Experience and judgment by your plastic surgeon is essential when considering revision breast surgery.
Depending upon the amount of breast tissue you have and the previous surgery that you've had with the augmentation, this will dictate whether you will undergo capsulectomy (removal of scar tissue), capsulotomy (release of the scar tissue) or components of both procedures.
Capsulectomies are very useful in removing thickened, hard scar tissue that forms what is referred to as a capsule around a prosthetic device such as a breast implant. The capsule is made of three components, fibroblast, collagen and blood vessels. The etiology of the capsular contracture and the increased capsular scar tissue is not specifically known. However, it may be associated with the possibility of a micro infection of staph, epidermis staph aureus or some other type of bacterium. But at this time, no guaranteed specific etiology for the reason why one patient will develop scar tissue and one will not, is not specifically delineated.
In any case, whenever a capsulectomy is performed, the word "ectomy" means to remove the scar tissue.
When a patient has thin tissue and not a lot of breast tissue and/or breast glandular tissue, removing a significant of the scar tissue or capsule can cause severe deficiency in coverage of the implant which may lead to severe rippling, visibility and possibly even skin necrosis due to poor blood supply. Therefore, the judgment of your plastic surgeon is essential when determining how much scar tissue to remove.
Over-exenteration of scar tissue can be very dangerous and can lead to thinning out of the tissue with poor aesthetic results, including visibility, palpability and an ugly disfigured appearance to the breast. Therefore, when I perform these operations every day in my Beverly Hills Plastic Surgery Center, I am very careful to judge where and how much scar tissue or capsule to remove in order to prevent visibility and palpability of the bag.
Capsulectomy is simply a term for releasing the scar tissue. This is often performed alone on patients who have had multiple surgeries of the breast, requiring multiple revisions due to hardening.
In capsulotomy, the term "otomy" means to release. Releasing scar tissue is very important to soften the pocket and allow for more volume space so that the implant will feel soft and will not look hard and contracted.
In a Baker IV capsular contracture, there is hardening, palpable, visible distortion and possibly pain and coldness to the breast.
A capsulotomy can be performed on any portion of the capsule, superiorly along the infraclavicular region, laterally along the anterior axillary region, inferiorly along the inframammary fold or medially along the parasternal angle.
Again, the amount of scar tissue release is especially important and the judgment of the doctor is very important. If too much scar tissue is released especially along the sides of the breast, the implants may lie too far laterally and reduce the cleavage, which may look terrible. If the inframammary fold is released too much, then a bottoming out may occur with the implant ending up too low and the nipple on top of the breast. Once again, absolute experience in judgment is required whenever a capsulectomy or capsulotomy is performed. Often, when the surgeries are performed, the implants will be removed and new ones will be used to replace them.
Silicone gel implants have a significantly higher rate of scar tissue formation than saline, as micro silicone bleeding through the porous shell of the implant can cause calcifications and hardening with much thicker scar tissue capsules and is usually seen with saline implants.
Also, placing the implants in the subpectoral (behind the muscle) or dual plane technique, the muscle will then afford increased coverage and lubrication of the implant and reduce scar tissue formation significantly.
We perform hundreds of revisions and place over several hundred implants each year. Patients fly in from all over the United States and the world for breast implant or breast implant revision surgery to fix breast problems due to scar tissue contracture.
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Stuart A. Linder, M.D., F.A.C.S. is a Beverly Hills plastic and reconstructive surgeon specializing in breast augmentation, liposuction, tummy tuck, and more.
Dr. Linder is certified by the American Society of Plastic and Reconstructive Surgeons and is a diplomate of the American Board of Plastic Surgery.