A Little Setback

We have to take the bad with the good, right?  Cathy had a little setback this week.  It's not a cancer related setback, but a reconstruction related setback.  As she has been healing from reconstruction she has been feeling a particularly powerful tightness on her right side.  The left side, which is ironically the side that was troublesome with the expanders, has felt pretty good.  After seeing Dr. Butterfield, we've learned that Cathy has developed capsular contracture.

Capsular contracture is a condition that deals with the scar tissue that the human body develops.  Because the implant is a foreign body, Cathy's body has developed a capsule of scar tissue that surrounds the implant to wall it off from the rest of her body.  This process is normal.  It's one of the body's defense mechanisms to fight off foreign invaders.  In her left breast, the capsule of scar tissue is thin, light, and supple, allowing for normal healing.  However, the capsule in her right breast is tightening and forcing the implant to shift in position.  The capsule of scar tissue is connected with other tissue, like skin and muscle, so as the capsule contracts it pulls on the tissue to which it is connected, causing some considerable discomfort.  

There is a grading system for degrees of capsular contracture.  It's called the Baker scale and it looks like this:

• Grade I — the breast is normally soft and appears natural in size and shape
• Grade II — the breast is a little firm, but appears normal
• Grade III — the breast is firm and appears abnormal
• Grade IV — the breast is hard, painful to the touch, and appears abnormal

In Cathy's instance, her contracture is a Grade IV.  So, all of this boils down to another surgery.  Sometime in April, Cathy will have to have a capsulectomy and then have her implants replaced.  The silicone implants will be replaced by textured saline implants that will reduce the likelihood of another capsular contracture.  The bad news is that once significant capsular contracture occurs the odds that it will recur are about 50/50.  We're praying that Cathy will be on the good side of that 50/50.  We're hoping things will turn out well, but if they don't the only further options are another surgery with no reconstruction or microvascular surgery using tissue from her buttocks.  Neither of those options is preferable.