Capsular contracture is the most common complication following breast augmentation, affecting roughly 10-20% of breast augmentation patients. While this condition is never desirable, thankfully there are a number of ways to prevent and even correct it. In today’s blog, acclaimed breast surgeon and study author Dr. Schlesinger shares 7 tips to help surgeons and patients prevent capsular contracture and obtain beautiful breast augmentation results.
- What is capsular contracture?
- What causes capsular contracture?
- Is capsular contracture dangerous?
- 7 tips for preventing capsular contracture
- Choosing a board certified plastic surgeon
What is capsular contracture?
Capsular contracture is a condition where a “capsule” of abnormally fibrous tissue forms around a breast implant following breast augmentation. While some scar tissue formation is a normal part of the body’s healing process, the excessively fibrous tissue associated with capsular contracture can constrict and harden over time, placing strain on nerves within breast tissue and causing pain and tenderness.
What causes capsular contracture?
Though the causes of capsular contracture are still largely unknown by medical professionals, plastic surgeons believe non-pathogenic bacteria are largely responsible for the development of capsular contracture. When bacteria enter the chest cavity, the body produces an immune response to fight a perceived foreign body, resulting in inflammation—and subsequent scarring—around a breast implant. Rare complications of breast augmentation surgery, such as blood clots, can also increase the risk of capsular contracture by stimulating an immune system response.
Plastic surgeons believe that non-pathogenic bacteria play a critical role in the development of capsular contracture.
Is capsular contracture dangerous?
Capsular contracture is not inherently dangerous, though it can be uncomfortable and even painful. It can also be very frustrating since there is no single cause and it can happen to anyone, even when a breast augmentation is performed by an experienced, board certified plastic surgeon. However, the risk of capsular contracture can be reduced by following 7 simple suggestions:
7 tips for preventing capsular contracture
During my 30+ year career as a board certified plastic surgeon, I have developed 7 tips for preventing capsular contracture, 3 of which are for surgeons and 4 of which are for patients. By adhering to these suggestions, patients can enjoy soft, natural-looking breast augmentation results for an extended period of time.
1.Use a Surgical Drain
Use a surgical drain to prevent bacteria growth. Blood is a natural host for bacteria, therefore it is no surprise that blood accumulation around an implant is the number one cause of capsular contracture. While surgeons are able to prevent bleeding from arteries and veins after surgery, they can’t prevent capillary leakage. I have my patients keep their drains in place for 2-5 days following their breast augmentation to help decrease any blood buildup in their chest cavity, thereby decreasing the number of places that bacteria can grow.
2. Use a Keller Funnel
Use a Keller Funnel to reduce the risk of introducing bacteria into the chest cavity. Even though plastic surgery is always performed in a sterile environment, it is impossible to eliminate 100% of bacteria from an operating room. (A breast implant is introduced to bacteria the second it is removed from its packaging.) This is why I always use a Keller Funnel to perform breast augmentations; the device eliminates the need for a surgeon to physically touch the implant during surgery, greatly reducing the risk of bacterial contamination that can occur from an implant’s exposure to the surgical environment or its contact with skin. In fact, a 2018 study published in Plastic and Reconstructive Surgery found that the Keller Funnel reduced the risk of capsular contracture by 87%.
The Keller Funnel’s no-touch technique also has the added benefit of allowing a larger implant to be inserted into the chest through a smaller incision, resulting in a smaller scar. Additionally, it reduces the potential damage to a breast implant.
Blood accumulation around an implant is the number one cause of capsular contracture.
3. Prescribe zafirlukast for 90 days after breast augmentation.
Prescribe zafirlukast for 90 days after breast augmentation. Zafirlukast (known by the brand name Accolate) is an anti-inflammatory drug that is typically used to manage asthma symptoms, but can also be used to block the immune system’s inflammatory response to bacteria. Prescribing zafirlukast daily for the first 90 days after breast augmentation can prevent the immune system from treating the implant as a “foreign body” and causing the corresponding development of excessive fibrous tissue around the implant.
Zafirlukast has very few side effects and has been used safely in the plastic surgery field for over 24 years. For more information on its effectiveness in preventing capsular contracture, please read my 2002 study published in the Aesthetic Surgery Journal, “Zafirlukast (Accolate): A new treatment for capsular contracture.”
- Take zafirlukast prior to receiving an immunization or getting a tattoo. Getting a vaccine, such as the flu shot or COVID-19 vaccine, or getting a tattoo can both stimulate an immunological response in the body which can lead to capsular contracture. This same immune response can also cause swelling around dermal fillers and any other medical implant. This does not mean you should avoid getting your necessary vaccinations (or a tattoo, if you so choose); just be sure to take zafirlukast daily for 2 weeks prior to your vaccine or tattoo appointment, and for two weeks after.
- Take an antibiotic before visiting the dentist. While visits to the dentist are absolutely necessary, they increase your likelihood of developing capsular contracture if you do not prepare accordingly. This is because dental work opens the gateway for bacteria to enter a patient’s bloodstream through the mouth, which can trigger an inflammatory response similar to vaccines and tattoos. Instead of zafirlukast, I always recommend my patients take an antibiotic, like amoxicillin, one hour before visiting the dentist. Antibiotics will create a neutral environment in your mouth in which bacteria cannot thrive.
- Treat your cold immediately. Similar to dental work, developing a cold or any other illness that affects the immune system can cause capsular contracture. As the immune system ramps up to fight foreign bodies, it can cause an inflammatory response in the body, especially around any medical implant or foreign object, such as a breast implant. To prevent capsular contracture from occurring if you begin to feel sick, you should immediately visit your doctor and begin taking an antibiotic.
- Undergo therapeutic ultrasound treatments if you suspect capsular contracture. While a capsulectomy was once the only remedy for capsular contracture, surgeons are now able to offer ultrasound therapy as a safe, effective, and non-invasive solution. Ultrasound therapy converts sound waves into heat energy, stimulating blood supply in the breasts (specifically white blood cells) to break down old collagen and soften the fibrous tissue responsible for causing capsular contracture.
If you suspect capsular contracture at any point following your breast surgery, contact the plastic surgeon who performed your procedure immediately.
I have found ultrasound therapy to be a highly effective treatment for patients who have developed capsular contracture symptoms within 6 months of their breast augmentation; after this initial healing period, a capsulectomy is typically needed to remove the scar tissue from around a patient’s implants, as the tissue has likely become too hard for ultrasound treatment to be effective on its own. If you suspect capsular contracture at any point following your breast surgery, contact the plastic surgeon who performed your procedure immediately.
Prevent capsular contracture by choosing a board certified plastic surgeon
The most important step you can take in preventing capsular contracture is to choose a board certified plastic surgeon for your breast augmentation. He or she will have the experience, knowledge, and skill required to provide beautiful, natural-looking results, and to help prevent capsular contracture.
Choose Hawaii’s favorite plastic surgeon for your breast augmentation
Board certified plastic surgeon Dr. S. Larry Schlesinger is a renowned breast surgeon in Honolulu, Hawaii with over 30 years of experience. In 2002, he published landmark research on capsular contracture that popularized the use of zafirlukast and therapeutic ultrasound treatments. Schedule a consultation with Dr. Schlesinger online or by calling (808) 597-8835 to learn more about his steps for helping prevent capsular contracture and ensuring a safe breast augmentation surgery and recovery.