Breast Augmentation: Cost, Reviews, Photos

Capsular contracture of breast implant after breast surgery is quite rare. The best ways to prevent this complication is bloodless surgery, use of antibiotics and massage and support after surgery. Signs of a harder capsule can be remove and the implant is replaced to the submuscular pocket. (Frank J. Ferraro, MD, Paramus Plastic Surgeon)

Capsular contracture

Now in answer to your specific question, it is NOT the implant. It sounds as if you have a Baker Grade 2-3 capsular contracture.

Implants generally do not get harder or do not dramatically change shape with age (they may yellow and older implants may bleed).

It is your body’s reaction to the implant that is making them feel different. Whether you pursue surgical correction is up to you.

In the meantime, if you have had silicone implants for 10 years, you should undergo an MRI to evaluate implant integrity or lack of such.

I would encourage you to perform breast implant excercises to prevent or minimize ongoing contracture. Some surgeons have advise the off-label use of Accolate therapy but this has generally been of benefit in early capsular contracture (less than 6 months old).

The surgical options have been described. However, if there is no progression of firmness and the implants are intact, I generally do not recommend surgery unless you have a desire to change the implants. (Lavinia K. Chong, MD, Orange County Plastic Surgeon)

You probably have some contracture

Contracture is expected to some extent after the placement of breast implants. It is a matter of degree and time, really. Frequently, the contracture is mild and we leave it alone. More severe contracture can raise the question of treatment. Silicone gel implants over the long term are very prone to contracture.

Surgical treament almost always reduces or eliminates the problem but it can recur particularly in breast reconstruction cases in which the patient has had mastectomy, radiation therapy, or chemotherapy. (Sanjay Grover, MD, Orange County Plastic Surgeon)

If the implants have begun to project more prominently forward and feel harder, they are almost certainly being surrounded by exaggerated scar tissues known as “capsular contracture.” This can be left alone if it doesn’t bother you too much or it can be treated surgically. The options for surgery include removing the scar tissue and replacing the old implants with new ones in the same location as before (ie above or below the muscle).

Alternatively, especially if the old implants were above the muscle, changing into a new pocket under the muscle is often performed. (Sanjay Grover, MD, Orange County Plastic Surgeon)

Hard implants usually suggest capsular contrature

Over the years following breast augmentation, the implant itself changes minimally, but the tissue around the implant sometimes changes quite substantially. In the case of a saline implant, if the breast volume is the same, but the breast feels harder, tighter, or firmer than it was from the beginning, you probably have developed capsular contracture. The breast appearance and feel coud probably be improved with a “capsulotomy” or release of the scar tissue.

You should be evaluated by a board certified plastic surgeon to confirm this diagnosis and review your treatment options. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)

Diagnosis of capsular contracture

Your body forms a capsule of scar tissue around your implants within months of your breast augmentation surgery.

This is normal and desirable, as the capsule helps in the long-term support of your implants to prevent capsular contracture.

Capsular contracture refers to tightening of the capsule, which causes the implants to look or feel hard. In advanced cases, capsular contracture can also can breast pain.

If your implants have become firmer, you probably have a capsular contracture.

Reasonable options:

1. If it doesn’t bother you, capsular contracture is not medically worrisome, and you could consider doing nothing if the process is stable.
2. If it is mild and early but bothers you, certain medications (Singulair, Accolate, Vitamin E) show promise in reducing or at least preventing progression of capsular contracture.
3. If it is moderate to severe, you may wish to consider surgery to loosen or remove part or all of the capsule (capsulectomy or capsulotomy) with implant replacement. (Grant Stevens, MD, Los Angeles Plastic Surgeon)

Capsular contracture signs

If the implant feels firmer to you, this is most likely capsular contracture. This is easy to diagnose by physical examination. Are they silicone? A leaking silicone implant can lead to capsular contracture in a previously soft breast. Seek a consultation with a board certified plastic surgeon to discuss your options. (Peter Ashjian, MD, Glendale Plastic Surgeon)

Signs of capsular contracture

To answer your question, a little bit of background about implants and capsules may help. When the breast implant is first placed, your body will form a scar around the implant. We call this scar the “capsule” of a breast implant.

In some patients, this scar can become excessive and tighten around the implant. This tightening is known as “capsular contracture.” Depending on the degree of tightening, you may be able to see or feel this scarring around the implant, and it may even be tender.

The implants may change in position, most commonly appearing to “ride high” on the chest wall. In some patients, the capsule will begin to calcify over time and it takes on the feeling of an egg-shell. During your exam with your plastic surgeon, these signs of capsular contracture are usually quite easily noted.

The more difficult decision is what to do. If the contracture does not bother you, it may be best to adopt a wait and see. Surgical options typically involve replacing the implants and either removing the capsule itself, or changing the position of the implant. (Peter Ashjian, MD, Glendale Plastic Surgeon)

Capsular contracture more common with older implants and relatively easy to fix

I am always surprised by the number of women who don’t realize that they have a relatively easy option for addressing capsular contracture and that there may be very little down time associated with the surgery. And so many women with older implants or who have had surgery 10 years or more simply accept a less optimal appearance to their breasts and associated firmness.

But it doesn’t need to be this way. The older implants are known to have greater gel bleed which allows smaller particle size silicone molecules to bleed out from the implant shell over time. This is though to incite a low grade inflammatory reaction and potentially contribute to capsular contracture. In addition, placement of the older implants above the muscle has been shown to put patients at greater risk for this, as well.

So how do you know you have capsular contracture? Some common signs and symptoms include the following: recent change in the appearance of one side (higher than the other side and contracted) increasing firmness of your breasts diffuse pain to your breasts

Although capsular contracture can be present even without these signs, these are the most common which signal the need for you to see your plastic surgeon. I have seen many patients in the last several years who have benefited from simple removal of the capsule (either total or partial) and a change of implants and who are now very happy with their results. If you would like more information on this, please contact me by email through my website address below. (Ronald Friedman, MD, Dallas Plastic Surgeon)

The question of if you have developed a capsular contracture breast can be answered by examination and patient history.

There are also different grades of contracture. If the contracture is causing discomfort to the patient and the breast are firmer and appear to be in a different position than they were previously this is indicative of a higher grade contracture.

Having a plastic surgeon assess your breast can help determine if you do in fact have a capsular contracture breast and if a surgical intervention is recommended. (Robert J. Carpenter, MD, Cumberland Plastic Surgeon)

Capsular Contracture after Breast Augmentation

The diagnosis of capsular contracture breast is made by clinical exam. There is grading system based on how the implants look and feel.

If your implants stick out more and feel harder, you are describing capsular contracture breast, which is relatively common in 10 year old implants, particularly saline implants.

Often, these changes are mild and don’t really cause a problem. If they become very firm, misshapen or painful, reoperation is indicated. You should be evaluated by a board certified Plastic Surgeon. (Julio Garcia, MD, Las Vegas Plastic Surgeon)

Harder implants

As we age, our breast will undergo changes. Your implants may feel harder if you have lost some of your own breast tissue – like with weight loss of hormonal changes, or a capsule or scar tissue has formed around the implants. Saline implants typically feel harder than gel implants. I would suggest seeing a board certified plastic surgeon to examine your breasts and address your concerns. (Benjamin Chu, MD, FACS, Honolulu Plastic Surgeon)

Capsular Constracture Following Breast Surgery

When a breast implant is placed, either under the breast tissue itself or the underlying muscle, the body will naturally form a lining around the implant called a capsule.

The formation of this capsule creates a pocket in which the implant is contained. Occasionally, these pockets can shrink in size giving the breast a more firm feel. This shrinkage is called a capsular contracture breast. In addition, the lining itself may become thick, also giving a firm feel to the breast. The degree of firmness may be anything from a mild change to a breast that is very hard.

In some extreme situations, the capsular contracture can also lead to a change in the shape of the breast. Typically, breast implants placed beneath the muscle have less incidence of capsular contracture breast. If you have a silicone implant and there is some leakage, a capsular contracture may develop. In order to better evaluate the changes that you are experiencing, it would be best for you to consult with your surgeon or another surgeon experienced in the procedure of breast augmentation. (Benjamin Chu, MD, FACS, Honolulu Plastic Surgeon)

Preventing capsular contracture

It sounds like you might want to develop a relationship with a PS in your area and have them see. Capsular contracture breast makes the breast feel firm or hard and is the most common problem with breast implants (Robert J. Carpenter, MD, Cumberland Plastic Surgeon)

Capsular Contracture symptoms after breast augmentation

After every breast implant augmentation your body identifies the implant as a foreign object.

Just like pacemakers and silicone shunts between the brain and abdomen, the human body treats these silicone devices by limiting its exposure to the rest of the body by placing a small scar tissue layer around the device that we term a capsule. The capsule is helpful to keep the implants in the same location and usually stays soft and pliable. But for unknown reasons occasionally the capsule will tighten. As it does, the capsule shrinks and becomes more firm as it tightens around the implant. Many times the implant does not change, but seems like it shapes into a ball. This is basic physics as a sphere has the least amount of tension at all points around the ball. The main two symptoms of capsular contracture are a misshapen implant and capsule usually into a higher more projected position, and pain.A lot of studies have been performed to identify the causes of capsular contracture. No one factor has been identified. So, there is not one style of augmentation or surgery for its treatment that is universally effective. I think the keys to successful initially augmentation for prevention are: IV antibiotics prior to the procedure, irrigation with an antibiotic solution, and good hemostasis (control of bleeding) during the procedure. Capsular contractures are graded (1-4).

1. soft pliable and requires no treatment
2. capsule with some firmness and requires no treatment
3. firm capsule misshaping the implant but without pain. Options for treatment include a capsulotomy (scoring the capsule in multiple directions), neo-pocket (removal of the implant from the pocket, going on top of the old pocket to create a new pocket with a new implant), capsulectomy (removal of the capsule and implant and placing a new implant either above or below the muscle), or implant removal.
4. capsule is tight with pain. Options are the same as grade 3 (Scott Haupt, MD, Salt Lake City Plastic Surgeon)

Signs of Capsular contracture of breast implant

Signs of capsular contracture of breast implant can be breasts rising to a higher position on the chest or looking oddly constricted and artificially round, like a baseball.

The capsule can get so small that the implant feels firm (grade 3 capsular contracture) or can even feel hard and be painful (grade 4 capsular contracture).

I would recommend seeing your plastic surgeon so he can check it out and let you know what would be your best option, either way usually after 10 years a change of implants is recommened. (Alan N. Larsen, MD, Atlanta Plastic Surgeon)

Hard implants at 10 years are likely to be capsular contractures, especially if there has been a change in the feel of the breast.

If the implant does not move, or is firm, it is the scar around the device (capsule), not the implant itself that is hard. (Marshall T. Partington, MD, FACS, Seattle Plastic Surgeon)

Capsular Contracture after Breast Augmentation

Capsular contracture of breast implant typically presents as a hardening of the breast. This happens because the body forms scar tissue around the implant and the scar tissue becomes overly tight and thick.

This squeezes the implant and cause the breast to feel firm and hard. In severe cases the patient can have pain in the breast. The capsule can also deform the breast by changing the shape and location of the implant. Fortunately it is rare that the capsule becomes so think and hard that it causes an issue for patients. When capsular contracture of breast implant does occur it can be treated. Typically it is treated by removal of the scar tissue and placement of a new implant. This will soften the breast and improve the overall shape of the breast. This is one of the many reasons it is important to have you surgery performed by a board certified plastic surgeon. There are many techniques that plastic surgeons use to try and prevent capsular contracture from ever happening. (Frank J. Ferraro, MD, Paramus Plastic Surgeon)

If you breasts became more firm 10 years following breast augmentation, it is very likely a sign of capsular contracture.

Additionally, it could be a sign that your implant(s) have ruptured.

Implant rupture would be the most likely reason for CC at this point.

There are some other extremely rare things that could be going on (delayed seroma), but they are much less likely.

The best way to diagnose would be physical exam.

It is hard and swollen, ultrasound would be idea to evaluate for seroma. MRI could be used to determine if your implant is ruptured, but it is usually unnecessary in the decision making process. Your implant and capsule need to be completely removed to solve this problem whether or not the implant is ruptured. (Marshall T. Partington, MD, FACS, Seattle Plastic Surgeon)

A change in the firmness of the implants without any visible changes is generally what prompts patients to present to their plastic surgeon. The only way to know for sure is with a physical exam. This issue is generally corrected by removing the capsule as well as the implant and replacing them with new implants. I encourage you to seek consultation with a board certified plastic surgeon to help you with your issue. (Alan N. Larsen, MD, Atlanta Plastic Surgeon)

Capsular Contracture

What you describe sounds very typical of capsular contracture of breast implant. After 10 years it is not suprising to see a degree of this. You should see a PS to get an opinion on wether any surgery is required but provided you have no pain or signs of rupture (sudden pain , change in shape) then there is no need to intervene straight away. Best wishes (Joel B. Beck, MD, FACS, Bay Area Plastic Surgeon)