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What treatment method would you recommend for capsular contracture?

Q:

I am 68 years old, and have had my Saline Breast implants for 36 years. I have never had any problems with them until recently. One has developed capsular contracture. Overall - I am in good physical shape, but do have a couple of auto-immune diseases. My question is 2 fold........ What method of testing for cancer would you suggest in lieu of a mammogram which could fracture the implants? What treatment method would you recommend to deal with the contracture issue in the affected breast?

A:

In my opinion, the best way to treat your capsular contracture is with a surgical capsulectomy. In this procedure the previous augmentation scar is re-opened and the scar tissue which has formed around the implant is surgically removed. This is commonly done under general anesthesia. I would also recommend that since you would already be undergoing a surgical procedure on your breast(s) that you seriously consider having your 36 year old implants replaced with new ones. I recognize that they are intact but at that age they have exceeded their realistic life expectancy. The newer implants also have the benefit that most of them come with a lifetime warranty from the manufacturer so that if a leak should develop, the manufacturer would provide you with replacement implants at no charge.

A breast screening option that you have other than a traditional mammogram is to have an MRI performed. I would refer you to an article by Dr. Priscilla Slanetz from the Beth Israel Deaconess Medical Center (see more at: http://www.bidmc.org/YourHealth/HealthNotes/MedicalImaging/DiagnosticTests/MammogramvsMRI_BreastScreeningsForHighRiskWomen.aspx) An MRI would not traumatize the breasts or the implants although generally implants can tolerate mammograms with no problems. MRIs do tend to be more expensive than mammograms and may not be covered by your health insurance as an initial screening tool. In any event, please be sure to follow your physician’s recommendation for breast screening frequency.

A:

An MRI would be the best diagnostic test for cancer.

A procedure called a capsulectomy which removes the breast implant capsule is the proper procedure. If you chose new implants textured implants wrapped with acellular dermis is the best option. You will need to replace both sides.

A:

Mammograms, MRIs, and ultrasounds are the recommended imaging modalities for breast cancer screening.  These methods typically will not fracture breast implants.  Be sure to let your doctor and the imaging team know that you have breast implants, in case additional views are needed to better evaluate your breast tissue.  

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Regarding your second question, surgical intervention is most likely needed to treat capsular contracture of breast implants.  This may entail opening the capsule and removing part or all of the capsule.  I encourage you to check with your medical doctor regarding your breast health, and also seek consultation with a board certified plastic surgeon to discuss your capsular contracture.  

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Visit the ASAPS homepage to find a board certified plastic surgeon near you.  

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For more information regarding breast cancer imaging, visit the National Cancer Institute (NCI) website at cancer.gov (or try the following link: http://www.cancer.gov/cancertopics/factsheet/detection/mammograms)

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