Treating Capsular Contracture
In the vast majority of cases, capsular contracture is treated with surgery. At the present time, there is no known non-surgical treatment that is guaranteed to be effective. While there are other non-surgical treatments that can be tried, it should be noted that they are very “hit and miss” (most often missing), much like throwing various things against a wall in hopes that something will stick.
Capsulectomy – the surgical removal of the capsule that surrounds the breast implant.
Capsulotomy – cutting, or scoring the capsule to open it up.
Capsular Contracture Treatment Options
A capsulectomy is the surgical removal of the capsule. Once the capsule is removed, a new capsule will form, hopefully not contracting like the previous one. This procedure can be performed through the nipple, crease, or transaxillary incision, although in the case of the latter, an endoscope is needed, and the procedure is a bit more difficult.
A capsulotomy is a procedure in which the capsule is scored. (The video shows a capsule being scored after the implant is taken out with the capsule in tact around it.) This procedure does not have quite as high of a success rate as the capsulectomy.
Surgeons may opt to make a decide on a capsulectomy or capsulotomy once the patient has been opened up. If the capsule is calcified and thickened, surgeons often choose the capsulectomy. Sometimes, depending on the circumstances, they feel that a capsulotomy would be a better choice.
This procedure is not endorsed by breast implant manufactures, and in fact, is looked down upon. A closed capsulotomy involves the surgeon squeezing the breast (implant) with enough force to break the capsule. Not only is this painful for the patient, the success rate is very low. There is a substantial risk of damage to the implant, and breast implant manufacturers will not honor warranties on breast implants that have been ruptured during a closed capsulotomy. In addition, while rare, bleeding can occur in the pocket, which can be uncontrolled. While not at all common, it is possible. The worst case scenario would require a surgery to control the bleeding. However, bruising is common in women that have had closed capsulotomies.
Recovering from Capsular Contracture Surgery
If surgery is required to treat capsular contracture, the recovery will feel much like your initial breast augmentation, although maybe not quite as uncomfortable. It is recommended that you not become too active too soon, and it is a good idea to avoid smoking, as well as anything that thins the blood (vitamin E, ibuprofen, aspirin, etc) for at least two weeks.
Treating Capsular Contracture with Medication
Several drugs have been used in an attempt to treat capsular contracture. So far, no drug treatment can guarantee a cure for contracture.
Accolate is an oral medication used to prevent asthma attacks. Because of how this drug works as an anti-inflammatory, it was thought that it may be beneficial to women with capsular contracture. Accolate is a luekotrine receptor antagonist (inhibitor). Basically, leukotrienes, which are found in white blood cells, are inflammatory chemicals the body releases after coming in contact with an allergen or allergy trigger. Accolate works to block this action, thus resulting in less inflammation.
In one study in 2002, women were given 20mg of Accolate by mouth twice a day for three months. Many of them showed a dramatic improvement regarding softening of the capsule after the treatment period. One of the authors of this study found that Singulair (montelukast), another type of asthma drug similar to Accolate, worked similarly, but requiring only one dose per day. The women treated with Singular did not have their firm capsules completely eliminated, but when this medication was used prophylatically, the occurrence of capsular contracture saw a dramatic decline. When the results of the Accolate and Singular treatments were analyzed, they found that the women treated with Accolate had a slightly better response.1
In a 2007 study, 120 women with a total of 216 breast implants were divided into two groups. One group received Accolate, and the other group received vitamin E. After a period of six months, the groups were re-evaluated. The group receiving Accolate showed a contracture reduction of 7.69% after the first month, 16.78% after three months, and 24.01% after six months. The vitamin E group did not show any significant improvement. This study concluded that Accolate may be effective in treating women with longstanding capsular contracture and breast pain, but wish to avoid surgery.2
Since Accolate is processed through the liver, some surgeons prefer to do blood tests to check liver function while their patients are taking this drug.
Other Types of Treatment
Massage is thought to work by keeping the pocket open. Many surgeons recommend massage for their patients whether or not they have capsular contracture. Some surgeons only recommend massage if their patient is showing signs of capsular contracture. While there is no proof that massaging can prevent or reverse capsular contracture, it certainly does not hurt to try it, unless you have textured implants. (Surgeons usually recommend against massaging textured breast implants.)
For many years, vitamin E has been popular among with capsular contracture. It’s cheap, easy to access, and has no inherent risks. It is thought to help soften the scar capsule, although no studies have proven that it is an effective treatment for capsular contracture. Nonetheless, when one has capsular contracture, they will try anything to avoid another surgery. Unfortunately, vitamin E doesn’t appear to have any sort of significant effect on capsular contracture. While it certainly doesn’t hurt to try it, one should expect to see no improvement, but still hope for the best.
Papaverine is a vasodilator and muscle relaxant. It works by opening up veins and arteries and relaxing smooth muscles. Unfortunately, there is no solid proof that this drug can reverse the effects of capsular contracture.
Ultrasound may offer some help in the fight against capsular contracture. Since many cases of capsular contracture are due to sub-clinical bacteria on the shell of the breast implant that do not respond to antibiotics, ultrasound is thought to be helpful. Ultrasound not only softens the scar tissue, it also renders the bacteria on the shell more vulnerable to the body’s immune system.
A study performed in 2011 showed that ultrasound therapy twice a week for for three to four weeks, coupled with massaging at home, improved at least one symptom of capsular contracture in 72% of patients, while 52% were completely satisfied with their results.3
Unfortunately, ultrasound, like all non-surgical treatments, cannot guarantee improvement or complete reversal of capsular contracture.
1. S. Larry Schlesinger, MD, Richard Ellenbogen, MD, et. al. Aesthetic Surgery Journal. American Society for Aesthetic Plastic Surgery. 2002. 22. 329-336.
2. Scuderi N, Mazzocchi M, Rubino C. Department of Plastic and Reconstructive Surgery, University La Sapienza. 2007. 577-84.
3. Frederick, Maryland. PRweb. “Ultrasound Therapy Shows Promise in Treating the Most Common Breast Implant Complication, Capsular Contracture, Dr. Donald Kress, Plastic Surgery One. 2011.