3911 sw 67th ave, Miami, FL 33155 ・ Phone: (305) 670-7650

3911 sw 67th ave, Miami, FL 33155
Phone: (305) 670-7650

Understanding Breast Capsular Contracture

Discover the Power of Acoustic Wave Therapy as a Surgery-Free Solution

What is capsular contracture?

  • All breast implants develop some degree of encapsulation as the body heals. This is normal and consists primarily of collagen fibers that hold the implant in place.
  • Trivial contractures that do not cause discomfort or pain and are not aesthetically displeasing do not need any treatment at all.
  • About 10-20% of breast implants develop contractures that become noticeable. These are graded on a scale of I-IV (known as the Baker Scale):
    • Grade I – breasts look and feel natural. Breast is soft and natural in size and shape.
    • Grade II – breasts show minimal contracture and firmness. Breast is a little firmer than normal but still looks somewhat natural.
    • Grade III – breasts show moderate contracture and firmness which is very noticeable. Breast is firm, with some distortion in size and shape.
    • Grade IV – severe contracture is observed and obvious symptoms experienced by the patient. Breast is very firm and grossly distorted.

How can you tell this is starting to happen?

  • One of the first capsular contracture symptoms is firmness to the touch or in appearance of the area around the implant.
  • There is pain or soreness of the breast.
  • As it progresses, the breast starts feeling hard and unnatural.
  • Eventually, the breast can become distorted and asymmetry between the breasts start to develop.
  • While there are many images of capsular contracture on the web, what pictures and videos cannot show is how capsular contracture feels. Patients report feeling:
    • “Hard, unnatural breasts”
    • “Feel different from normal breasts”
    • “Always aware of it”
    • “Always have some degree of discomfort in the breast or chest”
    • “Breasts with capsular contractures are neither physically nor aesthetically pleasing”

How Is a capsular contracture diagnosed?

  • A picture alone is usually not enough to diagnose a capsular contracture.
  • The best way to diagnose a capsular contracture is via physical examination with image guidance, usually ultrasound. Rarely is a CT or MRI needed to diagnose capsular contracture.
  • It’s important to see your plastic surgeon in person, if you suspect you may have capsular contracture.

Why does it happen?

  • Development of capsular contracture does not mean there was a problem with the surgery. It can happen to anyone.
  • Foreign Body Reaction – immune system reacts to a foreign body placed inside the body.
  • Infection
  • Hematoma at the implant site
  • Trauma
  • Radiation to the area
  • Having an underlying autoimmune condition
  • Biggest risk is revision breast surgery

What can be done to prevent it?

  • Following your plastic surgeon’s instructions is the most important advice to help prevent worsening of a capsular contracture.
  • Massage therapy has been used to control the development or worsening of contractures but there’s not a lot of data to support this. It can be done by patients themselves in the comfort of their homes and does not require any expensive medications or interventions.
  • No medications have been shown to reduce contractures consistently. Some patients find topical vitamin E creams or ointments help. Some plastic surgeons may use:
    • Steroids – dexamethasone either orally, intravenously, or injected at the implant site
    • Leukotriene receptor agonists (LTRAs) – montelukast (Singulair) or zafirlukast (Accolate)
    • Antibiotics
    • NSAID’s – can help with postoperative pain as well
    • H2 receptor antagonists – famotidine, roxatidine (not available in US)
    • Simvastatin has been studied but is not used much because there is not much evidence it works.

Is a capsular contracture the same as breast implant illness or implant rupture?

  • No, these are all different conditions. Many women who have breast implant illness never have a problem with capsular contractures.
  • The vast majority of women who have capsular contracture never develop breast implant illness.
  • For more information about breast implant illness, please click here.
  • Implant rupture is also not the same as capsular contracture, although capsular contracture can deform an implant. Usually, capsular contractures develop much earlier than implant ruptures.
  • Most implant ruptures occur 10 to 15 years after implantation.
  • Incidence increases over time.
  • About 15% of implants will rupture by 10 years after implantation.
  • Breast asymmetry, pain, and loss of breast shape all point to either rupture or contracture but contractures usually occur earlier.
  • The best way to diagnose whether someone has a capsular contracture or an implant rupture is by examination and imaging (usually ultrasound).

Treatment Options for Capsular Contracture

What treatments are available for capsular contractures?

  • If contractures do develop, early intervention with acoustic wave therapy (AWT) can not only prevent contractures from getting worse, they can even reverse contractures.
  • Patients even get treated with AWT prophylactically to prevent contractures.
  • For more severe contractures, we use a medical grade AWT machine with ultrasound guided hydrodissection to get the best results.
  • We can treat even Grade IV contractures with this protocol.
  • Sometimes, for severe Grade IV contractures, revision surgery is the only viable treatment option that can completely resolve an aesthetically displeasing result. Even at this level of contracture, however, interventional procedures can control the pain or discomfort without requiring revision surgery.
  • Revision surgery can often correct the cosmetic result but does not always control the pain or discomfort.

What is acoustic wave therapy (AWT)?

  • AWT is a non-invasive, all-natural treatment option that uses sound waves to treat the contracture. It can be used alone or in conjunction with ultrasound-guided hydrodissection.
  • This therapy has been available since the 1980’s. A form of this therapy has been used to break up kidney stones without surgery for many years. As technology has advanced, the equipment has become more sophisticated, precise, and compact, which allows us to offer this therapy in the office setting to patients with a variety of conditions, including capsular contracture.
  • Ultrasound-guided hydrodissection is injection of either normal saline or a medication at the capsular contracture to help soften the contracture, control discomfort, and resolve inflammation.
  • The injection is done under ultrasound guidance to ensure correct placement of the medication and to avoid damaging the implant or the breast tissue. This makes the procedure very safe.

What is the treatment protocol?

  • Usually requires 5-10 sessions, twice a week.
  • Not all sessions include ultrasound-guided hydrodissection injections.
  • Done in our office procedure suite in our up-to-date facility in South Miami.
  • For patients with anxiety or fear, we provide sedation to make the procedure even more comfortable.

Are there any side effects or risks associated with treatment?

  • Side effects are minimal and usually just soreness at the hydrodissection sites. These resolve with icing and rest on the day of treatment.
  • All procedures to treat capsular contracture, including surgery, can result in infection, bruising, or implant rupture. By using ultrasound guidance and sterile technique, we can minimize these risks.
  • Because it is so safe, patients who have had reconstructive surgery after mastectomies or radiation therapy can have this treatment and avoid revision breast surgery.
  • Neither AWT nor hydrodissection preclude breast surgery in the future or change the breast anatomy.

Is this treatment covered by my health insurance plan?

  • Most plans do not cover this treatment.
  • Even if it is not covered by a plan, FSA and HSA accounts can be used to cover the cost.
  • The cost is considerably less than the cost of revision surgery.

Want more information?

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(305) 670-7650