Capsular Contracture Part Three: Treatment
By: Oscar Ochoa, MD
Capsular contracture, once present, is a difficult problem to overcome.
The key to success for any treatment for capsular contracture is removing the source of inflammation. With that in mind, treatments that do not remove the affected capsule and implant will likely have a short-lived benefit.
The standard treatment of capsular contracture is capsulectomy, implant exchange and changing the location of the implant pocket. These techniques can be performed at the same time.
Capsulectomy is the partial or complete removal of the affected capsule. Because the implant may be contaminated during any additional surgery, implant exchange is also recommended. Changing the location of the implant pocket has also shown to be effective in decreasing contracture. For example, if the implant was previously located beneath the chest muscle, placement of the new implant above the muscle may decrease the chance of recurrence.
Use of acellular dermal matrix (ADM) along with capsulectomy can also effectively decrease the risk of contracture recurrence. ADM, in this setting, is used as a barrier between the implant and possible inflammation. However, this method is not the most common due to the higher costs for patients.
Breast cancer patients who have had radiation and choose implant reconstruction are also at a high risk for capsular contracture. This is due to the tissue damage caused by radiation treatments. The gold standard method for eliminating radiation induced capsular contracture is capsulectomy and replacement of the implant with the patient’s own tissue. Procedures like DIEP flap create soft natural appearing breast without the risk of further contracture complications.