Ask. Dr. Barber

Q.  I had a breast augmentation with silicone implants about 2 years ago. My right side is perfect, but my left side is very hard and does not look natural. My surgery was done in another state and I have moved to the Triad area and do not have a plastic surgeon. What can be done to improve the appearance of my “bad side”?
A.  What you describe is called a capsular contracture and is caused by aggressive scarring that has formed around your implant. It is not known exactly why contracture forms in a woman’s breast but it is postulated, and evidence is beginning to support, that hardness is caused by a bacterial infection around the implant. The infection is sub-clinical, meaning that it does not cause any symptoms such as fever, swelling, redness, or pain. But the bacteria that is on the implant will stimulate the immune system to fight the infection, and that process will cause inflammation which then leads to scar formation around the implant. This scar encircles the implant and squeezes it tightly and that is why the breast implant feels so hard. As the scar tissue continues to squeeze the implant, distortion of the implant occurs thereby making the breast look distorted. You can demonstrate to yourself what is happening by squeezing a balloon in your hands and you will notice that the balloon gets hard and distorted. That is precisely what is happening when the implant is being squeezed by scar tissue.
Once a capsule has started, there is little that can be done to reverse the hardness. The recommendation for treating this problem is to return to surgery at a convenient time to remove and replace your implant. Usually I will recommend that a different type of implant be used, that is, if you have a silicone implant, consider changing to a saline implant. If the implant is on top of the muscle, then change the pocket location to underneath the muscle. If the implant is under the muscle then remove most of the capsule (scar tissue) and put a new implant in the same sub-muscular space. Of course, if you change the implant on the affected side, then some consideration might be given to changing the implant on the opposite side to the same kind of implant to ensure symmetry. This point is debatable but should at least be discussed with you plastic surgeon. After changing the implant(s), the breast should be soft again. However, here is the bad news. Studies show that the incidence of recurrent capsular contracture is quite high, as high as 30%. It is heartbreaking if the hardness comes back again. If that happens, you can decide to just live with the hardness or maybe consider removing the implants altogether and just be done with them. You should definitely visit a plastic surgeon who is certified by the American Board of Plastic Surgery and see what your options are for making your breast better. Best of luck!

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