What are the local (chest wall) problems that are associated with implants?
Capsular contracture, which is the tightening of the scar capsule around the implant, is usually associated with subclinical infection of the scar capsule. Capsular contractures can be treated with a combination of antibiotics, massage exercises, high doses of Vitamin E and healing techniques that help resolve the subclinical infection. This must be done early, however, because once the capsular contracture is established and the collagen cross bonded, surgical treatment consisting of removal of the capsule is usually needed. Once the silicone begins to leak out of the shell, one can either see a new capsular contracture, if infection of the capsule occurs, or a softening of the capsule if disruption of the shell occurs without capsular contracture. With textured shells or with polyurethane shells, we often see thick capsules that can invade local tissues including breast, muscle, and the lining of the ribs if the implants are submuscular. These capsules can be difficult to surgically
