Capsular Contracture

What is Capsular Contracture?

When a foreign body is introduced into our body in the form of a breast implant, our body is programmed to respond by forming a “capsule” around the implant. 

This is essentially normal scar tissue that serves to isolate the implant. Capsular contracture is a condition that occurs after an implant surgery where the normal capsule starts to thicken thereby causing it to contract around the implant, and it is not usually dangerous to patient’s health. Although this condition can happen after any medical implant placement, after a breast implant surgery, this can present with the breast feeling firm, distorted in shape, and painful if severe. In fact, there is a grading system of capsular contracture based on severity.
  • Grade 1: In this stage, the breast appears normal and feels soft to the touch. This grade indicates no signs of capsular contracture.
  • Grade 2: This stage is a mild form of capsular contracture where the breast looks normal but the patient may feel that the breasts are slightly firmer than Grade 1.
  • Grade 3: Grade three represents a moderate case of capsular contracture, where the breast is visibly distorted and noticeably firmer and less natural to the touch.
  • Grade 4: This is the most severe stage of capsular contracture. Just like grade 3 capsular contracture, there is visible distortion and firmness to the touch. Additionally, the patient feels pain and discomfort from the tightening.

What causes Capsular Contracture?

The exact cause of capsular contracture is not clear but the current understanding points to several factors that may contribute to its development. It is important to understand that this condition is not caused by breast implants being in any way toxic or dangerous.
  1. Biofilm formation: Biofilm is a thin layer of bacteria that can form on the surface of breast implants. Biofilm may trigger an immune repose in some individuals, leading to inflammation and excessive scar tissue formation around the implant.
  2. Bacterial contamination: Infection of the breast implants can lead to the formation of capsular contracture, as bacteria can trigger inflammation and thick scar formation.
  3. Implant surface: Smooth implants are more likely to lead to capsular contracture than textured implants.
  4. Surgical technique: Careful dissection that minimizes tissue trauma can reduce the risk of capsular contracture.
  5. Hematoma or seroma: The accumulation of fluid (whether blood or body fluid) around the implant can trigger the inflammatory response that contributes to the development of scar tissue.
  6. Smoking: Smoking can increase overall complication risk, including capsular contracture.
  7. Genetics: Just as some people are more prone to aggressive scar formation, genetics can influence someone’s susceptibility to capsular contracture.
While these factors may contribute to capsular contracture, not all individuals will experience this complication. And for those who develop capsular contracture, it can occur even when all precautions are taken during surgery, and some may develop a “random” case of capsular contracture where there is no known identifiable external factor. Because capsular contracture is a highly treatable condition, the fear of developing this condition should not hold you back from getting breast augmentation surgery.

How do you prevent Capsular Contracture?

There are several ways to lower a patient’s risk of developing capsular contracture although there is no way of preventing this condition from occurring in every patient.
  • Choosing an experienced surgeon: Select a board-certified plastic surgeon who is experienced and skilled in reducing complications and minimizing surgical trauma.
  • Using the correct size of implant for the patient: Placing a large implant in a patient with insufficient natural breast tissue increases the risk of capsular contracture.
  • Minimal implant handling: Dr. Min utilizes a “no touch” technique that minimizes handling of the implant prior to being inserted into the patient’s breast to lower the risk of introducing bacteria.
  • Placing the implant “under the muscle”: Placing implants under the pectoralis muscles can significantly lower the risk of capsular contracture.
  • Following postoperative care: Follow your surgeon’s postoperative care instructions, including medications, restrictions, etc.
  • Avoiding smoking: If you smoke, quitting before and after surgery can reduce the risk of complications, including capsular contracture.
  • Considering implant exchange: Implant exchange surgery can be considered every 10 years or so, and newer implants may have a lower risk of capsular contracture.
It is important to note that while these measure can help reduce the risk of developing capsular contracture, it can still occur in some cases. If you suspect capsular contracture, it is important to communicate with your surgeon to effectively manage capsular contracture.

How is Capsular Contracture treated?

Management and treatment options for capsular contracture varies depending on its severity and the underlying cause.
Non-surgical treatments can include certain medications, like leukotriene inhibitors (i.e. Singulair), which can be used to potentially prevent or treat mild capsular contracture.
Surgical treatments would usually involve capsulectomy (removing a portion or the entire capsule) or capsulotomy (making incisions in the existing capsule to release the tightness). Additionally, the implant may be replaced with a new one, and the implant pocket placement may be adjusted. In recurrent capsular contracture, acellular dermal matrix (ADM) can be used to reinforce the implant as it has been shown to reduce the risk of future capsular contracture.
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