Changing breast implants in case of capsular fibrosis? Questions for PD Dr Mathias Tremp

The body forms a so-called breast capsule around an existing breast implant as a foreign body reaction. Usually the breast capsule is very fine and thin and does not cause any discomfort. The breast feels soft and mobile when you feel it.

Excessive capsule formation is called capsular fibrosis or capsular contracture. The thickened capsule formation compresses the breast implant, changes the shape of the breast and can cause pain.

Read also: Breast augmentation, Breast reduction, Breast lift, Reconstructive breast surgery to restore the breast,

How does capsular fibrosis develop in breast implants?

If a bruise or infection develops after breast surgery with a prosthesis, then the risk for capsular fibrosis is increased. In this context, the risk of capsular fibrosis is increased if the breast augmentation is accessed through the atrium. This is because of the increased risk of infection.

Similarly, the risk of capsular fibrosis is significantly higher when the breast implant is above the muscle than when the implant is below the muscle. The coating of the implant is also relevant: The so-called textured implants with a rough surface have a lower risk of capsular fibrosis than the smooth-walled implants.

How common is capsular contracture and when do the implants need to be removed?

The classification of capsular fibrosis is according to Baker: In BAKER I, a soft capsule surrounds the breast implant. No change can be detected; a slight thickening of the capsule may be seen in the ultrasound examination.

In BAKER II , the connective tissue is slightly hardened and there may be feelings of tension.

BAKER III describes a moderately hardened connective tissue. In addition, an incipient deformation of the implant is visible.

In BAKER IV, the connective tissue around the breast implants shrinks and deformations of the breast occur, which are accompanied by severe pain. If the implant is under the muscle, the risk of capsular fibrosis after 10 years is about 10%.

Prosthesis removal is recommended at the latest for the BAKER III-IV staging.

Does the health insurance cover the costs?

At the latest with a stage classification according to BAKER III-IV, the prosthesis removal and capsule removal is usually covered by the health insurance, less annual deductible and excess.

Prior to this, an application for cost approval must be submitted to the relevant health insurance fund.

What options are there after denture removal and what is my cost share?

There are several options after prosthesis removal. On the one hand, you can do without further breast implants, in which case you will not incur any additional costs. The aesthetic result depends on the skin elasticity and the size of the breast. A correction may then be necessary later.

Other possible options after prosthesis removal are: Breast lift, breast reduction, breast augmentation with autologous fat and/or implants. These options will be discussed during an individual consultation.

These operations are usually not covered by health insurance and are at the patient's expense. Depending on the additional procedures and the duration of the operation, you will receive a detailed written cost estimate from us.

Does the whole capsule have to be removed?

As a rule, the capsule is removed completely if the breast implant is over the muscle, if breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is suspected, or if the breast capsule is significantly thickened.

Can I prevent capsular fibrosis?

On the one hand, the risk of capsular fibrosis can be minimised by the choice of implant (smooth-walled), the position of the implant (under the muscle) and the access of the implant (underbust fold or armpit). Likewise, nicotine consumption is a risk factor for capsular fibrosis.

If you have already had capsular fibrosis, an anti-inflammatory medication (leukotriene antagonist) or preventive ultrasound treatments can reduce the further risk of capsular fibrosis after the prosthesis change. Regular implant massage can also minimise the risk of capsular thickening.

What are the risks, what is the procedure like and what do I have to keep in mind after the operation?

The operation usually takes place under general anaesthesia. The hospital stay usually takes two to three days. As the breast capsule is well supplied with blood, wound drainage tubes are often inserted, which can usually be removed after 24 hours. The corresponding risks and behavioural measures after the operation are the same as after a breast enlargement, breast reduction or breast lift.

Do you have any questions?

Make an appointment for a consultation.

Contact us during office hours to arrange a no-obligation consultation with PD Dr. med. Mathias Tremp in Cham near Zug.

Our offer for aesthetic medicine and plastic reconstructive surgery

Our range of treatments covers the entire spectrum of aesthetic medicine and plastic-reconstructive surgery. Each treatment is an individual procedure that is precisely tailored to your wishes, needs and prerequisites.

We stand for transparent and fair prices. The costs include all measures such as preliminary consultation, operation, anaesthesia, stays and follow-up checks. The costs for cosmetic surgery treatments are only covered by health insurance in exceptional cases. Contact us for your questions about the treatments.

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