If capsular contracture develops after breast augmentation surgery, what are the treatment options?
Despite our best efforts to prevent capsular contracture with careful surgical planning and techniques and proper postoperative care, the complication still occurs in significant numbers, often with no identifiable cause. If capsular contracture develops, there are various treatment options including non-surgical and surgical options. Among the non-surgical options, a technique known as closed capsulotomy was used in the past. This involved forceful compression of the breast to rupture the implant capsule. Use if this technique was found to result in significant complications, including injury or rupture of the implant and hematoma. For those reasons, this technique is no longer routinely utilized or advised.
An alternative non-surgical approach, especially if employed early following the development of capsular contracture, includes physical therapy. The therapeutic techniques include aggressive manipulation with massage and strapping or use of garments to soften the breast and influence the mal-positioned implant. In addition, external ultrasound devices have proven beneficial in reversing the process of capsular contracture. If these non-surgical techniques are successful, long-term maintenance is required with continued breast massage, possible further use of garments or strapping and possible maintenance ultrasound treatments. The risks of these treatments include possible implant injury or rupture.
If non-surgical approaches to treatment of capsular contracture fail or there are long-standing contractures, the non-surgical approaches are less likely to be successful, and surgical intervention may be the best option.
Surgical techniques to treat capsular contracture include open capsulotomy, which involves cutting through the full thickness of the capsule to release the tightening. Capsulectomy involves actual excision of the entire implant capsule or of only specific areas. Additional surgical techniques routinely utilized include use of antibiotic irrigation and anti-inflammatory agents such as corticosteroids to reduce the risk of development of a recurrent contracture.
Bacterial contamination and infection are one of the more common causes of capsular contracture and any surgical treatment of capsular contracture should involve obtaining cultures of any fluid in the implant pocket to determine whether specific antibiotic therapy is indicated and whether the implant may possibly need to be removed for adequate treatment and prevention of recurrent contracture.
Other techniques utilized to reduce the risk of recurrent contractures include the use of textured-surfaced implants.