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My breasts are starting to look weird, what is going on?

Capsular Contracture

A frequent consult seen in our office is patients with breast implants who are concerned because they seem to be changing.  By the time patients come to us, they have strange appearing breasts that are firm and painful.  These patients are suffering from capsular contracture.  This process develops when the scar tissue sac surrounding the implant becomes thick and inflamed.  Anytime a foreign body is placed into a patient (heart valve, hip implant, ankle screw, etc), the body will wall off this device with a scar tissue sac. This is what we call the capsule.  A normal capsule is soft and pliable, surrounding the implant but not putting pressure on it.

Capsular_Contracture_Repair

Capsular contracture repair. Before is on the left. She had implant removal and fat grafting.

If the capsule becomes inflamed and thick, it can distort the appearance of the implant. The longer the process is allowed to continue, the more likely that the scar tissue will start to cause pain and may even limit movement of the arm on the affected side.

Most capsular contractures are the result of one of two things.  First, a ruptured silicone implant can cause inflammation. The silicone inside the breast implant is irritating to the scar tissue and frequently leads to thickening.  The older versions of silicone implants (think 70’s, 80’s, and 90’s) had a thinner outer shell more prone to breaking.  They also had a thinner internal silicone that can be problematic with rupture.  For this reason, if a rupture is diagnosed with a silicone implant, the implant should be replaced.  The second reason for contracture is something called a biofilm.  A biofilm is a low grade, subclinical infection, think plaque on your teeth as an example.  This infection does not cause a rip-roaring infection landing you in the emergency room, but causes chronic inflammation (like the inflammation plaque causes on your gums called gingivitis).   These bacteria are typically normal skin flora that unfortunately becomes introduced at the time of surgery.

In the past, this process was very difficult to treat and women frequently had recurrent issues with abnormal scar tissue.  Many women wish to keep their implants and the process results in multiple surgeries and frustration.  In our practice, we have developed a treatment that has a very low recurrence rate.  The key to such low recurrence rates is treating every possible cause at the time of surgery.  First, the entire capsule needs to be removed.  Not a single piece can be left behind or recurrence is almost certain.  Although some surgeons will leave the “back wall” or portions behind, we have found this as a common cause of recurrence.  Cultures are sent at the time of surgery to test for biofilm, and patients are treated with antibiotics for at least two weeks.  The last vital piece is use of an acellular dermal matrix.   This is a prosthetic which is a component of human skin, the dermis or strength layer.  Use of this has been shown to reduce rates of recurrence as well.

Some women just want their implants out, and this is a reasonable option as well.  We have many options for implant removal that will leave you with breasts you are proud of.  Stay tuned for future blog posts about the amazing options for patients opting for implant removal instead of replacement.