Cosmetic Question: What is the difference between a breast implant capsule and a capsular contracture? How are they treated?
Cosmetic Answer:
The capsule around a breast implant – or any implant – is the body tissue that separates the implant from the rest of your body. It is a thin layer of connective tissue, a normal reaction to any implant.
A capsular contracture means that the capsule is irritated – and has thickened and tightened. Severe irritation leads to calcium deposits in the capsule, so it truly can become rock hard.
Breast implants capsular contracture vary in severity –
Grade I – No capsular contracture. Your breast is soft and feels and looks normal.
Grade II – Your breast has a little firmness, but looks normal.
Grade III – Your breast is firm, its shape has changed and it may hurt.
Grade IV – Your implant is very hard, hurts, is out of place and looks abnormal.
Anything that irritates a breast implant capsule can cause capsular contracture – leaking gel implants, biofilm infection, sleeping position, bleeding around the implant are some causes.
Treatment depends on how bad your problem is – from your perspective. I have seen many women in their 80s, with round, hard, old silicone gel implants who are very happy with them and want nothing done. However, I have also seen women who are very bothered the slightest firmness.
Before having anything done, remember that the risk of a capsular contracture is about 1% for every year you have the implant. Surgery to correct capsular contracture does not always work.
We usually approach capsules this way –
If it does not bother you, do nothing.
If it bothers you but not enough for surgery, then medical treatment with Singular (an asthma medicine), ultrasound and piperidine may help.
If this does not work – a closed capsulotomy may help. Popular in the 1980s, this is a simple, very painful and unpredictable procedure. Your surgeon squeezes your breast until the capsule pops. I will do this on request, because it may damage the implant or only partially release the capsule, making your breast look worse.
If nothing works and you hate the capsular contracture, consider surgery. Here are your options:
Implants are removed with a breast lift to tighten the breast.
Or only implants removed
Or implant removal, capsule removal and breast lift.
If you intend to keep the implants, here is what may be done —
New implants – always
Possibly a new kind of implant, e.g. saline not gel, textured instead of a smooth.
Capsule release (capsulotomy) or removal (capsulectomy) – always
New position for new implant — often.
Acellular dermal material (ADM) to support the implant – often
Fat implants around the implant – for thin skin, visible implant rippling.
Finally, with the increasing use of large volume fat transplants, you can have the implants removed, breast expansion with the Brava system for 2-3 weeks and fat transplants into your existing breasts.
Obviously the cost of treating a capsular contracture goes up as treatment becomes more complex. You will need to have a very detailed discussion with your surgeon to plan exactly what should be done – and remember, with any breast implant, the capsular contracture risk is still 1% a year, even if surgical results are perfect.
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Copyright E Morgan July 2014