Las Vegas Plastic Surgery: Board-Certified Plastic Surgeon Dr. Jeffrey J. Roth

Board Certified Plastic Surgeon Dr. Jeffrey Roth Explains Breast Implant Capsular Contracture – YouTube

Learn about breast implant capsular contracture as expert Dr. Jeffrey Roth explains causes, treatment options, and more.

Board Certified Plastic Surgeon Dr. Jeffrey Roth provides a comprehensive explanation of breast implant capsular contracture. As an expert in the field, Dr. Roth breaks down the process of capsule formation in the body and discusses how it can sometimes lead to hardness or scarring in breast implants. He goes on to explore various treatment options, including capsulotomy and capsulectomy, shedding light on the different techniques and considerations for each. Dr. Roth’s depth of knowledge and clear delivery make this video a valuable resource for anyone seeking information about breast surgery and implant contracture.

Capsular Contracture

Explanation of breast implants and capsules

Breast implants are a popular option for women who wish to enhance the size or shape of their breasts. These implants are typically made of a silicone shell filled with either saline or silicone gel. When a breast implant is surgically placed, the body naturally forms a protective lining around it called a capsule. Capsules will form around other implanted devices like pacemakers and chemotherapy ports. This capsule is a normal part of the healing process and helps to keep the implant in place. However, in some cases, the capsule can become thick and tight, resulting in a condition known as capsular contracture.

Prevalence of capsular contracture

Capsular contracture is a complication that can occur after breast augmentation surgery. While the exact prevalence is difficult to determine, studies suggest that approximately 10% to 20% of women who undergo breast implant surgery may develop capsular contracture. The risk may vary depending on factors such as implant type, surgical technique, and individual patient characteristics. It is important to note that not all cases of capsular contracture require treatment, as mild forms may not cause significant discomfort or aesthetic concerns.

Treatment options for capsular contracture

The degree of capsular contracture may vary, (Baker classification 1 to 4, with 4 being the hardest).  Less severe cases may sometimes be treated with message, medication, or other non-invasive modalities.

When capsular contracture causes significant pain, discomfort, or changes in breast appearance, surgical treatment options may be considered. The main treatment options for capsular contracture include capsulotomy, capsulectomy, and removal of the capsule and implant altogether.  In some cases to help to prevent recurrence, one can also change the pocket, or use acellular dermal matrix, (ADM). The choice of treatment depends on the severity of the condition, individual patient factors, and the desired outcome.


Types of capsulectomy procedures

Capsulectomy is a surgical procedure aimed at removing or releasing the thickened capsule that surrounds a breast implant. There are different types of capsulectomy procedures that can be performed, depending on the extent of the capsule contracture and the desired outcome. Some common types of capsulectomy procedures include:

  1. En-bloc capsulectomy: This procedure involves the removal of both the capsule and the implant as a single unit. It is sometimes recommended in cases of severe capsular contracture or when there is a concern for implant rupture or contamination.
  2. Total capsulectomy: In this procedure, the entire capsule is removed, and the implant is also removed as two separate units.  This may be done to better visualize the structures when dissecting. 
  3. Partial capsulectomy: As the name suggests, this procedure involves the partial removal of the capsule without removing the entire structure. Partial capsulectomy may be chosen when the severity of the capsular contracture is moderate and there is no need for complete removal of the capsule or implant.

Considerations for choosing the appropriate procedure

Choosing the appropriate capsulectomy procedure requires careful consideration by both the patient and the surgeon. Factors such as the severity of capsular contracture, individual aesthetic goals, the integrity of the implant, and overall patient health should all be taken into account. It is important for patients to have a thorough discussion with their plastic surgeon to understand the potential benefits, risks, and expected outcomes of each procedure.

Special cases for capsulectomy

In some cases, there may be additional considerations for capsulectomy procedures. For example, patients who have experienced implant rupture or leakage may require special attention during the removal of the capsule. Additionally, patients with a history of breast implant-related infections or complications may require a more specific approach to their capsulectomy procedure. It is crucial for patients to disclose their complete medical history and any previous breast surgery experiences to their surgeon to ensure appropriate treatment planning.


Procedure and purpose of capsulotomy

Capsulotomy is a less invasive alternative to capsulectomy for the treatment of capsular contracture. In this procedure, the surgeon manually releases or cuts the thickened capsule, allowing for increased flexibility and softness of the breast. The purpose of capsulotomy is to address the tightness and discomfort associated with capsular contracture without removing the entire capsule or implant.

When capsulotomy is recommended

Capsulotomy may be recommended in cases where the capsular contracture is mild to moderate, and the patient wishes to avoid the complete removal of the capsule or implant. The procedure can help to improve breast symmetry, relieve pain or discomfort, and restore a more natural appearance and feel to the breasts. However, it is essential for patients to understand that capsulotomy may not be a permanent solution and that capsular contracture may still recur in the future.

Cautions and considerations for capsulotomy

While capsulotomy can be a viable option for some patients, there are certain cautions and considerations to keep in mind. Additionally, capsulotomy may not be suitable for patients with severe capsular contracture or in cases where the capsule has calcified or become unusually thick. As with any surgical procedure, it is crucial for patients to consult with a qualified plastic surgeon who can assess their individual situation and provide personalized recommendations.

Special Considerations

Patient anatomy and its influence on procedure choice

Every patient has unique breast anatomy, and this plays a significant role in determining the appropriate capsular contracture treatment. The size, shape, position of the implants, and the thickness of the capsule can vary between individuals. Surgeons must carefully assess each patient’s anatomy to choose the most suitable surgical technique and achieve the desired outcome while minimizing the risk of complications or unsatisfactory results.

Complications and risks of capsular contracture treatment

As with any surgical procedure, capsular contracture treatment carries certain risks and potential complications. These can include infection, bleeding, poor wound healing, changes in breast sensation, implant malposition, implant rupture, and the recurrence of capsular contracture. It is important for patients to discuss these potential risks with their surgeon and follow all pre- and post-operative instructions to minimize the chances of complications.

Breast Implant Illness and its relation to capsules

Breast implant illness (BII) refers to a range of symptoms that some women attribute to their breast implants. While the connection between BII and breast implants is still under investigation, some individuals with BII have reported improvements in their symptoms following the removal of the capsule and implant. It is important for patients who suspect they may be experiencing symptoms related to breast implant illness to consult with a medical professional experienced in managing such cases to determine the best course of action.

Q&A with Dr. Jeffrey Roth

Addressing common questions and concerns about breast surgery

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