Your body forms a protective capsule of thick scar tissue around any foreign object inside of it. When you get breast implants, this protective capsule helps keep them in place.
For most people, the capsule feels soft or a little firm. However, for some people who get implants, the capsule can tighten around their implants and create a condition called capsular contracture.
Capsular contracture is the most common complication for breast implant surgeries and occurs in about 10.6 percent of women with implants. It can lead to chronic pain and distortion of your breasts.
Serious cases of capsular contracture are usually managed with surgery.
A capsulectomy is the gold-standard treatment option for capsular contracture.
In this article, we’re going to take a look at what you can expect during a capsulectomy. We’ll also look at when this surgery may be needed and how long it takes to recover from it.
Before Capsulectomy Surgery
Who needs capsulectomy surgery
Capsulectomy surgery removes the tough scar tissue around your breast implants known as capsular contractures. Capsular contracture can be measured using a method called the Baker scale, which has four grades:
. Grade I: Your breasts look soft and natural.
. Grade II: Your breasts look normal but feel firm.
. Grade III: Your breasts look abnormal and feel firm.
. Grade IV: Your breasts are hard, look abnormal, and feel painful.
Grade I and grade II capsular contracture aren’t considered clinically significant and don’t require surgery.
Women with grade III and IV capsular contracture often require either a capsulectomy or a less invasive surgery called a capsulotomy to reduce pain and regain the natural appearance of their breasts.
What causes capsular contracture?
People who receive breast implants will develop a capsule around their implant to keep it in place. However, only roughly 10.6 percent of people with implants develop capsular contracture.
It’s not entirely clear why some develop capsular contracture and some don’t. It’s thought that capsular contracture may be an inflammatory response that causes your body to produce an excess of collagen fibers.
People who’ve had radiation therapy in the past have an increased risk of developing capsular contracture. Capsular contracture may also have a higher chance of happening if one of the following occurs:
. biofilm (a layer of microorganisms such as bacteria) caused by infection
. hematoma (buildup of blood) during surgery
. seroma (buildup of fluid) under the skin
. rupture of an implant
In addition, a genetic predisposition to developing scar tissue may increase the risk of capsular contracture.
Some evidence suggests that textured breast implants lower the risk of developing capsular contracture compared to smooth implants. However, it’s unknown whether this is actually the case. As well, the Food and Drug Administration (FDA) has banned many brands of textured implants.
Weeks before having a capsulectomy, if you smoke, you’ll likely be asked to stop. Smoking reduces your blood flow and slows your body’s ability to heal itself.
Quitting smoking is often difficult, but a doctor can help create a smoking cessation plan that works for you.
You may also be asked to stop taking certain supplements or medications about 2 weeks before your surgery.
During Capsulectomy Surgery
Here’s what happens during a capsulectomy:
- Beforehand, you’re given general anesthesia so that you’re asleep through the surgery.
- Your surgeon makes an incision along the scars from your original implant surgery.
- Your surgeon removes your implant. Depending on the type of capsulectomy being performed, they then remove either part or all of the capsule.
- A new implant is inserted. The implant may be wrapped in a skin substitute material to prevent thick scar tissue from forming.
- The surgeon then closes the incision with stitches and wraps your breasts with gauze dressing after the surgery.
The most common complications of breast capsulectomy include bleeding and bruising.
You might be able to return home the same day as the surgery, or you may need to spend a night in the hospital.
Types of capsulectomy
Capsulectomy is an open surgery, which means that it requires a surgical incision. Capsulectomies can be divided into two types: total and subtotal.
. Total capsulectomy
During a total capsulectomy, a surgeon removes your breast implant and your entire capsule of scar tissue. Your surgeon may remove the implant first before removing the capsule. They then replace your implant once the capsule is removed.
. En bloc capsulectomy
An en bloc capsulectomy is a variation on a total capsulectomy.
During this type of surgery, your surgeon removes your implant and capsule together instead of one at a time. This may be the best option if you have a ruptured breast implant.
In some cases, this type of capsulectomy may not be possible if the capsule is too thin.
. Subtotal capsulectomy
A subtotal or partial capsulectomy only removes part of the capsule.
As with a total capsulectomy, your breast implant is likely to be replaced during this type of surgery. A subtotal capsulectomy may not require as large of an incision as a total capsulectomy, so it may leave a smaller scar.
After Capsulectomy Surgery
Recovering from a capsulectomy
After your surgery, your breasts may feel sore. You may be instructed to wear a compression bra on top of your surgical dressing for several days or weeks.
Depending on how thick the capsule was or if your implants were ruptured, your surgeon may place temporary drainage tubes in the area to help decrease swelling. These tubes are usually removed in about a week.
Your surgeon can give you a specific time frame for your recovery. In general, a breast capsulectomy takes about 2 weeks to recover from completely.
It’s a good idea to avoid strenuous activity and smoking until you’re completely healed.
Capsulectomy vs. capsulotomy
Even though a capsulectomy and capsulotomy may sound similar, they’re different surgeries. The suffix “ectomy” refers to a surgery that involves removing something. The suffix “tomy” refers to making an incision or cut.
A capsulectomy is more invasive and has a higher risk of complications including nerve damage. During a capsulectomy, a surgeon removes all or part of your capsule from your breast and replaces your implant.
During capsulotomy surgery, the capsule is partially removed or released. The surgery can be open or closed.
During the open surgery, your surgeon makes an incision in your breast so they can access the capsule.
During closed capsulotomy, external compression is used to break up the capsule. Currently, closed capsulotomies are rarely performed.
An open capsulotomy performed on one breast takes about 20 to 30 minutes. A capsulectomy takes about an hour longer. Capsular contracture has similar reoccurrence rates in both surgeries.