Yes, capsular contracture is higher when we have to cut the breast. It is the lowest when we can cut in the inframammary fold and stay out of the gland.

Published on Jul 11, 2012

Capsular contracture appears to be most likely related to exposure of the implant to biofilm, which is a mix of bacteria, proteins and other microscopic material that can get onto an implant's surface during placement. For this reason, straightforward breast augmentation is probably best done through the inframammary approach when a patient does not need a lift, and there is data to support that. However, when a lift is needed, many surgeons do not like the idea of making the incision around the nipple, which is required for a lift in all cases, and then arbitrarily adding an inframammary scar just to introduce the implant.

So most of the time, if a lift is being done, the surgeon will place the implant through the lift incision, whether at the areolar portion, the vertical limb (in a lollipop or anchor lift) or the inframammary crease portion (in a full anchor lift). However, you should really be concerned more about what approach - augmentation alone or augmentation + lift - is expected to give you the best result in the surgeon's opinion.

In some cases, a patient simply IS NOT A CANDIDATE for augmentation alone because the result will not look right. Depends on a number of factors that can only be fully assessed with an in-person examination.

Published on Jul 11, 2012

No, there is no higher incidence of capsular contracture with the breast lift (mastopexy) when also performing a breast augmentation.

Michael Eisemann M.D.
Plastic Surgeon
Houston

Published on Jul 11, 2012

The risk of bleeding for a breast augmentation with or without a lift is still about 1%. Having a breast lift synchronized with an augmentation is a standard practice and avoids the risks of two anesthesia sessions. It allows for one healing time and one down time.

Waiting for a lift at the time of augmentation has some attributes. I have found if you are reluctant to have extra incisions or you are worried about nipple sensory loss, that you may defer on having a lift. Another major reason a woman may defer on a lift is that she is not sure she has completed her fertility.

The trade-offs are always the scar, the cost and the extra incisions and healing. The upside benefits are that you have a flat, droopy breasts when you start, and full perky breasts when you have the aug/lift combined.

The woman who gets a breast augmentation who prospectively needs a breast lift is usually disappointed she didn't get the lift at the time of the augmentation. You know what you want, and the consultation process should teach you what you need to make you happy with how you look in the mirror. The end goal is beautiful shape and fuller volumes in a single intervention. Look at my gallery photos for patient outcomes you'll love, before you decide on a surgeon to to your surgery!

Get what you want and need!

Published on Jul 11, 2012

The leading theory of risk of capsular contracture is that a biofilm can form around the breast implant within the normal scar that forms the capsule. These bacteria, either from normal breast bacteria that contact the implant at surgery or bacteria that get into the blood stream and make their way to the breast as a foreign body, cause a low grade bacterial infection that can lead to capsular contracture.

All attempts are made to minimize this contamination at surgery by avoiding the breast tissue (staying beneath the breast under the muscle and using an incision in the fold beneath the breast rather than the nipple) but with a breast lift, contact with breast tissue is inevitable so the incidence theoretically may be higher.

Published on Jul 11, 2012

Breast implant capsular contractures are usually caused by Staph Epidermidis which is every where on our skin. Increased exposure with more additional surgeries and their potential problems can increase the rates. However with good technique, hemistasis, antibiotic irrigation and drainage (if needed), the risks would be minimized.

Published on Jul 11, 2012

The risk of capsular contracture is higher in breast lifts when the surgeon doesn't first place the implant through an inframammary incision and close that space off prior to starting the breast lift. This means no true "lollypop-shaped" scar, which is OK!

Published on Jul 11, 2012

The risk of capsular contracture does not necessarily increase with having a breast lift. Unfortunately, there is no one single explanation or cause of capsular contracture. In fact, despite numerous detailed studies, capsular contracture remains poorly understood. However, all of the scientific research done in the past several decades has shed some light on capsular contracture and there are some theories to help explain why it sometimes happens. It is important to remember that many cases of capsular contracture can happen without any apparent cause.

One possible cause of capsular contracture is the presence of excess blood in the breast pocket. This usually occurs during the initial surgery. If there is an excessive amount of bleeding, or the blood that collects in the breast pocket is not removed or cleaned out prior to inserting the implant, this excess blood can stimulate the inflammatory process that leads to capsular contracture.

Capsular contracture may also result from a hematoma. A hematoma is a collection of blood that forms after surgery. When it occurs, the breast becomes very swollen and painful. Once this happens, surgery is required to remove the blood. Studies show an increased risk of capsular contracture if someone develops a hematoma after breast surgery.

If someone develops capsular contracture, it does not mean that they must have had excess bleeding or a hematoma. Capsular contracture sometimes occurs for unknown reasons. This is just one of many theories that may explain some cases of capsular contracture. Preventing bleeding during breast surgery through careful and meticulous operative technique can help minimize this risk.

There are many studies that show that the presence of bacteria on the implant or in the breast can cause capsular contracture. The presence of even a few bacterial cells (which would not cause any infection) may lead to an inflammatory process that results in capsular contracture. This is called a "subclinical" infection because the amount of bacteria involved is so small ("sub") that there will not be an infection visible ("clinical"). The theory is that these few cells of bacteria in the breast pocket and on the implant produce a thin film of molecules on the implant surface called a "biofilm". The biofilm may be responsible for setting off the process that leads to capsular contracture.

There are many things that can be done to prevent the chance of bacteria contaminating the breast pocket or breast implant during surgery. One thing is to use an inframammary incision (under the breast). This incision avoids the nipple and areola, as well as the underarm area, which are areas that are normally covered and filled with a large amount of bacteria. There are various other techniques that are utilized to minimize contamination such as using an antibiotic solution to cleanse the skin where the implant will be inserted, washing gloves with the antibiotic solution, and not touching the implant when inserting it by using a device called the Keller Funnel.

Taking the extra steps to prevent capsular contracture has decreased our capsular contracture rates to one of the lowest rates of any surgeon in the world.

Capsular contracture remains a poorly understood complication after breast surgery. There are several theories as to what can cause it. These include excess blood in the breast pocket, the presence of bacteria in the breast or on the implant, contamination of the breast or implant with microscopic particles and rough handling of the breast tissues and muscle.

Patients can develop capsular contracture even when there is no evidence of bleeding, bacteria, contamination or rough handling of tissues. Therefore, there may be, as of yet, unknown reasons why capsular contracture may occur.

Published on Jul 11, 2012

Thank you for your question. There may be an increased risk for capsular contracture in combining a breast augmentation with a breast lift procedure due to more dissection, bleeding, and/or the possibility for bacteria translocation. However in practice, these risk factors are significantly reduced, especially with submuscular implant placement via an inframammary incision prior to beginning the mastopexy procedure. I would recommend discussing your concerns further with your board certified operating plastic surgeon, but please remember that these procedures are routinely performed together. I hope that you find this helpful.

Published on Jul 11, 2012