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Capsular contracture is a scar formation issue which may develop in some cases after breast augmentation. When internal scar tissue creates a tight, thickened envelope around the breast implant, it tightens and contracts on the implant which causes it to feel firm and appear misshapen.
Every breast implant will naturally form a thin, durable scar capsule as an expected part of the healing process. Whether silicone or saline, scar tissue is the body’s natural protection which forms around any foreign object placed into the body. The thin capsule of tissue which forms around a breast implant will typically allow it to remain soft and natural-looking, but “contracture” or tightening of that capsule is classified as capsular contracture and not considered to be a normal outcome.
Most often, symptoms of capsular contracture such as discomfort, asymmetric firmness and breast shape distortion, usually will develop within the first 2 months of surgery. In fact, roughly 75% of cases develop in this early post operative phase. However, capsules may develop later than the first year.
Development of this complication without a known cause such as infection, hematoma or radiation, is known as silent capsular contracture. Many medical studies and analyses of data have led to theories about the possible triggers for this problem which include bleeding in the implant pocket and bacterial contamination.
Factors which are considered to be known risks include:
- Hematoma or seroma in the implant pocket, surrounding the implant.
- Autoimmune disorders, such as lupus
- Severe breast trauma
- Radiation therapy
- Oversized implant placement with inadequate tissue and healthy circulation surrounding it.
- Older style silicone implants leeching contents into breast implant pocket
- Infection in the body at the time of surgery or implant contamination
Many patients will be concerned that they have developed capsular contracture as they experience swollen, firm breasts in the initial weeks after breast augmentation surgery. Symptoms of capsular contracture development differ from normal swelling and pain in a few ways. Very high-riding and especially asymmetric high implant position which doesn’t begin to settle as the patient recovers could be cause for concern. Breast firmness is expected for a time after surgery, however breast firmness which increases after the first 10-14 days is not expected.
When one breast becomes more painful, tight or moves higher on the chest, this should be assessed in person by the Plastic Surgeon. Breasts which develop capsular contracture can appear very round and, “ball-like,” as well as rippled. Commonly, only one breast is affected.
The Baker grading system is the assessment guide used to measure the degree of capsular contracture. The system includes four levels:
- Grade I: At this stage, the breast is soft and appears natural. There is no cause for intervention.
- Grade II: At stage 2, the breast feels slightly firm, but looks normal.
- Grade III: The breast is firm to the touch, immovable and looks abnormal.
- Grade IV: The grade 3 CC breast is hard, feels painful and appears distorted.
There are only a few non-surgical treatments for capsular contracture. The only treatment that guarantees the condition won’t return is the permanent removal of the implants and surrounding scar tissue. Capsular contracture is one of the reasons that women opt for breast implant removal. Treatments for early stage capsular contracture development can include the use of sound waves to soften the breast, oral vitamin E supplementation and anti-inflammatory medications such as Accolate or Singulair. These interventions occasionally lead to reported reversal of symptoms and patient satisfaction.
If the problem has progressed and scar development is thick, uncomfortable and distorting aesthetic results, returning to the operating room for surgical scar tissue release or removal may be necessary. There are a number of precautions which can be taken by both surgeon and patient to reduce risks of developing this relatively rare complication. Placement of the breast implants partly under the pectoral muscles is believed to reduce rates of this complication. Preventative antibiotics are often given to the patient prior to and after surgery.
Breast implant massage in the early post op period was once mainstream practice and is not as common now. With newer, “bloodless” atraumatic surgical techniques designed to minimize bleeding during and after surgery, great care is taken to avoid bleeding in the breast pocket. Some surgeons advise gentle implant displacement maneuvers, others no patient intervention at all.