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Pre-operative patient - Right capsular contracture - Resolution of contracture


As our American Society for Aesthetic Plastic Surgery has reported, breast augmentation is one of the three most popular cosmetic procedures in 2009, including over 300,000 procedures. Clearly the demand for larger, better contoured breasts, remains high. Whether saline or silicone gel implants – provided by Allergan – are used, the one most common complication of this procedure remains the development of scar tissue around the implant. This process is commonly termed, capsular contracture, and is a well known, well researched risk to the surgery. The incidence, depending upon various sources, is between 5% and 10%, but increases with smoking, infection, bleeding at the surgical site, and various wound-healing problems. The onset of this problem can occur any time from the fourth week, post-operatively, beyond. But usually, if it does occur, it will present within the first year following surgery.


This process of scar tissue formation around the implant is largely unavoidable and in most situations, remains a normal part of the healing process. When the scar becomes thickened and generates a tight, elevated, even distorted breast, there could be considerable discomfort; the over production of scar tissue around the implant is termed capsular contracture. Most plastic surgeons grade these contractures on a Bakers classification system from I to IV. A Bakers I is barely detectable and is considered within the range of normal healing. A Bakers II may render some elevation of the breast, some hardening and mild discomfort upon touching. Bakers III contracture is more painful and more firm. Bakers IV contracture results in a breast, which is very firm, cold, distorted and painful most of the time.


Because mammograms are so important in the early detection of breast cancer, any process which decreases the effectiveness or the accuracy of mammograms, needs attention. Breast augmentation patients, who have a Bakers III or IV capsular contracture, are probably unable to obtain a good screening mammogram. Additionally, breast self-exams become difficult and confusing for the woman with painful scar tissue.


It is important for every breast augmentation patient to have regular examinations with her doctor and to return to her plastic surgeon upon the suspicion of any problem. The surgical treatment for capsular contracture includes a return to the operating room with the removal of the implants and a complete opening or removal of the entire capsule. This operation includes a replacement of the implants if they are over ten years old and absolute meticulous surgical care. The pocket, receiving the implant, should be positioned under the pectoralis muscle, as the incidence for recurrence is decreased in this position. There is no guarantee that the scar tissue will not return, but the overall results for this surgery are hopeful and largely successful for most patients.