Capsular Contracture

Capsular contracture is the most common complication after breast augmentation, up to 10% and the most common reason for further surgery. Unfortunately, it is not possible to predict who will have this problem or when it will occur.

Although breast augmentation is an overwhelmingly positive experience, there are potential problems that can develop. The most common of these is called a capsular contracture.

In virtually every woman who has breast augmentation, the body responds to the presence of the implants by forming a capsule of scar tissue around the implant. Like scars on the skin surface, the development of scar tissue is a process that starts within days of surgery and continues for a year or more. Most often, the presence of this scar capsule is not detectable, and the breasts look and feel very natural. Sometimes, however, the capsule contracts around the implant. The breast will then feel firm to hard, and in some cases, the shape of the breast will be distorted.

The human body forms a layer of scar tissue around any implanted material, and this also happens with breast implants. Usually, this layer is quite thin and soft, but in some people it can become thick and hard, making the breast feel and look unnatural. When this occurs, it is called a capsular contracture.

Capsular Contracture in Thailand can be quickly corrected by our Thailand Surgeons, all being high experienced in the corrective surgery of Capsulectomy.

No one knows exactly why the capsules surrounding the breast implants contract, nor can they predict who will develop this problem.

It can occur almost immediately or happen many months later. It can affect one or both breasts.

People have attributed this to wound healing, infection, and minor bleeding.

Probably the most widely held theory is related to any implant and popular thought attributes this to a biofilm that develops on the surface of any prosthesis. This is actively being studied as it relates to implants used in many fields of medicine such as orthopedics, cardiac surgery, dental surgery, urology, plastic surgery, etc.

A biofilm is a layer of bacteria with their associated excreted proteins that form a layer on the surface of the implant. The bacteria become dormant and somewhat resistant to normal doses of antibiotics.

The bodies response to the biofilm (sometimes called bio slime) results in some of the complications associated with implants including capsular contracture.

Textured breast implants are routinely used in Thailand, helping deter capsular contracture formation because their rough surface discourages a hard capsule of scar tissue from forming around the breast implant. In scientific studies, however, this benefit has been shown only in sub glandular (above the muscle) breast augmentations. Since most breast implants today are placed fully behind the chest wall muscle (submuscular or sub pectoral), the benefits of textured implants are limited. The disadvantages of textured implants are that the texturing process makes the wall of the implant thicker, making it more likely that you will be able to see or feel the edges of the implants.

Under the muscle placement (sub-pectoral or partially submuscular) of the implant reduces the risk of capsular contracture to approximately 8- 12% over your lifetime. Over the muscle (in front of the muscle, submammary or sub glandular) has a 12-18% chance of capsular contracture. Complete under (totally submuscular) provide even more protection, with your risk of capsular contracture being reduced to 4-8% over your lifetime.

Massage may or may not help prevent capsular contracture formation. Although there are no good studies proving the effectiveness of this technique, many plastic surgeons do believe in massage. Our Thailand Surgeons believe in massage on an individual basis. They are not convinced that massage alone can help prevent capsular contracture formation, but do believe that massage can help the breasts soften post-operative. It may hasten implant “dropping and fluffing” (implant settling into the pocket as the muscle relaxes, and the implants descend into the proper position). In addition, to helping reduce swelling and make a patient feel better faster post-operatively.

The “no-touch” technique. In this method, the sterile package containing the implants is opened only at the moment they are ready to be inserted into the body. No one else handles the implants except the surgeon. The surgeon resterilizes the skin of the breasts with betadine, drapes the operative field surrounding the breasts with new sterile towels, and replaces his gloves. The surgeon washes the surface of their new gloves to remove any powder, and only then will he touch the implants. When the implants are inserted into the body, they take care, not to allow the implants to touch any instruments, the skin of the patient, or any sterile drapes surrounding the operative field. In this manner, there can be little chance of surface contaminants on the implants once they are inside the body. All of these measures help ensure that no foreign substances attach themselves to the implant, which could inflame the surrounding tissue and cause complications such as capsular contracture.

Initially, you may notice that one or both of your breasts are not as soft as they once were or may actually begin to harden. Your breasts may begin to look or feel different, or you may experience some discomfort from the tightening of the capsule. The appearance of any of these signs should alert you to the need to have your breasts examined by a plastic surgeon at your earliest convenience.

Plastic surgeons grade the quality of the capsule around breast implants using a system called Baker Classification.

Grade I: When a breast implant has a perfect result of softness and appearance

Grade II: If the implant starts to develop firmness, but still looks completely normal

Grade III: If a contracture advances enough, such that it feels not only firm, but also now is asymmetric or drawing the implant upwards

Grade IV: The most advanced capsular contracture is a Baker Grade IV, which means the implant feels hard, looks asymmetric or distorted and is now painful.

In a seven-year study, capsular contracture developing to a stage Baker Grade III or IV was found to develop in as high as 15% of patients. It was also the most common cause for reoperation in the postoperative period. Patients with Baker Grade II contractures do not require any treatment. When a patient reaches Baker Grade III or IV, called advanced capsular contracture, and treatment is required..

There are two types of surgery: total capsulectomy and sub-total capsulectomy.
In the first type, the whole of the capsule is removed, and the breast implant is replaced with a new one.

The sub-total capsulectomy involves the partial removal of the capsule but only if the implant has not broken or moved. Either way, the implant will probably be removed.

The idea is to remove the troublesome capsule and insert a new implant that will last longer than the previous one. Your surgeon has several options open to them regarding the incision and positioning of the implant, depend on your body type and personal recommendations.

Your surgeon will break open the scar tissue of the capsule that releases the tension and remove this. They will then make an incision is either the crease underneath the breast, the armpit or the edge of the areola.

The incisions are then closed with fine stitches that are either dissolvable or non-dissolvable ones. They will place tapes over the stitches for additional support. A light dressing will also be put in place.

This surgery takes around 1.5 hours to 3 hours to perform and is usually done under a general anesthetic. It usually means an overnight stay in hospital although, in some cases, it can be done as day surgery. It is more complex than breast augmentation surgery.

After your Capsular Contracture surgery in Thailand procedure is completed, you will be taken to recovery and then returned to your hospital room at Phuket International Hospital. Once there, a nurse will check your blood pressure and other vital signs. She will also check the condition of your surgical wounds. Surgical drains (small tubes) may still be in place. Don’t worry, these are temporary only and are only there to remove excess fluids.

Your breasts will feel sore and bruised. You will be tired and out of sorts that are a normal reaction to surgery. A general anesthetic can make you feel groggy, nauseous and disorientated for up to 48 hours. You will have some pain, but this can be controlled with pain medication.

You will have to wear a special bra for a couple of weeks, same as you did after your Breast Augmentation. You will also have to keep the dressings in place for that time. Make sure they do not get wet. After a 7 days, the wounds will be checked and cleaned but until that time, ensure that the dressings stay dry.

There will be scarring, and these will have a firm, pink appearance for the next six weeks. Bear in mind that these will stay the same size for several months. It could be two years before they completely fade.

As with other forms of surgery, you need to avoid any unnecessary bending, stretching or physical activity. You should get plenty of rest although you may be able to do some light activities after a couple of days.

Do not undertake any sports or other physical activities for at least 7 to 10 days. You are looking, on average, at two weeks for a full recovery.

You will have to attend a series of regular follow-up visits both in Thailand and when you return home, to check on your progress. These are to ensure that there are no long-term complications such as infections or the formation of capsules.

The main benefits of having Capsular Contracture correction surgery in Phuket is the release of the unpleasant constriction of the breast implant caused by the capsules. Plus, the insertion of a new implant to replace the affected one will ensure a more natural looking appearance.

You will feel more confident and self-assured about your appearance. The breasts will be softer and more natural looking. As will all cosmetic surgery make sure you have realistic. You may or may not need new implants although this is up to your surgeon. If you do, then your surgeon may change their placement as well.

No surgery is without its risks. This procedure is safe, but complications do happen. The main one is the reforming of capsules around the new implants. Capsules are a normal bodily reaction when confronted by a ‘foreign body’, but the danger is that they will increase in size to the point that they constrict or damage the implant

The potential complications of these procedures are similar to those that may occur after the initial breast augmentation. Postoperative bleeding is a particular risk after surgery for capsular contracture. The old implant may be damaged during the surgery, as it is not designed for removal and reinsertion. The damage is something that may not be apparent at the time of surgery, but could potentially lead to rupture of the implant at a later time.

Infection is uncommon, but antibiotics are given to minimise the chances of this occurring. In some cases, the previous incision can be used, but for capsulectomy it is often necessary to make a new incision. Some people form bad scars, red lumpy scars my need treatment with steroid injections or silicone sheet. Keloid scars may be difficult to treat with any form of treatment.

Capsular contracture often does not affect both breasts to the same degree and some degree of breast asymmetry may persist after the operation. Replacing the implant in a new pocket will alter the shape of the breast. Despite all the precautions taken to minimise the chance of capsular contracture recurring, it may not be possible to prevent it from happening again. The only way to be certain of, not developing a further capsule is to have the breast implants removed and not replaced.

The cost of having capsular contracture corrected through Capsulotomy surgery in Thailand may vary. The price of capsular contracture correction varies for each person. The cost depends on the extent of treatment necessary.

  • Treatment of the breast capsule on both sides and replacement of both implants
  • Treatment of the breast capsule and removal of both implants without replacement.
  • Treatment and release of the capsule on both sides without replacement or removal of implants

Our advice to get a clear picture of what is going to work to achieve your results is to submit your images and patient information so our Thailand Surgeons can provide you with recommendations. These recommendations will include what surgery will achieve your results, confirmation of price and duration you require for recovery in Phuket. The more information you can provide on the original surgery and any investigative step you have taken, the easier it will be for the surgeon to determine the best course of treatment.

The pricing below is  for standard Capsular Contracture correction in Phuket and should be used a  guide only pending having surgical recommendations provided.

Surgery THB AUD
Removal of Breast Implant  + Capsulectomy 100,000 $3800
Simple Revision of Breast Implant 150,000 $5,800
Capsular Contracture Information

The following information sheet has been created as a general guide to assist patients considering having Capsular Contractor Corrective Surgery in Thailand and is intended to provide a broad overview of the important considerations related to the decision to have capsular contracture corrected through surgery. The specific nature of the surgery will vary between individuals and is dependent on the unique circumstances of each person.

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