Capsular Contracture after Breast Augmentation
Capsular contracture is the one of the most concerning and feared problems after breast implant surgery. It happens when the tissue around the implant starts to tighten and harden. This may cause the breast to change shape. The breast may even appear distorted. This condition can be very painful in some cases.
Capsular contracture can happen on one or both breasts. It does not matter what type of implant is used – both saline and silicone breast implants can be affected. It can happen just weeks after surgery or not until years later. (Though, most often it happens within the first year). Since it is so unpredictable, it can be quite frustrating. It can be especially frustrating because a second surgery is sometimes needed to correct the issue. In severe cases, it can recur even after the breast implant revision surgery. It may require multiple attempts to resolve the problem because it keeps coming back after surgery.
Capsular Contracture: before & after correction photos*
What is Breast Implant Capsular Contracture?
When a foreign object is placed in the body – like a breast implant – the body responds by creating a thin layer of fibrous tissue around the object. This tissue is quite like scar tissue. When this tissue forms around an implant it creates a capsule. All of this is normal. The problem occurs when that tissue thickens, tightens or hardens. Even when the capsular contracture is severe, the breast implant itself is not hardened. It is the tissue around it. This will squeeze the implant. It can cause it to change shape. This may be visible from the outside. When the tissue hardens it can be quite painful.
There is a scale on which capsular contracture severity is measured. It is called the Baker scale. There are four grades:
- I – No capsular contracture. The breast still appears normal. The tissue is soft. The capsule is still flexible.
- II – Mild symptoms. The breast has some firmness, but still appears normal. The edges of the breast implant may be able to be felt through the skin.
- III – Moderate symptoms. The breast is firm. The breast implant edges can be felt through the skin. There is a visible abnormality. This may be a distortion, or a more rounded shape, or a tilt. This capsule can be thick.
- IV – Extreme. The breast is now very firm. It may be painful. Like Grade III, the abnormality is visible. This capsule can be very thick.
Since mild capsular contracture is not usually problematic, many times it will not be treated. Some women even find they prefer the look at Grade II. However, once the symptoms become much more noticeable, the plastic surgeon will work out what treatment is necessary.
What causes Capsular Contracture?
The contracture itself seems to be caused by the immune system. What triggers it to occur is not known. That said, there are some factors that are thought to increase the risk:
- Rupture of the breast implant shell
- Leaking silicone gel
- Bacteria on the implant surface (this can come from the skin during the surgery)
- Infection within the surgical area
- Internal bleeding, such as seroma (pooled fluid) or hematoma (broken blood vessel or clot)
- Placing the implant above the muscle (more scar tissue forms around it)
- Trauma to the breast
- Smoking (smoking reduces the amount of oxygen in the blood, which can delay healing and contribute to several of the factors above)
- Radiation (such as from cancer treatment)
What are the treatment options for capsular contracture?
If you suspect capsular contracture, contact your plastic surgeon. After it happens, there are surgical options:
- Capsulectomy is often required. This means removing the capsule surgically. It will require the removal and replacement with a new implant as well. This is the most effective treatment. One advantage to this option is that changes can be made to the implants at the same time. For example, the implant size or type could be changed. Sometimes the implant is replaced at a later date to lower the risk of having the same problem again. However, even if the capsule is removed, it can reoccur. In fact, if you have had it once, you are more likely to have it again.
- In some cases, the surgeon can release or removal only a portion of the scar tissue. This allows the capsule to widen. This is a capsulotomy.
There are also less effective, non-surgical treatments used in some cases, such as:
- Pulsed electromagnetic field therapy
- External ultrasound
- Medicines taken that prompt the tissue to relax or soften
- Steroid injections by the surgeon
- Vitamin E
It is not recommended to try to manipulate or break the capsule externally. Such actions could cause the implant to rupture. This used to be a common approach in the 1980’s. Not only could it cause rupture, but it was also painful. And the capsule contracture may still return.
If you suspect you may have capsular contracture, talk to your plastic surgeon about options. It is best to treat it sooner rather than later.
What can be done to reduce the risk?
You may be wondering how this can be prevented. Since the cause is not known with certainty, the prevention is tough. However, since there are many factors thought to increase risk, much can be done to minimize those. To reduce the risk:
- Place the breast implant below the muscle instead of just below the breast glands. This may also mean less scar tissue.
- Minimize how much the implant is handled; also minimize how much it touches the skin before insertion. This can reduce the chance of contamination.
- The plastic surgeon can use antibiotic solution to clean the area.
- Some plastic surgeons advise creating a “pocket” during surgery that is larger than the breast implant. (As opposed to a pocket that is a snug fit). The idea is to give more room for the tissue to form around it without causing problems.
- Use saline implants. (Capsular contracture can happen with either type of implant, but some data shows a higher incidence with silicone implants)
- Avoid the periareolar incision. (Some bacteria exist in the breast ducts).
- Take all prescribed medications before and after the breast augmentation. This includes antibiotics to lessen the risk of infection.
- Some massages after breast augmentation surgery can keep the tissue supple.
- If you have drains in place after surgery, be sure they are emptied on time. This can prevent fluid buildup that may contribute to the contracture.
George Washington University Professional Center
The Loudoun Center for Plastic Surgery
45155 Research Place, Suite 125
Ashburn, VA 20165