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Introduction
Capsular contracture is one of the most common complications following breast implant surgery. After an implant is placed, the body naturally forms a thin scar capsule around it. While this capsule usually remains soft and pliable, in some patients it tightens and thickens, squeezing the implant and causing firmness, discomfort, and cosmetic distortion. At Monarch Plastic Surgery & Skin Renewal Center in Sandy Springs—serving Buckhead and Atlanta—Dr. Carmen Kavali offers a comprehensive approach to managing and correcting capsular contracture. From early detection and non-surgical interventions to advanced surgical techniques such as capsulectomy and implant exchange, our goal is to restore comfort, shape, and confidence.
What Is Capsular Contracture?
When a breast implant is inserted, your immune system responds by forming a capsule of scar tissue around the foreign object. Usually, this capsule adapts to the implant’s surface and remains flexible. Capsular contracture occurs when this scar tissue tightens excessively, compressing the implant. Patients may experience:
- Grade I: Breasts feel soft and appear natural (normal capsule).
- Grade II: Breasts are slightly firm but appear normal.
- Grade III: Breasts are firm and show visible distortion.
- Grade IV: Breasts are hard, painful, and visibly misshapen.
Grades III and IV typically prompt patients to seek treatment due to discomfort and aesthetic concerns.
Why Capsular Contracture Develops
Although the exact cause remains under investigation, several factors appear to increase the risk of contracture:
- Bacterial Contamination: Even minimal bacterial biofilm on implants can trigger chronic inflammation, leading to thicker capsules.
- Bleeding / Hematoma: Blood accumulation around the implant encourages excess scar formation.
- Radiation Therapy: Radiation for breast cancer can disrupt normal tissue healing, increasing scar tightness.
- Implant Surface: Smooth implants carry a slightly higher contracture rate than textured surfaces, although textured devices have other risks such as BIA-ALCL.
- Subglandular Placement: Implants placed above the muscle may have more contracture than those under the pectoralis muscle.
- Genetic Predisposition: Some patients appear more prone to excessive scar tissue (keloids or hypertrophic scarring).
Understanding these factors guides both prevention and treatment strategies.
Who Is at Risk?
Any patient with breast implants can develop capsular contracture, but risk increases if you:
- Underwent reconstructive surgery after mastectomy and received radiation therapy.
- Experienced a hematoma or seroma in the early postoperative period.
- Had an infection around the implant pocket, even if subclinical.
- Chose smooth implants in a subglandular pocket.
- Have a history of hypertrophic or keloid scarring.
During your consultation, Dr. Kavali will review your surgical history, implant type, and any postoperative complications to assess your individual risk and tailor a personalized treatment plan.
Recognizing the Signs & Symptoms
Early detection can help manage contracture before it progresses. Watch for:
- Firmness: A gradual increase in firmness around the implant pocket.
- Pain or Discomfort: Ranges from mild tightness to significant chest pain or tenderness.
- Distortion: Change in breast shape—high-riding implants, unevenness, or rippling.
- Asymmetry: One breast feels firmer or looks different from the other.
If you notice any of these changes—especially within the first year after surgery—schedule an evaluation. Monitoring enables timely intervention and may prevent the need for more extensive surgery.
Diagnosis & Evaluation
Physical Examination
Dr. Kavali performs a thorough exam, comparing both breasts for firmness, mobility, contour, and symmetry. She grades contracture on the Baker scale (I–IV) to guide treatment decisions.
Imaging Studies
- Ultrasound: Detects fluid collections (seroma) or hematoma.
- MRI: Assesses implant integrity, capsule thickness, and potential implant rupture.
Laboratory Tests
Occasionally, blood markers of inflammation can help assess the degree of immune response—particularly if infection or autoimmune factors are suspected.
A complete evaluation ensures that your symptoms are truly due to capsular contracture and not unrelated issues such as implant rupture or breast pathology.
Non-Surgical Management
In early or mild cases (Baker I–II), non-surgical options may soften the capsule and provide relief:
- Massage & Exercises: Regular, gentle breast massage combined with “capsule-stretching” exercises can sometimes reduce tightness.
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Medications:
- Leukotriene Inhibitors (e.g., Singulair): May interfere with inflammatory mediators involved in scar formation.
- NSAIDs: Short-term anti-inflammatory therapy to reduce pain and swelling.
- Ultrasound Therapy: Targeted sound waves can soften peri-implant scar tissue.
- Closed Capsulotomy: An older technique of manually compressing the breast to break the capsule; largely abandoned due to high recurrence and risk of implant damage.
While these measures can delay progression, they often provide only temporary improvement and are best used as adjuncts while planning definitive treatment.
Surgical Treatment Options
When contracture reaches Baker Grade III or IV—causing discomfort, visible distortion, or both—surgical intervention is generally required to restore breast shape and comfort.
Capsulectomy Types
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Total Capsulectomy
Removal of the entire scar capsule surrounding the implant. Provides a fresh pocket for a new implant and lowers recurrence risk.
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Partial Capsulectomy
Excision of only the tightest portions of the capsule, leaving healthier tissue intact. Often combined with contralateral adjustments for symmetry.
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En Bloc Capsulectomy
Complete removal of the implant plus capsule as one intact unit. Employed in cases of suspected silicone leak or BIA-ALCL risk, ensuring no capsule remnants remain.
Implant Exchange & Pocket Adjustment
After capsulectomy, considerations include:
- Submuscular Pocket Conversion: Moving the implant from above to beneath the pectoralis muscle reduces contracture risk.
- Pocket Reinforcement: Using acellular dermal matrix (ADM) or surgical mesh to support the new implant and discourage scar tightening.
- Implant Replacement: Selecting a different size, shape, or surface (smooth vs. textured) based on your goals and anatomy.
Dr. Kavali customizes every detail—pocket plane, implant type, and reinforcement materials—to minimize the chance of future contracture.
The Surgical Journey: Step by Step
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Anesthesia & Preparation
- Performed under general anesthesia.
- Preoperative markings identify the existing pocket and preferred incision sites.
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Incision & Implant Removal
- The previous inframammary, periareolar, or transaxillary scar is reused to minimize new scarring.
- The existing implant is removed gently, preserving surrounding tissue.
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Capsule Excision
- Dr. Kavali performs total or en bloc capsulectomy, meticulously excising all scar tissue.
- The pocket is inspected for residual debris or calcifications.
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Pocket Revision & Reinforcement
- If indicated, the implant pocket is converted to a submuscular plane.
- Acellular dermal matrix or mesh may be placed to create a more stable environment.
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Implant Placement
- A new implant—silicone or saline—is chosen to match your desired size and profile.
- Dr. Kavali ensures precise positioning for optimal symmetry.
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Closure & Dressing
- Deep tissue and skin are closed with multi-layer absorbable sutures.
- Fine skin sutures or adhesive strips minimize visible scarring.
- A supportive surgical bra is applied to control swelling and support the new pocket.
Duration: 1–2 hours (varies by technique)
Setting: Accredited outpatient surgical suite—same-day discharge with a responsible escort
Recovering Comfortably
Immediate Post-Op
- Pain Control: Oral medications manage discomfort.
- Support Garments: Wear a supportive bra continuously for 4–6 weeks.
- Positioning: Sleep with upper body elevated to reduce swelling.
First Two Weeks
- Follow-Up Visits: At one week to assess incision healing and bra fit.
- Activity: Light walking is encouraged; avoid upper-body exertion.
Weeks 3–6
- Scar Care: Begin gentle massage or silicone gel application as recommended.
- Exercise: Resume non-chest workouts at week three; defer chest exercises until week six.
Months 2–6
- Final Contour: Implants settle and capsule remodeling completes by three to six months.
- Monitoring: Routine checkups ensure pocket stability and early detection of any recurrence.
Strict adherence to Dr. Kavali’s aftercare instructions maximizes comfort, promotes optimal healing, and minimizes the risk of repeat contracture.
Prevention Strategies
For patients planning primary augmentation, Dr. Kavali employs evidence-based techniques to minimize contracture risk:
- No-Touch Technique: Using insertion sleeves or funnels to avoid implant contact with skin or gloves.
- Antibiotic Irrigation: Lavage of the implant pocket with triple-antibiotic solution to reduce bacterial biofilm.
- Submuscular Placement: Positioning implants beneath the pectoralis muscle when anatomy allows.
- Meticulous Hemostasis: Avoiding hematoma formation through careful surgical technique.
- Surface Discussion: Thoroughly reviewing the pros and cons of textured versus smooth implants.
Combining these strategies has been shown to significantly lower capsular contracture rates.
Choosing the Right Surgeon & Facility
When addressing capsular contracture or planning augmentation, look for:
- Board Certification: Verification by the American Board of Plastic Surgery ensures rigorous training.
- Facility Accreditation: AAAASF or Joint Commission accreditation guarantees adherence to safety protocols.
- Capsulectomy Expertise: Demonstrated experience in both straightforward and complex contracture corrections.
- Before-and-After Gallery: Examples of natural-looking, consistent results.
- Patient Reviews: Testimonials praising surgical skill, communication, and follow-up care.
Dr. Carmen Kavali’s specialized training and our fully accredited surgical suite provide the highest standard of care for managing and preventing capsular contracture.
Lifestyle Impact & Long-Term Maintenance
- Regular Self-Exam: Monitor breast firmness and shape changes.
- Supportive Bras: Wear well-fitting bras—especially during exercise—to support implants.
- Weight Stability: Maintain a consistent weight to reduce fluctuations in breast volume and capsule stress.
- Sun Protection: Protect incisions and scars from UV exposure to promote optimal healing.
- Routine Follow-Up: Annual checkups help detect early signs of contracture or other implant concerns.
By adopting these healthy habits and attending scheduled appointments, you can enjoy comfortable, natural-looking results that last for years.
Next Steps: Scheduling Your Consultation
If you are experiencing breast firmness, discomfort, or changes in shape after implant surgery, early evaluation can prevent progression and simplify treatment. Contact Monarch Plastic Surgery & Skin Renewal Center to discuss your options:
- Call: 404.250.3333
- Email: info(at)drkavali(dotted)com
- Visit: 6045 Barfield Rd, Suite 100, Atlanta, GA 30328
- Online: Request a Consultation
Dr. Kavali will design a personalized plan—whether it’s non-surgical management, capsulectomy with implant exchange, or preventive strategies—to restore your comfort, symmetry, and confidence.