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Capsular Contracture
Capsular Contracture: Beverly Hills Breast Revision Expert for Capsular Contracture

RISK FACTORS FOR CAPSULAR CONTRACTURE:


There are many reasons why some patients develop capsular contracture.  After many years of research, plastic surgeons and researchers have been unable to predict the exact cause of breast implant capsular contracture. Studies, however, have shown that some conditions may increase the risk for capsular contracture.  Whether or not you have any of these risk factors, if you feel that you have developed early or late capsular contracture, schedule a consultation for capsular contracture with our board certified plastic surgeon, Dr. Raffy Karamanoukian, in the Los Angeles area.  The following problems have been associated with capsular contracture:

  1. Radiation Treatment to the Breast or Chest Wall
  2. Breast Implant Infection or Subclinical Infection
  3. Breast Implant Hematoma or Seroma Formation
  4. Subglandular Breast Implants (Higher Rate of Capsular Contracture than Submuscular Implants)
  5. Trauma or Traumatic Rupture of Breast Implant


BAKER'S GRADE CAPSULAR CONTRACTURE:


Capsular contracture is an established diagnosis and clinicians have sought out ways to not only prevent capsular contracture but to treat the problem.  The first step in the diagnosis of capsular contracture is to identify the severity of the problem using a grading scale known as Baker's Grade for Capsular Contracture. The following system seeks to identify patterns in capsular contracture and breast implant tissue capsule formation in order for physicians to accurately and objectively compare information regarding the problem.  

  1. Class I: The breast appears natural on examination.  There is no evidence of breast implant thickening and there is minimal evidence of breast implants on examination.
  2. Class II: There is minimal breast implant contracture.  Often, there is a palpable thickening around the implant but there is minimal visible change in the breast when examined. 
  3. Class III: There is moderate breast implant contracture. There is palpable thickening of the implant capsule and hardening of the breasts that can be assessed on examination.  There is a visible change in the shape of the breast.
  4. Class IV: This is known as severe breast implant contracture.  There is palpable thickening of the breast tissue and tissue capsule.  Visible changes are more severe than in Baker's Class III and there is some pain associated with the breast. 

Patients who have Class IV capsular contracture are often debilitated by the problem as pain and stiffness begin to affect activities of daily living.  Severe capsular contracture can be managed with surgical capsulectomy and patients are often able to regain an active lifestyle and restore natural breast contours after surgery. Pain and stiffness can be dramatically improved after capsular contracture surgery, but if the procedure is performed early, physical therapy and occupational therapy may be needed.  Class IV capsular contracture is likely caused by progressive inflammation and thickening of the breast implant tissue capsule. 

 

If you feel that you may have capsular contracture, it is important that you attempt to establish the diagnosis as early as possible in order to prevent progression of the tissue capsule and minimize the risks to your breast implants.  Dr. Raffy Karamanoukian will begin the consultation with a full discussion of capsular contracture and include a breast examination and possible diagnostic studies such as mammogram, ultrasound, or MRI to obtain a more accurate diagnosis of your problem.  

 

PREVENTING FUTURE CAPSULAR CONTRACTURE:

  1. Closed Filling System: One of the most meticulous approaches to minimize the risk of capsular contracture in saline implants is to use a closed filling system that minimizes the theoretical contamination of the sterile saline solution placed within a saline breast implant.  Dr. Karamanoukian believes that this closed filling system for saline implants maximizes aseptic technique and sterile technique to reduce technique driven and iatrogenic causes of capsular contracture.  During your consultation for capsular contracture, discuss this option with Dr. Karamanoukian if you are choosing saline breast implants.
  2. MInimize Hematomas: A hematoma is a blood collection that forms in the surgical dissection pocket when performing any type of surgery.  In breast augmentation, the submuscular plane the pectoralis muscle is very vascular if manipulated and can cause a small collection of blood to form around the breast implant.  If this occurs, some patients will develop an inflammatory reaction that may lead to thickening of the breast implant tissue capsule.  To minimize the risk of this occuring, you should follow the strict activity recommendations recommended by your surgeon and also minimize the intake of any herbs or supplements that may thin your blood before surgery.  Many patients do not realize that some very common foods and vitamins can lead to thinning of the blood before plastic surgery.  Even Vitamin E can lead to an increased risk of bleeding.  Further, some medications like Aspirin may have effects in your body weeks after you take them, so make sure you discuss all of your medications with your plastic surgeon prior to breast augmentation. 
  3. Massage Breasts: After breast augmentation, you should begin massaging your breasts including the medial cleavage area and the underside of your breasts.  Some plastic surgeons will discount the utility of breast massage, but Dr. Raffy Karamanoukian believes that it is an important element in obtaining perfect results.  The massaging allows the breasts to settle into the pocket and assume a relaxed position within the breast.  Dr. Karamanoukian will provide you with his own protocol for breast implant massaging after breast augmentation. 
  4. Sterile Technique: At the heart of breast implant surgery is the concept of sterile technique.  It is thought that capsular contracture may be caused by contamination, although subclinical, of skin bacteria that may elicit an inflammatory response in the tissue capsule. This exaggerated inflammatory response may cause  thickening of the breast capsule, leading to breast tissue hardness and loss of compliance.  

 

DUAL PLANE BREAST AUGMENTATION:

 

If you have significant capsular contracture with upward movement of a breast implant that is asymmetric, you may benefit from a capsulectomy and revision of your breast implant pocket to a dual plane.  This will allow relaxation of the breast implant inferiorly to allow for a more natural appearance of the breast, thus minimizing asymmetry.  To learn more about the dual plane or biplanar technique for breast augmentation please schedule a consultation with Dr. Karamanoukian in Beverly Hills or Santa Monica.


  1. What is the basic problem with capsular contracture? Capsular contracture is a breast implant problem in which the normal tissue capsule around a breast implant begins to thicken and ultimately cause problems with the breast implants.  Breast implants may rupture, shift, and the breast may harden.  If you think you have capsular contracture, Los Angeles plastic surgeon Dr. Raffy Karamanoukian can help you diagnose and treat your condition.
  2. What methods are used to diagnose capsular contracture?  
  3. How do you diagnose breast implant rupture? 
  4. Choosing Breast Implant Size - Video
  5. What are some signs of breast implant capsular contracture? Breast implant capsular contracture can occur from saline and silicone breast implants that have been placed long ago or as early as a few months prior.  Breast capsular contracture is caused by an increased thickening of the tissue capsule that is naturally formed around a breast implant.  The treatment of breast capsular contracture is initially conservative until there is obvious progression of the thickened capsule.  These signs may include thickening of the tissue capsular, hardening of the breast, changes in the shape and size of the breast, and recognized asymmetry of the breast that occurred after initial implantation.  Breast implant capsular contracture can cause significant cosmetic and medical changes in the breast that should be addressed in the early stages.  Dr. Raffy Karamanoukian is a breast implant capsular contracture specialist and is available for consultation for the procedure.  He has extensive experience in the surgical and nonsurgical management of capsular contracture and performs all surgeries in Santa Monica and Beverly Hills.  To schedule a consultation for breast implant capsular contracture, please call our Los Angeles plastic surgery patient care coordinator at 310-998-5533.
  6. How can we treat repeated capsular contracture of the breast? Capsular contracture can occur as an early or late stage complication after breast implant surgery.  Both silicone and saline breast implants are vulnerable to capsular contracture and a capsulation.  Dr. Raffy Karamanoukian is a board certified plastic surgeon practicing in Santa Monica and Beverly Hills.  He has extensive experience in the management of capsular contracture of the breast as a result of cosmetic breast enhancement surgery.  In an unique subset of patients, repeated capsular contracture can lead to longstanding thickening and hardening of the breast related to the thickened tissue capsule.  These recurrent capsular contractures can cause physical changes in the breast as well as symptoms of pain and discomfort.  If you have a repeat capsular contracture or recurrent capsular contracture and wish to undergo treatment, the surgical protocols described by Dr. Raffy Karamanoukian can improve your long term condition.  Dr. Karamanoukian advises the patients to undergo implant replacement that may be one staged or dual staged in order to reduce the potential bacterial load surrounding an existing breast implant.  Dr. Karamanoukian sees patients in consultation from his Los Angeles plastic surgery office and is available for consultation by calling 310-998-5533.
  7. Can hard breast implants be caused by capsular contracture? Capsular contractures of the breast are a known complication after breast augmentation surgery.  Both saline and silicone breast implants placed under the muscle and or above the muscle can be implicated in the development of capsular contracture and breast tissue capsular hardening.  The initial changes that women notice after the development of capsular contracture include hardening or thickening of the breast tissue surrounding a breast implant.  This is likely caused by a thickened tissue capsule that begins to restrain and restrict the movement of the breast implant within the breast.  This may occur after submuscular or supramuscular implantation.  Dr. Karamanoukian is an experienced plastic surgeon practicing in Santa Monica and Beverly Hills and can provide you with an analysis of your breast capsular contracture risk prior to initial breast augmentation or after development of capsular contracture.  He is available for consultation at 310-998-5533.  Dr. Karamanoukian also is a specialist in breast enhancement surgery including breast lift, breast reduction, and breast implant revision.  During your consultation you will be advised of the many options available to treat capsular contracture as well as restore the natural contours of your breast.
  8. Can saline breast implants cause capsular contracture?  Saline breast implants remain popular for the majority of the last decade as a result of limitations in the use of silicone breast implants.  Both saline and silicone breast implants can be involved in a thickened tissue capsule that causes capsular contracture.  Dr. Raffy Karamanoukian is a board certified plastic surgeon in Los Angeles and can provide you with many options for capsular contracture.  If you have saline breast implants and are concerned that you may have developed capsular contracture, Dr. Karamanoukian can perform a physical examination during your consultation and determine whether the changes in your breast tissue are result of capsular contracture or breast implant rippling or visibility.  He is available for consultation at 310-998-5533 and can provide you with a sound surgical plan to repair the capsular contracture.  If you have questions related to your breast implants, whether saline or silicone, please call the office of Dr. Raffy Karamanoukian to schedule your comprehensive consultation for breast implant revision
  9. Can I have a breast lift at the same time as a breast capsular contracture repair?  Often, breast implant capsular contracture can encourage a late consequence of a silicone or saline breast implant.  The changes inherent in the tissue capsule can cause changes in the overall shape, size, and appearance of the breast.  These changes can occur in combination with breast droopiness as a result of normal aging process.  Dr. Raffy Karamanoukian is an expert in breast enhancement surgery and can provide you with a detailed plan regarding the use of combination breast lift and breast capsular contracture surgeries.  In many cases, the patients who request breast capsular contracture may require a change in the implant as well as a breast lift to improve the overall contours of the breast.  Dr. Karamanoukian is a double board certified plastic surgeon who practices in Santa Monica and Beverly Hills.  He is available for consultation in Los Angeles by calling 310-998-5533.  Our plastic surgery patient care coordinator can help facilitate your visit with Dr. Karamanoukian and can provide you with basic answers to your questions about breast lift surgery and or breast capsular contracture surgery.
  10. What is capsular contracture? Capsular contracture is a benign condition that usually affects intact and ruptured breast implants that are placed for cosmetic or reconstructive reasons.  The patients who have breast implants or volume enhancement or breast cancer reconstruction may develop a tissue capsule around a breast implant.  This tissue capsule can often become thickened and in extreme cases, cause changes in the consistency and shape of the breast.  Capsular contracture is essentially a hardening and thickening of the tissue capsule surrounding a breast implant, which ultimately leads to breast changes, changes in breast shape and volume, with restriction of the breast implant, implant malposition, and breast implant asymmetry.  The patient may also develop symptoms associated with capsular contracture including breast pain, discomfort, and achiness of the breast.
  11. Does Dr. Karamanoukian specialize in capsular contracture? Capsular contracture is a benign condition that can have severe implication.  Both cosmetic and medical problems can be associated with breast implant capsular contracture.  Trusted plastic surgeon Dr. Raffy Karamanoukian is a specialist in breast implant revision and capsular contracture.  During your consultation with Dr. Karamanoukian, he will examine your breast and obtain a thorough medical history in order to determine the grade of capsular contracture in your breast.  Often, capsular contracture can be diagnosed with a simple physical examination and breast examination, whereas in more complicated and complex cases, diagnostic studies such as MRI, mammogram and ultrasound are used to detect implant rupture and thickening of the breast capsule.  Dr. Karamanoukian can make a diagnosis and determine which surgical and nonsurgical option is best for your condition.  The patients who have subclinical infection or implant rupture associated with their breast implant capsular contracture, may need additional procedures in order to reduce the recurrence rate of breast implant complications.  Dr. Karamanoukian is assistant clinical professor or plastic surgery at the University of California Irvine School of Medicine and can help you improve the cosmetic appearance of your breast and reduce the recurrence of capsular contracture.  Please call our Los Angeles plastic surgery patient care coordinator at 310-998-5533 to schedule your consultation.
  12. What can I expect during my breast implant capsular contracture consultation? During your consultation, Dr. Karamanoukian and his physician assistant will go over your thorough medical history and surgical history to determine the likelihood of capsular contracture.  The medical exam will be followed by a through physical examination in order to correlate your symptoms with a diagnosis of capsular contracture or breast implant malposition.  During the consultation, Dr. Karamanoukian will provide you with several options including breast implant removal, breast implant revision, capsulectomy, capsulotomy, or a combination of nonsurgical option.  Throughout the consultation, you will be able to discuss these options in detail including recovery time and risk of breast implant capsular contracture.
  13. What is a capsulectomy? If a diagnosis of capsular contracture is made, there are several surgical options for breast implant revision. The most common surgical procedure for capsular contracture release is known as capsulectomy, in which the entire breast implant capsule is removed from the breast implant pocket.  Some surgeons may advocate a procedure known as an anterior capsulectomy in which the anterior aspect of the capsular contracture is removed while maintaining the posterior most implant capsule intact.  A partial or complete capsulectomy is chosen based on the specifics of your condition.  During a capsulectomy a breast implant is either removed or replaced.  Replacement of a intact breast implant is often associated with a higher risk of recurrence, but this is still a viable option in many patients.
  14. What is a capsulotomy? A capsulotomy is a surgical procedure wherein the tissue capsule surrounding an intact breast implant is separated in order to relieve the restriction and pressure surrounding a tight capsular contracture.  A capsulotomy can be performed as an outpatient breast revision procedure and has high rates of success in most cases.  To determine whether a capsulotomy or capsulectomy is needed, visual inspection of your breast implant capsule during surgery is often necessary.  The actual thickness and volume restriction of a particular breast implant capsular contracture is often difficult to assess until the time of operation.  Dr. Karamanoukian can discuss your options and provide you with alternative if you should choose to forgo a secondary surgical procedure.
  15. What is recovery life after breast implant capsular contracture surgery? The extent of recovery is largely determined by the complexity of your capsulectomy or capsulotomy procedure.  Many women wish to undergo a combine procedure including capsulectomy, capsulotomy and simultaneous breast lift or implant replacement.  In these particular cases, recovery is typically three to seven days and the patients are able to resume normal activities within several days of the procedure.  Incisions usually heal within the first week of surgery and activity is usually restricted to non-strenuous exercise.  Capsular contracture surgery often has less downtime and a typical breast implant surgery or breast reduction surgery because there is less surgical dissection associated with the underlying muscle.
  16. When is my first followup after breast implant capsular contracture surgery? Typically, the patients are asked to return to the office of Dr. Raffy Karamanoukian within three to five days after their cosmetic plastic surgery.  Recovery is usually expedited by avoiding strenuous activity and maximizing the nutritional content of your postoperative diet.  A high protein load and vitamin-rich food can improve wound healing and can maximize your chance of success after surgery.  Dr. Karamanoukian will prescribe a pain medication and an antibiotic after your surgery.  Most patients will obtain a surgical dose of an IV antibiotic during their surgery.
  17. What type of anesthesia is used for capsular contracture surgery? In our Los Angeles plastic surgery office, Dr. Karamanoukian performs most procedures on an outpatient basis in an accredited operating room.  Anesthesia types include IV sedation and general anesthesia, in consort with a board certified anesthesiologist who specializes in the surgical management of cosmetic surgery patients. These procedures can be performed safely without hospitalization or a lengthy recovery.  During your consultation with Dr. Karamanoukian, he will provide you with the options for anesthesia and orient you with the anesthesia process before and after surgery.  Our team of anesthesiologists are board certified and have extensive experience with cosmetic surgery patients and reconstructive plastic surgery patients.
  18. How soon will I see my results after capsulectomy? The cosmetic improvement in the breast is often seen immediately after capsulectomy or capsulotomy procedure.  The patients will soon return to normal activities and will note release in their symptoms associated with a tight capsular contracture.  Dr. Karamanoukian will take pre and postoperative photos of your breast for objective analysis of the degree of improvement.  The patients will soon note a improvement in the contour of the breast as well as the symmetry of the breast after surgery.
  19. How can I schedule a consultation for breast implant capsular contracture? Our plastic surgery office focuses on facial cosmetic surgery, breast implant surgery, breast implant revision, body contouring, and liposuction.  If you are considering a consultation for cosmetic plastic surgery for breast implant revision, please call our Los Angeles plastic surgery patient care coordinator at 310-998-5533.  Our office can help you answer the questions about capsular contracture and can facilitate scheduling a consultation for capsular contracture.  Please call 310-998-5533 to speak to one of our cosmetic surgery patient care coordinators.
  20. Is it possible to have painful capsular contracture without breast implant hardening? Capsular contracture is an inflammatory process resulting in deposition of scar tissue and recurrent inflammation around a breast implant.  Stimulation of the inflammatory cycle may lead to a number of different complaints, ranging from tissue capsule thickening, calcification of the tissue capsule, distortion of the breast implant, tightening of the implant with malpositioning and asymmetry, pain, generalized discomfort and inflammation of the breast.  These symptoms can vary considerably from individual to individual and are rarely predictable in terms of onset, duration, or time to resolution.  There is a grading scale for silicone and saline breast implant capsular contracture which is known as a Baker scale.  In assessing the severity of capsular contracture, doctors use the Baker classification in order to determine the progression of capsular contracture.  It is possible for breast implants to cause discomfort and pain in association with inflammation around the tissue capsule without a noticeable or palpable tissue capsule.  Although this is less likely in compression to a thickened capsular contracture that is causing pain and discomfort, it is definitely a possibility.  Dr. Raffy Karamanoukian is an expert in capsular contracture surgery and has incorporated many of the scar revision techniques that he has demonstrated on national television in the treatment of capsular contracture.  By reducing the inflammatory process, Dr. Karamanoukian can minimize the complications associated with capsular contracture and also reduce recurrence rates of breast implant tissue capsule thickening
  21. Why does hematoma and bleeding increase the risk of capsular contracture? Capsular contracture is likely an inflammatory process with unknown precipitative.  Although there have been many associations with capsular contracture, clinicians and plastic surgeons do not know the specific reasons why capsular contracture occurs in a first place.  Infection, inflammation, contaminants, and hematomas can increase the risk of capsular contracture formation.  It is thought that the blood products from a hematoma or within the periimplant space can initiate an inflammatory process that is not self resolving.  This inflammation may lead to deposition of collagen by fibroblast around the breast implant, leading to a thickened implant capsule that may further lead to capsular contracture.  There are many different types of grades for capsular contracture ranging from minimal problems to severe cases with associated pain and discomfort and visible and palpable changes in the breast tissue.
  22. Is it a good idea to take antibiotics to decrease the chance of capsular contracture? Capsular contracture often occurs in association with breast implant infection or contamination of a breast implant from extrusion or technical problems during the surgery.  The association of infection with capsular contracture has been established, but this is not the only reason why patients develop thickening of the breast implant tissue capsule.  Patients who becomes sick in the perioperative setting or who have a latent infection such as a sinus infection or urinary tract infection, may inadvertently increase the risk of developing capsular contracture of their breast.  If you are experiencing a cold or flu, it is advised that you delay breast implant surgery in order to minimize the risk of tissue capsule formation.  In addition, the patients who avoid antibiotics perioperatively may also increase their risk of postoperative inflammation and tissue capsule formation.In the Los Angeles area, Dr. Karamanoukian is one the leading experts in capsular contracture surgery and can provide you with specific details regarding your risks and benefits of capsular contracture recurrence.  If you have questions about capsular contracture surgery, please call our office at 310-998-5533.
  23. Is the entire capsule removed during a capsulectomy? There are many different types of capsulectomy procedures performed for capsular contracture.  Depending on the breast implant pocket being above or below the muscle, Dr. Karamanoukian can advise you on whether you will require a complete capsulectomy or partial capsulectomy procedure.  Patients who have submuscular implants with minor capsular thickening along the pre-intercostal tissue plane may benefit from an anterior capsulectomy with preservation of the posterior capsule.  In addition, the patients who have thinning of the breast tissue may also benefit from a partial capsulectomy in order to minimize thinning of their breast tissue.  The indications for partial capsulectomy are many and these are mainly reserved for patients who have secondary problems associated with their breast implant.

 

Choosing a breast implant surgeon for capsular contracture can be difficult as women are faced with the possibility of undergoing additional surgery to correct their previous breast implants.  Dr. Karamanoukian provides expertise in capsular contracture and can help you regain your confidence and regain beautiful, natural breasts.  The first step towards achieving these goals is to schedule a consultation with Dr. Karamanoukian in Los Angeles and discuss your concerns about breast capsular contracture. Schedule a consultation by calling (310) 998-5533. Our Los Angeles plastic surgery patient care coordinator will help you schedule a consultation for capsular contracture in Los Angeles.
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