Capsular Contracture of Breast Implants

What is capsular contracture?

Capsular contracture is when breast implants cause the formation of a collagen tissue capsule around the breast implants. Normally this is very soft and is unnoticeable.  However, in 7% of individuals, it can tighten and squeeze the breast implants and cause “capsular contracture”.  Breast implant capsule contracture may be more common after infection, hematoma or seroma formation, or maybe related to genetic factors.

What causes breast implant capsular contracture?

The exact cause of breast implant capsular contracture is not fully understood, but several factors are believed to contribute to its development. These factors include:

 

  1. Biofilm Formation: A biofilm is a thin, sticky film of bacteria that can form around the implant. It is thought that certain bacteria can trigger an inflammatory response, leading to the formation of excessive scar tissue and subsequent contracture.

  2. Surgical Technique: Factors related to the surgical procedure itself can influence the risk of capsular contracture. For instance, excessive bleeding or contamination during surgery, improper implant placement, or inadequate pocket creation can increase the chances of developing contracture.

  3. Implant Rupture or Leakage: A ruptured or leaking implant can cause irritation and inflammation, potentially leading to the formation of excessive scar tissue. Silicone gel implants may have a lower risk of capsular contracture compared to saline implants in the event of rupture, as the gel tends to remain within the implant pocket.

  4. Implant Surface and Material: The surface texture of breast implants can impact the risk of capsular contracture. Smooth implants are associated with a higher risk, as they allow for greater mobility within the breast pocket, potentially leading to more friction and inflammation. Textured implants, on the other hand, are designed to adhere to surrounding tissue and may help reduce the risk of contracture.

  5. Genetic Predisposition: Some individuals may have a genetic predisposition that makes them more susceptible to developing capsular contracture. Genetic factors can influence the way the body responds to foreign objects and the healing process, potentially increasing the likelihood of excessive scar tissue formation.

It is important to note that while these factors are believed to contribute to the development of capsular contracture, the condition can still occur without any identifiable cause. Research is ongoing to better understand the mechanisms and risk factors associated with capsular contracture in order to improve prevention and treatment strategies.

 

What are the symptoms of capsular contracture?

Capsular contracture symptoms can vary in severity and may develop gradually over time. The most common signs of capsular contracture include:

 

  1. Breast Firmness: The affected breast may feel noticeably firm or hard to the touch. It can feel different from the natural breast tissue or the opposite breast.

  2. Change in Breast Shape: Capsular contracture can cause the breast to appear distorted or misshapen. It may appear rounder, higher, or more elevated compared to the unaffected breast.

  3. Breast Pain or Discomfort: Some individuals with capsular contracture may experience mild to moderate pain or discomfort in the affected breast. This can range from occasional discomfort to persistent or throbbing pain.

  4. Tightness or Pressure: A sensation of tightness or pressure in the breast can be present due to the constrictive nature of the scar tissue capsule around the implant.

  5. Visible Rippling or Wrinkling: In advanced cases of capsular contracture, visible rippling or wrinkling of the skin over the implant may occur, creating an uneven or unnatural appearance.

  6. Changes in Breast Sensation: While less common, capsular contracture can sometimes lead to changes in breast sensation, such as increased sensitivity or decreased feeling in the breast or nipple area.

Baker Scale Grading for Capsular Contracture

Capsular contracture of breast implant can be graded from Baker I to IV depending on the severity:

 

  • Grade I:       No palpable capsule. Breast feels soft as an unoperated breast.
  • Grade II:     The breast is less soft and the breast implant can be palpated but is not visible.
  • Grade III:   The breast is harder, the breast implant is easily palpated and the breast implant is visually distorted
  • Grade IV:    The breast is very hard, tender, painful, and cold.  The distortion of the breast implant is severe.

What is the treatment for breast implant capsular contracture?

Capsular contracture treatment depends on the severity of the condition and the symptoms experienced by the individual. The following are some common treatment approaches for capsular contracture:

 

  1. Non-Surgical Interventions: In mild cases of capsular contracture, non-surgical interventions may be attempted first. These can include massage techniques, oral medications (such as leukotriene inhibitors or Vitamin E), and ultrasound therapy. However, the effectiveness of these methods in treating capsular contracture is still under debate.

  2. Capsulotomy: A capsulotomy involves making incisions in the scar tissue capsule to release the tightness and allow for better mobility of the implant. This procedure can be performed using various techniques, including closed capsulotomy (manually breaking the scar tissue from outside the breast) or open capsulotomy (creating an incision to directly access the capsule). However, open capsulotomy has become less common due to increased risk of complications.

  3. Capsulectomy: A capsulectomy involves surgical removal of the scar tissue capsule surrounding the implant. This procedure is typically recommended for more severe cases of capsular contracture. In some instances, total capsulectomy (complete removal of the capsule) may be necessary, while in others, a partial capsulectomy (removing a portion of the capsule) may be performed.

  4. Implant Replacement or Exchange: In cases where capsular contracture persists despite surgical intervention, replacing the implant may be necessary. This can involve exchanging the implant for a new one, changing the implant type (e.g., from smooth to textured), or adjusting the implant size or position.

How to avoid capsular contracture?

While it may not be possible to completely prevent capsular contracture, there are several strategies that can potentially reduce the risk. Here are some measures that may help minimize the likelihood of developing capsular contracture:

 

  1. Choose an Experienced Surgeon: Select a board-certified plastic surgeon who has extensive experience and a good track record with breast augmentation procedures. A skilled surgeon will use proper techniques during Breast Augmentation surgery, reducing the risk of complications.

  2. Implant Placement: Discuss with your surgeon the most suitable implant placement option for your anatomy. Submuscular placement (underneath the chest muscle) may offer some advantages in terms of reducing the risk of capsular contracture compared to subglandular placement (above the muscle).

  3. Consider Implant Type and Texture: Textured implants have been associated with a lower risk of capsular contracture compared to smooth implants. However, it’s essential to discuss the pros and cons of different implant types and textures with your surgeon, taking into account your individual circumstances and preferences.

  4. Minimize Bacterial Contamination: Infection can contribute to capsular contracture, so it is crucial to maintain proper hygiene and follow your surgeon’s instructions for wound care after surgery. Additionally, ensure that any surgical instruments, implants, or materials used during the procedure are sterile.

  5. Avoid Trauma to the Breasts: Protect your breasts from excessive pressure or trauma, especially during the initial healing period. This includes avoiding activities that may cause trauma or excessive stretching of the chest muscles or breast tissue.

  6. Regular Breast Implant Surveillance: Attend regular follow-up appointments with your surgeon for routine check-ups and monitoring of your breast health. This allows for early detection of any potential issues, including capsular contracture.

  7. Smoking Cessation: If you smoke, consider quitting before undergoing breast augmentation surgery. Smoking has been associated with a higher risk of capsular contracture and can impede the healing process.

It’s important to note that while these measures may help reduce the risk of capsular contracture, the condition can still occur despite taking precautions. Discussing your concerns, expectations, and potential risk factors with your surgeon will help guide you in making informed decisions about breast augmentation surgery.

 

Dr. DeConti has an extensive experience in treating breast implant capsular contracture.  If you are interested in learning more or would like to schedule a consultation to discuss treatment options, please contact DeConti Plastic Surgery at 804 673-8000.

 

Learn more:

American Society of Plastic Surgeons: Risks of Breast Augmentation

804 673-8000