Breast Augmentation: Cost, Reviews, Photos

Signs of Breast Implant Scarring or Capsular Contracture

Breasts gradually “Sticking way out” and “feeling harder” are just two ways in which excessive scarring around breast implants manifests itself.

Normally, as part of the healing process, scar tissue is placed around the implants resulting in a soft cocoon. When the scarring is normal it is classified as a Class I contracture (Normal).

As the scarring becomes more excessive it can progress from only felt but not seen (Class II capsular contracture), to being felt AND seen (Class III capsular contracture – which sounds like what you have), to felt, seen and uncomfortable or painful breasts (Class IV contracture).

You need to return to your surgeon to be examined.

Capsular contracture can be detected by your plastic surgeon

A board certified plastic surgeon can easily detect and determine if you have capsular contracture just from feeling the implants and from the shape of the breasts. Encapsulation can vary depending on the severity and complexity of the case. If you experience some discomfort and feel abnormal firmness, it may indicate that you have excessive scar tissue around the implants.

You may want to discuss your options with your plastic surgeon. Unfortunately, even after 10 years, scar tissue may develop. If your case is mild, you may be able to use aggressive massage to soften the breasts. However, if it’s more severe, you may want to consider revisionary surgery. (Tom J. Pousti, MD, FACS, San Diego Plastic Surgeon)

If you prefer to see another surgeon for some reason, consult the directory of The American Society of Plastic Surgeons (www.PlasticSurgery.org) to help you choose.

Although various non surgical modalities have been tried (ultrasound, Vit E, accolade etc) none have been uniformly successful.

You MAY require either an Open CAPSULOTOMY (a surgical release of the scar(s))

OR a Partial CAPSULECTOMY (removal of the scar tissue) which may be done with replacement of the implants, if you wish. (Tracy Pfeifer, MD, Manhattan Plastic Surgeon)

Capsular Contracture Feels Like…

All implants form a capsule. Which ones will develop capsular contracture we cannot tell.

But if it occurs, diagnosis is very easy. The breast becomes harder, the implants become rounder and may be more projecting, or the omplant can displace.

The PS will be able to tell you if you have capsular contracture and can grade that contacture.

If it bothers you, the treatment is surgery. (Ronald Friedman, MD, Dallas Plastic Surgeon)

A capsular contracture is best diagnosed by physical exam and symptoms. If the implant is firm and does not move around very well or is elevated on the chest more so on one side than the other, then more than likely you have a capsular contracture. They can also be painful. (Tracy Pfeifer, MD, Manhattan Plastic Surgeon)

How to diagnose capsular contracture

The reality is that all women who have implants will develop some scar tissue or capsule around the implant. The degree of firming around a breast implant is categorized according to the Baker system: I: soft, natural; II slightly firm, implant edge not visible; III firm, implant edge visible and palpable; IV firm, painful and distorted. Very few surgeons will recommend surgery for Baker capsular contracture grades below III.

Once a Baker IV capsule distorts the shape by making it more narrow, shift upwards and possibly have the breast tissue fall off it, surgery is the only option. Lesser grades may be manageable with massage and or drugs such as Accolate or Singulair. A surgeon who has an active interest and experience with breast implants will be able to evaluate you. This diagnosis does not require any objective studies, such as a MRI. (Tom J. Pousti, MD, FACS, San Diego Plastic Surgeon)

Capuslar contractures following breast augmentation may require further surgery

Capsular contracture, or hardening of your breast implants, may be mild or severe. If mild, one can generally leave it alone; however, if severe, the implant can get quite hard or firm and cause some discomfort.

Additionally, the implant can look deformed and migrate upwards causing asymmetry of your breasts. In this case, many patients will benefit from open capuslectomy where the scar tissue is actually removed surgically. (Lavinia K. Chong, MD, Orange County Plastic Surgeon)

Breast implants themselves do not get harder or softer, it is the tissue around them that can change. Usually years after implants are put in the firmness is a capsular contracture.

This is scar tissue that has become thick or tight around the implant causing the implant to feel “hard” or distorted. It becomes a problem if it bothers you. Ten years after surgery the only remedy is surgery. (Mark D. Epstein, MD, Stony Brook Plastic Surgeon)

Signs of capsular contracture with breast implants

If your breast implants begin to feel very firm to the touch or appear to be distorted, you may have early signs of capsular contracture, or hardened scar tissue around your implants.

Often times they may feel painful to the touch as well, which can occur in more advanced forms of this condition. You can try to massage the implants to relieve some of these signs/symptoms, but you should contact and visit your plastic surgeon for a more thorough evaluation. This may ultimately require surgery to be corrected. (Mark D. Epstein, MD, Stony Brook Plastic Surgeon)

Do I have a capsular contracture?

The implants even at ten years should not only feel soft but, move freely around the pocket. If they are firm, do not look a like and have limited mobility in the pocket, they probably have a component of a capsular contracture. The issue is the degree of distortion and the firmness.

This is where the most accurate way to determine this is touching the breasts although in many cases a picture may be sufficient initially. The treatment in my practice involves moving the implant to the sub pectoral position if they are on top of the muscle and placing a smooth surface implant. I will either remove the existing capsule or create a new pocket in front of the capsule if the implants are already in the sub pectoral position termed “Neo subpectoral”. (Roger J. Friedman, MD, Bethesda Plastic Surgeon)

Touch, feel and look…

Are they hard, distorted, painful? does one look or feel harder than the other? Do your breasts hurt when it is cold outside? If so, than you have a capsular contracture that will only improve with surgery. Return to your surgeon and ask her or him . (Roger J. Friedman, MD, Bethesda Plastic Surgeon)

Capsular contracture breast implants

Capsular contracture is an abnormal hardening or circumferential compression of the implant. The causes have not conclusively been determined although some things that increase capsular contracture are: 1) Infection, 2) Hematoma (collection of blood around the implant), 3) History of breast radiation, and 4) History of previous capsular contracture. The best person to diagnose capsular contracture is the patient and the original surgeon who placed the implants and has been following you on a regular basis. Capsular contracture can be obvious such as hardening, pain, high-riding implant, and an abnormally round implant that is cahning shape. More subtle signs are mild discomfort. Capsular contracture can be progressive. Capsular contracture can develop at any time after the placement of the implant. It is also very important to note that breast pain, discomfort,or changing shape should not be attributed to just simply capsular contracture. You should see your plastic surgeon who can perform several studies in addition to a physical exam (i.e. mammogram, ultrasound, MRI). Always rule out breast cancer (if you have risk factors such as age, family history, etc.) (Grant Stevens, MD, Los Angeles Plastic Surgeon)

Capsular Contracture

It’s normal for the body to develop a scar or fabric around breast implants.

Occasionally this scar or film shrinks and tightens around the implant.

When this happens, the implant has less space to move and begins to feel tighter, firmer and rounder.

These changes can vary from very subtle to extremely obvious.

An experienced plastic surgeon can tell quite easily if there is capsular contracture.

It doesn’t necessarily require treatment if you are still happy with the appearance and feel of your breasts. (Niki Christopoulos, MD, FACS, Toledo Plastic Surgeon)

Why do capsules form around breast implants

A capsule is basically a scar around the breast implant. Every breast implant forms a scar. The extent of the scar has everything to do with how soft the breast is and how natural the shape becomes. There are two main reasons capsules form around implants. One is a trauma theory.

Early after breast implants are placed there is a highly vascular layer of tissue that forms around the breast implant. When there is excessive movement of the arms such as exercising or sporting activities occur this may cause small tears around this vascularized tissue.

These tears causes some bleeding around the implant. Where blood forms is where scars will tend to develop. For example if the blood pools along the lower part of the breast where gravity takes it, the lower pole may develop excessive scars and push the implant upwards. The other theory is a Biofilm theory. In this case the presence of blood make it a perfect medium for bacteria to proliferate around the implant.

Bacteria may seed the implant from activities such as teeth cleaning, urinary infections etc. When bacteria such as Staph Epidermidis lands around the implant they colonize the implant pocket and create a chronic state of inflammation which lead to the formation of excessive scars. This is usually a progressive problems and leads to gradual worsening of the breast capsule. When this occurs a total capsulectomy with implant exchange is needed to correct the problem. (Michael B. Tantillo, MD, Boston Plastic Surgeon)

Capsular contracture breast implants

If your implants are firmer, and have changed shape – then yes, this is most likely a capsular contracture breast implants. An experienced plastic surgeon can make this diagnosis clinically – by hearing your story and physical examination.

No other testing is required, unless there is a suspicion of a ruptured implant.

If you are having pain, or the shape change is significant or causing asymmetry, it could be fixed with surgery – capsulectomy and new implant placement. (Thomas Fiala, MD, Orlando Plastic Surgeon)

Capsular contracture

Capsular contracture breast implants is determined by physical examination. Plastic surgeons stratify implant capsules into four grades:

Grade 1 – normal capsule – capsule and breast are soft and completely normal

Grade 2 – the breast feels firm to the touch but looks normal and there is no pain

Grade 3 – the breast feels firm to the touch and looks abnormal because the implant is displace upward.

Grade 4 – the breast feels firm to the touch, looks abnormal and is painful

Your best advice will come from your surgeon at the time of consultation. (Thomas Fiala, MD, Orlando Plastic Surgeon)

What you describe is likely capsular contracture. Once the capsule that surrounds the implant, and 100% of women have a capsule but not capsular contracture breast implants, starts to become smaller, it will disttort the implant and make it feel harder. In cases where we do surgery to alleviate caspular contracture and we temporarily remove an implant, it is always soft. I think in your case it is not the implant causing the firm feeling , but a degree of capsular contracture. A visit to your surgeon can confirm this and also offer solutions for your case. (Michael B. Tantillo, MD, Boston Plastic Surgeon)

Capsular contracture breast implant after Breast Augmentation

Breast implants should remain soft for the lifetime of the implant.

Your body will form a scar around the implant which we call a capsular contracture breast implant.

This scar may be slightly firm and unnoticeable or can be very firm and painful with deformity of the breast and underlying implant.

No one knows the exact cause of capsular contractures but current research is pointing towards subclinical infection, bleeding episodes, or implant rupture.

You should have an evaluation by a board certified plastic surgeon to determine your unique situation and how to remedy your concerns. (Andrew Goldberg, MD, Fairfax Plastic Surgeon)

Signs of capsular contracture breast implant

When a breast augmentation is performed, the patient’s body forms a thin layer of scar tissue around the implants. Although capsule formation is normal, thickening of the scar tissue may result in a capsular contracture.

Capsular contracture breast implant is caused when the thickened scar tissue surrounding the breast implant squeezes. The complication is essentially defined by there being firmness when trying to squeeze the implant.

Therefore, the main sign of capsular contracture is increasing firmness of the breast implant. This is commonly associated with the breast implant appearing more round and higher. (Andrew Goldberg, MD, Fairfax Plastic Surgeon)

Signs of Capsular contracture breast implant After Breast Augmentation?

At the time of a breast augmentation, the surgeon creates a pocket into which the breast implant is placed. Over time the body will “encapsulate” the breast implant to protect itself from a foreign material.

The resulting capsule that surrounds the implant may, in differing percentages, begin to shrink and even squeeze the breast implant. This is known as a capsular contracture. The signs and symptoms of this phenomenon range in severity. It may be that the breast implant does not move as much as it once did yet the breast appearance has not been affected.

The capsule may begin to squeeze the implant where not only does the breast feel more firm, but also its shape has been affected. In more advanced cases, the capsule can be squeezed to the point that there is pain associated with the breasts and the breast shape has changed. It may look as though the implant has risen on the chest. There may be more rippling. I would refer you back to your original plastic and reconstructive surgeon to assist you in answering questions and let you know what your options are. (David Rapaport, MD, Manhattan Plastic Surgeon)

Capsular contracture after breast implants

The best way to determine if you have a contracture is to visit a board certified plastic surgeon for evaluation. Anytime an implant feels harder, or more firm, it is most likely from a contracture but evaluation and a plan to treat the problem will still be needed. After the augmentation was performed, a capsule (scar tissue) forms around the implants. This is typical and oftentimes post surgical breast displacement exercises are recommended to ensure this capsule and pocket stays open and therefore decreases the chance of a capsular contracture forming. There are different grades of a capsular contracture breast implant and typically patients elect to proceed with surgery if there is a noticeable implant shape change or shift in implant placement or the implant becomes uncomfortable and painful.

The best way to treat a capsular contracture is to remove the capsule via a capsulectomy and replace the implant. It is best to wait sufficient time after formation to decrease the chance of a recurrence – typically up to a year or as long as you can tolerate if painful. Most implant companies now warranty their implants for at least 5 years to help provide new implants and financial assistance for the additional surgery. (Joel B. Beck, MD, FACS, Bay Area Plastic Surgeon)