Wine Bar, The Capital Grille, Yao Atlanta, and Louisiana Bistreaux.