As a board certified Plastic Surgeon that specializes in breast and body contouring I am often asked for advice about problems associated with cosmetic surgery.  I  received an email yesterday asking for help with breasts that have become firm and hard following breast augmentation surgery.  I’d like to comment on this here to provide other women with this common problem an avenue to find out additional information that may help them. 

The most likely diagnosis for firm breasts following breast implants is capsular contracture.  An implant capsule is a scar that forms around the implant on the inside of the breast.  Capsules develop in all women who have undergone breast augmentation.  In and of themselves,  capsules are not a problem.  The problem begins as the scar begins to shorten or contract around the implant.  In milder forms this squeezing on the implant causes breast firmness.  Unfortunately, the problem can be progressive causing very hard breasts, change in the shape of the breast,  or even pain in the breast.  In a recent study by Allergan, an implant manufacturer, the risk of developing significant capsular contracture after silicone breast augmentation is 14.8% at 6 years. 

Capsular contracture, at least in theory,  is reduced when implants are positioned behind the pectoralis muscle, when implants are massaged daily to stretch the implant capsules, and by the use of textured implants.  That being said, capsules can still develop even when all of these options are exercised.  Some patients may have a predisposition to developing exuberant scars.  Others may develop a collection of blood around their implants (hematoma) or an infection that can contribute to the development of the problem. 

There is research being conducted into the use of medications to prevent and treat capsular contracture.  Accolate(Zafirlukast) a leukotriene antagonist used initially for reactive airway disease showed promising results in reducing breast firmness over a 6 month treatment course.  More recently, Pirfenidone, an antifibrotic medication prevented the development of capsular contracture in an animal model.  Both of these medications will need additional study before being used widely in the treatment of capsular contracture.

The mainstay of treatment at this point for capsular contracture is surgery.  Implant capsules can be opened up in a procedure called capsulotomy, or they can be removed in a procedure called capsulectomy.  Implants are typically  exchanged at that time.  Some women may elect to have their implants removed and not replaced.  If this is the case, additional breast contouring procedures such as breast lift (mastopexy) may be necessary.   

I have included a case presentation that demonstrates the typical findings of this problem.  She is a 49 y/o woman who underwent a subglandular silicone breast augmentation in 1988.  Over time, her breasts have become ”rock hard” and are now causing her pain.  These are the preoperative views of the patient showing distortion of the breast and firmness in the upper portions on both sides.  Examination of the breast demonstrated extremely firm breasts with probable calcification of her capsules.  Here is the preoperative view:

The patient underwent a procedure where her breast capsules were opened (capsulotomies) and removed (capsulectomies) to restore softness to the breast.  New implants were positioned into the Dual Plane to reduce the risk of recurrence of her capsular contractures.  We spoke about performing a breast lift for her but she declined and was only interested in addressing her implant capsules.  These are the postoperative views at 6 months:

The surgery achieved her goals of a much improved and natural slope of the upper portion of the breasts.  The breasts are completely soft and no capsule is palpable by examination.   

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs for review.  I invite you to schedule a consultation with me if you are experiencing this problem and are looking to learn more about this common problem.  Please feel free to contact our office at (713) 661-5255 if you have any questions. 

-Brice W. McKane, M.D.

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