Breast Implants Capsules Alternative to Surgery
Capsular contracture with breast implants is a problem suffered by patients who have had breast augmentation surgery. This complication has bewildered many plastic surgeons as well as their patients. It is not pleasant for either party.
A capsular contracture complication is when the normal healing process of the breast augmentation which normally forms a flexible and thin shield around the implant becomes excessive. This thickening of the typical tissue found around the implant can make the breast feel hard, and even cause back pains. The scar tissue contracts( constricts ) as is the usual with scar and this is why its called capsular contracture. Plastic surgeons classify this according to grading system named after Dr. Baker.
Baker's Grading System
Grade 1 The breast is still soft and moves freely , no scar contraction.
Grade 2 The breast looks good but the breast feel firm.
Grade 3 The breast feels firm but also looks slightly distorted.
Grade 4 The breast feels hard and clearly looks deformed.
In all of these Dr. Baker's Grades except 1 , the breast implant be it silicone or saline , the implant itself is not hard. Its the scar tissue around the implant which compresses the implant which makes it feel hard.
Surgery For Capsular Contracture
Surgery is the last result and in Dr. Pasquale's practice he has resolved the issue at times times when the thickened scar tissue is removed surgically. There may be no other choice. Even so a very small minority reoccur.
Non Surgical Approach to Capsular Contracture
So Dr. Pasquale has tried to develop over the last 25 years a technique and protocol which deals as effectively as possible with this problem in a non-surgical way. First and foremost is prevention. That means such things as being meticulous with surgical technique and making sure that there is no post operative stimulation of capsule formation such as bleeding. If it does occur it must be dealt with and the blood removed from the surgically created area where the implant was placed.
The first step is early detection of a breast which may become firmer as healing takes place. This is essential to try and arrest the development of a grade 2 or 3 contracture. This is done by teaching our patients what to look for and we see them regularly for examination in the early stages of healing.
The second step if indeed it appears that the patient is starting to develop this complication we recommend that they take medication or continue with what we have started for a longer period of time. At the same time we recommend gentle ultrasound treatments which are sound waves to reduce the inflammatory process.
Depending on what our examination shows we may advise more aggressive massage or less aggressive or no massage. This will depend on many factors such as how long after surgery it occurs, what we think the reason for the complication and the like.This is individualized.
Injection with a steroid to the surrounding scar tissue may be tried and has worked in some cases, but this must be done only in selected patients and with great care as not to puncture the implant or cause tissue atrophy. It is also not widely accepted among all surgeons. Unless they have had experience with this technique which most plastic surgeons have not, we do not advise it for every patient. Dr. Pasquale has done this on selected patients on and off for many years and has had good result. Dr. Flowers and other plastic surgeons taught him this technique many years ago and despite the criticism, it does work according to Dr. Pasquale, the problem is many surgeons do not know how to use this approach. Many times surgeons and patients confuse this with placing steroids during the initial surgery which has NOT been shown to work by scientific research.
Stem cell injection with or without fat transfer around the capsule. This is an experimental technique which has not been studied to make a determination as to the benefits. As this is studied it may prove promising but as of this writing there is no evidence either way. Suzanne summers had a similar procedure done and that article is here
The alternate techniques available for non surgical treatment of capsular contracture are limited, but you may wish to try before undergoing another surgery. What ever technique is used as with all of medicine first do no harm.
- Authored by: Michael Pasquale