Conservative Treatment: This is non-operative treatment. The patient is advised to push the breast implant in an effort to stretch out the shrinking capsule. Any way to press firmly on the breast to cause stretch of the capsule is helpful. We do not really know how long or how hard to press, but within reason the firmer the better for as long as reasonably possible, without causing actual injury.

Surgical Treatment: This takes it one step further. Parts of the breast capsule can be removed – even removal of all of the capsule might be possible. Also cuts can be made in the capsule causing the capsule to be divided into several parts which can spread apart. This gives the breast implant more room to move around. Of course new scar tissue will grow between the parts of the capsule or all around the breast implant if the capsule has been removed. We hope that the new scar tissue will be thin and will not become thickened and shrink like the previous scar tissue, but we do not know. This is because we cannot treat the actual cause because we do not know what the cause is. I also like to replace the breast implant because of the theory that some contamination of the breast implant might contribute to the cause. If we did not replace the breast implant and the capsular contracture comes back quickly, we would always wonder if we would have had a better outcome if the breast implant had been replaced.

It can happen in one breast or both. It can happen soon after surgery or years later. We cannot predict who will get capsular contracture (shrinkage of the scar tissue) or capsular relaxation (stretching out of the scar tissue).

If the scar capsule shrinks it will squash and compress the breast implant. This makes the breast implant feel hard and become rounded. If part of the capsule shrinks it can push the breast implant out of position – usually upwards. The firmness can vary between a little firm to very hard. The breast implant does not move around. It stays in one position, even if you lie down. It happens in about 15 – 20% of patients if the breast implant is on top of the muscle and 3 – 5% if the breast implant is partially under the muscle.

There are no known statistics for capsular relaxation. In this situation there is too much room around the breast implant and the breast implant moves around too much. When you lie down the breast implant moves too far outwards to your side leaving the breast area empty. When you stand up the breast implant moves back to the right place and looks good. It feels very soft. In my personal observation it seems to be more likely in people who are over weight or who have lost a lot of weight.

Many people suspect that the cause of capsular contracture might be due to a sub clinical infection. In other words, the infection is so mild that you do not know anything about it. Perhaps a few bacteria are going through the bloodstream, and before your natural defenses can kill them off they land on a breast implant. Because a breast implant is not living tissue it has no defenses of its own and the bacteria can live for a while and stimulate the scar capsule to shrink. Another theory is that blood around the implant can irritate the tissues and cause contracture. I always try to do the procedure with as little bleeding as possible.

I recommend antibiotics be given in a single large dose before any dental treatment – including teeth cleaning. This is because some bacteria are often released into the blood stream during dental care, and we guess that they may have a chance to land on the breast implant. Antibiotics could perhaps kill those bacteria before tey find the breast implant. This is only an unproved theory, but it seems like a good idea.

When breast implants are placed in the human breast the space for the breast implant becomes lined with scar all around, like a ball or like the lining of a pocket. We call this scar the “capsule”. It is just a fancy name for scar inside.

Capsules (scars) inside can shrink and sometimes stretch. We don’t know why and we cannot control them.

If your pocket lining shrinks and you have a balloon in your pocket it will get compressed and feel hard and become unnaturally round. This is capsular contracture.

It can also stretch out and I call this capsular relaxation.

More on the management of capsules in breast implant and breast enhancement surgery next time. Email me by filling out the contact form if you have questions. My practice is in Stockton, California. We are close to Lodi, Modesto, Manteca, Tracy, Elk Grove and the foothills.

1. First we need to analyze what is different about the breasts. It might be shape or volume or both. Measurements are taken.

2. Second it is important to find out from the patient what she wants and which breast she prefers.

3. Then we can figure out what needs to be done. Options include breast implants on one side or unequal breast implants to both sides to correct the volume differences. Then we need to discuss what can be done about the shape. A lift on one side or unequal lifts (mastopexy) might be chosen. Even a breast reduction on one or both sides might be necessary. Every combination of breast implants (breast enlargement), breast lift (mastopexy) or breast reduction might be chosen.

There are lot of different choices that can be made. They are made in discussion with the patient. Some patients want as little as possible done and some want more done. I have seen lots of people with breast deformities at my plastic and cosmetic surgery practice in Stockton, California. We are near Modesto, Tracy, Lodi and Galt.

Call us at (209) 952-2251 so that we can meet and discuss all options that are available for your situation, if you have unequal breasts.

I will answer you if you ask me about breast implants, breast lift, breast enhancements, breast reduction, tummy tucks of all types and also liposuction. As you know my practice is well known for excellent results in these areas.

I am fascinated by these subjects as well as all questions related to beauty and would be happy to enter into a spirited conversation with you. I will even digress to non plastic surgery subjects if you want me to. Let’s talk about the economy, weight loss, life changing situations, poltics, health care and art.

I invite you to participate.

From 2007-2008, there was over a 12 percent decrease in the total number of cosmetic procedures. Surgical procedures decreased by 15 percent, and nonsurgical procedures decreased by almost 12 percent.

The top five surgical cosmetic procedures in 2008 were: breast augmentation (355,671 procedures); liposuction (341,144 procedures); eyelid surgery (195,104 procedures); rhinoplasty or nose reshaping (152,434 procedures); and abdominoplasty or tummy tuck (147,392 procedures).

The top five nonsurgical cosmetic procedures in 2008 were: Botox injection (2,464,123 procedures); laser hair removal (1,280,964 procedures); hyaluronic acid (1,262,848 procedures); chemical peel (591,808 procedures); and laser skin resurfacing (570,880 procedures).

This is a very difficult question because there is no standard and how can you describe a cup size in words? To make things more difficult the “C” cup for a 32C and 34C and 36C are all different. Also all bra manufacturers make bras that fit differently even for the same cup size. There is no standard.

We need to talk about the planned and desired outcome size differently, but it remains difficult.

Breast implants come with a volume label in milliliters (mls or ccs – they are the same) and not a cup size. A small implant in a large breasted person will not result in a small breast! The final result is the natural breast volume plus the breast implant volume. The cup size is an opinion, and not a fact. Confused? So is everyone else!

What counts is what it looks like and not the number on the breast implant. That is why we measure the breasts in such a detailed manner. The goal is to achieve a beautiful shape and be guided by the patient’s desire for not so large or large or as big as possible. Not all sizes are possible or even appropriate and should be customized to the patients goals and body characteristics, such as skin elasticity and tissue thickness.

It is not easy, but it is worth the trouble to think about the options and try to get the very best possible outcome for everyone. That is our goal.