Breast revision for capsular contracture requires meticulous procedures to prevent the complication from recurring. The core guideline is to eliminate the bacteria, which are believed to cause the body to react and release a thick biofilm or scar capsule that causes hardness and asymmetry of the breast.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated breast revision for capsular contracture on his Snapchat. The surgery involved a patient with silicone implants she had for eight years; these were implanted by a different doctor.
The patient’s left breast appeared constricted and “high-riding” due to the thick fibrous scar tissue, while the right side had no such problem. Dr. Smiley said that about 98 percent of capsular contracture affects only one side due to unknown reasons.
Every time an implant—e.g., breast implant and pacemaker—is placed, the body makes a layer of tissue called capsule. Dr. Smiley said this is an auspicious natural process that prevents implant malposition.
He said that the only time that the capsule is considered capsular contracture is when it becomes too copious and “problematic,” leading to hardness of the breast, asymmetry and unnatural contour (narrow and constricted base), and a varying degree of pain and discomfort with arm motion.
The celebrity plastic surgeon cited medical literature suggesting that the risk of capsular contracture in primary breast augmentation is around 5 percent, and may reach as high as 33 percent in revision surgery.
Dr. Smiley said that irrigating the breast pocket with strong antibiotic solution reduces the capsular contracture rate by “killing the microorganism.” According to several studies, low-grade bacteria may cause the copious production of fibrous tissue, but not enough to cause an infection.
To further reduce the capsular contracture rate in primary and revision breast augmentation surgery, Dr. Smiley emphasized the importance of using brand new implants and removing the entire scar capsule, instead of just incising or eliminating some parts.
In addition, Dr. Smiley said that placing the implants beneath the muscle than above this layer (with only the breast tissue enveloping the prostheses) further minimizes the risk of capsular contracture. The theory is that the reduced contact between the implant surface and the tissue known to harbor staph bacteria, and the constant massage provided by the pec muscle preclude the formation of copious scar tissue.