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Capsular Contracture

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When we talk about breast implant surgery and capsular contracture, there are two things to keep in mind. First, it is the most common side effect. And second, it is still quite uncommon. Those two facts seem to be at odds with each other. But it’s a good thing, because it means the most common side effect of breast implant surgery isn’t that common after all, says Grant Stevens, M.D., F.A.C.S., medical director of Marina Plastic Surgery in Marina del Rey, CA.

In Dr. Stevens’ most recent study, he found that capsular contracture affects less than three percent of breast implant patients when followed over 12 years. “The number one side effect is still happening only three percent of the time,” he says. Compare that to other surgeries, and it lends perspective to the issue.

What is Capsular Contracture?
A breast implant is a foreign object, and your body recognizes it as such. To protect itself, it forms a tissue “capsule” around the implant (this is sometimes called a “scar capsule,” but it’s not the same thing as scar tissue). In some women, the capsule starts to tighten and squeeze the implant. When this happens, the area around the implant can feel hard and painful. As the tissue continues to squeeze the implant, it can also make the implant take on an abnormal shape. Capsular contracture doesn’t do lasting damage: it’s specific to the implant.

Can You Prevent Capsular Contracture?
Women seeking breast implants are often concerned about capsular contracture, and want to know what they can do to prevent it. Your surgeon, of course, will do everything possible to prevent it. But there is no magic formula. We do know that there is a lower rate of capsular contracture when implants are placed under the muscle (called “submuscular placement”), Dr. Stevens says. Also, infection (caused by bacteria around the implant shell) leads to inflammation, which can cause the capsule to contract. That’s why you may be given antibiotics before, during, and after surgery. During surgery, Dr. Stevens also irrigates the implant pocket with betadyne.

Textured implants seem to have a slightly lower rate of capsular contracture, Dr. Stevens says. However, regarding what the implant is filled with: there is no higher rate with silicone, as has been reported in the past, he says. “The fear of capsular contracture shouldn’t be a deciding factor between silicone and saline,” he says. He uses silicone implants, which he finds superior in every way—especially when it comes to patient satisfaction. In fact, the next generation of gel implants (the fifth generation, if you’re keeping track) may have a lower rate of capsular contracture. Stevens and his colleagues recently released results from a study of the newest cohesive gel, form-stable implants (sometimes called “gummy bear implants” because they resemble the texture of a gummy bear). "We actually found that form-stable silicone implants have a lower capsular contracture rate and a decreased incidence of wrinkling when compared to fourth-generation silicone gel implants," he reports.

A few other things you can do that may reduce your risk:

• Vitamin E: Vitamin E is thought to soften the collagen fibers that make up the capsule. Some surgeons recommend taking it daily.
• Massage: massaging the implants twice a day for the first year and once a day thereafter. Dr. Stevens recommends it to his patients. (Check with your surgeon to see if they recommend.)
• Taking non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen (if you can tolerate it and your surgeon okays it).

Your surgeon will consult with you on the best way to handle capsular contracture, depending on the severity. Surgery is usually required to correct it, which often includes having the implant removed and replacing with a new implant.

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