What is Capsular Contracture?

04 Oct What is Capsular Contracture?

Causes, Prevention and Surgical Treatment for Capsular Contracture

Capsular contracture is a concerning complication that can occur after breast augmentation surgery. This condition develops when the scar tissue that naturally forms around breast implants begins to tighten and squeeze the implant, potentially causing discomfort, distortion, and other undesirable effects. Capsular contracture can have an impact on both the aesthetic outcome and overall well-being.

Perth Specialist Plastic Surgeon Dr Robert Owen has many years of experience performing breast procedures, including breast augmentation, breast reduction and breast lift.

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Capsule Formation Process after Breast Implants Surgery

Normal capsule development

When you undergo breast augmentation surgery, your body naturally responds to the presence of the implant. This response involves the formation of a thin layer of scar tissue around the implant, known as a capsule. This process is a normal part of healing and serves to isolate the foreign object within your body.

The development of a capsule is an expected outcome of breast implant surgery. A normal, healthy capsule is typically thin, pliable, and almost translucent. It helps to keep the implant in place, preventing any unwanted movement or slippage. This fibrous capsule is your body’s way of creating a protective barrier around the implant.

Abnormal capsule contraction

While capsule formation is normal, capsular contracture occurs when this scar tissue becomes unusually hard and begins to tighten around the implant. This condition can have an impact on both the appearance and feel of your breasts.

Capsular contracture is graded on a scale known as the Baker grade:

• Grade 1: The breast feels soft and looks natural.
• Grade 2: The breast feels somewhat firm but appears normal.
• Grade 3: The breast feels firm and looks abnormal.
• Grade 4: The breast feels hard, looks abnormal, and may be painful.

Keep in mind that not everyone who undergoes breast augmentation will experience capsular contracture.

Risk Factors for Capsular Contracture

Several factors can increase your risk of developing capsular contracture:

• Bacterial contamination: The presence of bacteria, often introduced during surgery or from an infection elsewhere in the body, can trigger an inflammatory response. This can lead to excessive scar tissue formation.
• Genetic predisposition: Your genetic makeup may influence how your body responds to foreign objects like breast implants. If you have a family history of autoimmune diseases or a tendency to develop thick scar tissue, you might have a higher risk.
• Implant placement: The position of the implant can play a role. Submuscular placement, where the implant is positioned below the chest muscle, may reduce the risk of capsular contracture.
• Implant surface: Some studies suggest that textured implants may have a lower risk of capsular contracture compared to smooth implants.
• Surgical technique: The incision site and your surgeon’s approach can influence the risk. For instance, periareolar incisions (around the nipple) may have a higher risk compared to other techniques.
• Post-operative care: Following your plastic surgeon’s instructions for recovery is important. Proper care can help ensure the implant settles correctly and the capsule forms normally.
• Radiation therapy: If you’ve had radiation therapy, particularly after initial breast reconstruction, it can significantly increase your risk of developing capsular contracture.
• Complications: The development of a haematoma (blood collection) or seroma (fluid collection) after surgery can increase the risk.

Recognising Capsular Contracture

Early Signs

Identifying capsular contracture in its early stages is essential for timely intervention. You might notice subtle changes in your breasts within 3-6 months after your breast augmentation procedure. The initial signs can be quite subtle, making them challenging to spot. Keep an eye out for:

• A feeling of tightness around the implant
• Increased firmness in the breast tissue
• Mild discomfort or a sensation of pressure
• Subtle alterations in breast shape

It’s important to remember that these early symptoms may develop gradually, and you might not experience all of them simultaneously. Regular self-examinations and being attentive to any changes in your breasts can help you detect capsular contracture early on.

Advanced Symptoms

As capsular contracture progresses, the symptoms become more noticeable and may have an impact on both the feel and look of your breasts. Advanced signs include:

• Visible distortion of breast shape
• Breasts appearing overly round or ball-shaped
• Implants sitting too high on the chest wall
• Asymmetry between breasts
• Increased pain or discomfort, especially when lying on your breasts
• Rippling or wrinkling of the skin
• Restricted mobility of the implant

These symptoms can develop over time, ranging from weeks to years after your breast augmentation surgery. If you notice any of these changes, consult your plastic surgeon promptly.

Diagnostic Methods

To determine whether you have capsular contracture, your plastic surgeon will need to conduct a thorough examination of your breasts. The diagnostic process typically involves:

1. Physical examination: Your surgeon will assess the firmness, shape, and symmetry of your breasts through touch and visual inspection.
2. Baker Grade assessment: This grading system helps classify the severity of capsular contracture:
3. Imaging tests: In some cases, your surgeon might recommend imaging studies like ultrasound or MRI to evaluate the condition of the implant and surrounding tissue.
4. Patient history: Your surgeon will consider your medical history, including any recent infections or complications, which might have contributed to the development of capsular contracture.

Remember, early detection and prompt treatment can help manage capsular contracture effectively. If you have any concerns about changes in your breasts following augmentation surgery, don’t hesitate to reach out to your plastic surgeon for an evaluation.

Download Dr. Guy Watts’ Guide to Breast Augmentation

Guide To Breast Augmentation

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Preventative Measures for Capsular Contracture

Reducing the risk of capsular contracture is essential for anyone considering breast augmentation. By taking certain precautions before, during, and after surgery, you can significantly lower your chances of developing this complication. Here are some effective preventative measures:

Pre-operative considerations

Before your breast augmentation surgery, there are several steps you can take to minimise your risk of capsular contracture:

• Choose a skilled surgeon: Selecting a plastic surgeon with extensive experience in breast augmentation is crucial.
• Discuss implant options: Talk to your surgeon about different implant types. Some studies suggest that textured implants may have a lower risk of capsular contracture compared to smooth implants.
• Consider implant placement: Submuscular placement, where the implant is positioned below the chest muscle, may reduce the risk of capsular contracture.
• Stop smoking: If you smoke, it’s essential to quit before surgery. Smoking can impair healing and increase the risk of complications.

Intra-operative techniques

During the surgery, your surgeon can employ several techniques to reduce the risk of capsular contracture:

• Use of a Keller Funnel: This device allows for a no-touch insertion of breast implants, significantly reducing the risk of bacterial contamination. Studies have shown that using a Keller Funnel can lower the occurrence of capsular contracture by about 9%.
• Minimal implant handling: The less a surgical team handles the implants, the better. This approach helps to reduce the risk of bacterial contamination.
• Antibiotic irrigation: Dr Owen might use antibiotic solutions to irrigate the implant pocket before insertion.
• Proper incision choice: The infra-mammary incision (under the breast fold) is often preferred as it may have a lower risk of bacterial contamination compared to other incision sites.

Post-operative care

Your actions after surgery can also play a role in preventing capsular contracture:

• Follow post-operative instructions: Adhering to your surgeon’s guidelines is essential. This typically includes avoiding strenuous activities and heavy lifting for 4-6 weeks after surgery.
• Wear a supportive bra: A good supportive bra can help ensure proper healing and implant positioning.
• Massage technique: Your surgeon may recommend gentle breast massage to help keep the implant pocket open and reduce the risk of scar tissue formation. However, only perform this if specifically instructed by your surgeon.
• Maintain a healthy lifestyle: A nutritious diet rich in vitamins and minerals can boost your immune system and reduce inflammation, potentially lowering the risk of capsular contracture.
• Avoid smoking and nicotine: Nicotine can constrict blood vessels, reducing blood flow to breast tissue and potentially increasing the risk of complications.
• Attend follow-up appointments: Regular check-ups with your surgeon allow for early detection and management of any potential issues.

Treatment Options for Capsular Contracture

Conservative treatments

If you’re experiencing capsular contracture, your surgeon may first recommend conservative treatments. These non-invasive approaches can be effective, especially when the condition is detected early. One common method is breast massage, which aims to keep the implant pocket open and reduce scar tissue formation. Your surgeon might instruct you on specific massage techniques to perform regularly.

Another conservative treatment option is oral medication. Your surgeon might prescribe vitamin E or leukotriene receptor antagonists (LTRAs) to help manage capsular contracture. LTRAs, typically used for asthma treatment, have shown promise in reducing inflammation and potentially softening the fibrous capsule around breast implants.

Surgical options

When conservative treatments don’t yield satisfactory results, surgical intervention may be necessary. The most common surgical approach is a capsulectomy, where your surgeon removes the hardened scar tissue capsule and replaces the implant. This procedure can be performed as a partial or total capsulectomy, depending on the severity of the contracture.

In some cases, your surgeon might recommend an open capsulotomy. This involves making small incisions in the capsule to release the tension and create more space for the implant. Sometimes, the existing implant is also replaced during this procedure.

For recurrent cases of capsular contracture, more advanced techniques may be employed. One such method is the use of biological materials, such as Strattice, to encase the implant and minimise the chance of contracture recurring. Your surgeon might also consider changing the implant placement, such as moving it from above the muscle to below the muscle, which has shown to reduce the risk of capsular contracture.

Long-term outlook

The long-term outlook for patients who have undergone treatment for capsular contracture is generally positive, but it’s important to understand that there’s always a risk of recurrence. Regular follow-up appointments with your surgeon are important to monitor your progress and detect any early signs of recurrence.

It’s worth noting that the best approach to capsular contracture is prevention. This includes choosing an experienced surgeon, following post-operative care instructions, and maintaining a healthy lifestyle.

FAQs about Capsular Contracture

What steps can I take to minimise the risk of capsular contracture?

To lower your chances of developing capsular contracture, consider these precautions:

• Select an experienced surgeon
• Adhere to your surgeon’s post-operative care guidelines
• Regularly perform massages
• Engage in exercise
• Maintain a nutritious diet
• Avoid smoking
• Use antibiotics as prescribed
• Utilise anti-inflammatory medications

Which vitamins can help prevent capsular contracture?

• Vitamin E, taken at a dosage of 2000 IU daily, alongside breast massage, has been utilised to help reduce the incidence of capsular contracture. While these methods are helpful, they have not completely eliminated the issue.

What are the methods to alleviate capsular contracture?

• In the initial stages of capsular contracture, conservative approaches such as vigorous massage or manipulation might be recommended. These techniques aim to break down the restrictive scar tissue and promote the body’s acceptance of the implant.

How does vitamin E contribute to the prevention of capsular contracture?

• Vitamin E is believed to play a role in preventing capsular contracture due to its ability to inhibit the inflammatory phase of wound healing and reduce wound tensile strength. These properties make vitamin E a suggested preventative measure against the hardening of the breast implant capsule.

Further Reading about Breast Implants

• Read more about Different Types of Silicone Breast Implants
• Read more about History of Breast Implants
• Read more about Returning To Exercise After Breast Augmentation Surgery
• Read more about How to Sleep Better After Cosmetic Breast Surgery
• Read more about Options for Breast Implant Placement

Medical References for Capsular Contracture

• A literature review and summary of capsular contracture
• Unveiling the Enigma: Exploring capsular contracture–Unraveling its link with autoimmune disorders and comprehensive examination of predisposing factors
• Use of Antimicrobial Irrigation and Incidence of Capsular Contracture in Breast Augmentation and Immediate Implant-Based Breast Reconstruction
• Risk factors for developing capsular contracture in women after breast implant surgery: A systematic review of the literature
• Capsular contracture rate in a low-risk population after primary augmentation mammaplasty