Capsular contracture is a condition that some people face after undergoing breast implant surgery. It involves the body’s response to the foreign objects (implants) by forming a capsule of scar tissue around them. In some instances, this capsule can tighten and squeeze the implant, leading to discomfort and changes in the appearance and feel of the breast.
This condition can affect anyone who has breast implants, regardless of the reason for the surgery. Whether for cosmetic enhancement or reconstructive purposes following mastectomy, the risk exists.
In this blog, Consultant Plastic Surgeon Anca Breahna aims to shed light on what capsular contracture is, why it occurs, and treatment options, providing a complete overview of this condition.
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Capsular contracture is a response by the body to the presence of breast implants. It is characterised by the formation of a thick, fibrous scar tissue capsule around the implant, which can contract and cause the breast to feel hard and look unnatural. This condition can occur in one or both breasts and varies in severity.
The formation of some scar tissue around a breast implant is a normal part of the healing process. However, in capsular contracture, this scar tissue shrinks or tightens around the implant, leading to discomfort, pain, and aesthetic changes. The reasons why some people develop a severe contracture while others do not are not fully understood, but several factors, including surgical technique and individual health, may play a role.
The stages of capsular contracture are categorised according to the Baker grading system:
Early stages may not require invasive treatments and can often be managed with non-surgical options. However, more advanced cases might need surgery to correct the issue and relieve symptoms.
Though the exact cause is often unclear, several factors have been identified that could increase the risk of developing this condition:
One leading theory suggests that bacterial contamination during surgery might trigger an exaggerated healing response, leading to capsular contracture. Even a small number of bacteria, which might not cause an obvious infection, could stimulate the body to create a thicker, more constrictive scar capsule around the implant. This is why strict sterilisation techniques and antibiotic prophylaxis are crucial during implant surgery.
A haematoma is a collection of blood inside the body tissues, which can occur after any surgery, including breast augmentation. If a haematoma develops around a breast implant, it can increase the risk of capsular contracture. The body’s response to the blood collection may lead to more aggressive scar tissue formation. Prompt treatment of haematomas is important to reduce this risk.
Similar to a haematoma, a seroma is a collection of serous fluid within the body tissues. This fluid can accumulate around the implant following surgery. While seromas often resolve on their own, their presence can increase inflammation and stimulate the formation of dense scar tissue, contributing to capsular contracture.
The type of implant and its surface texture might also influence the risk of capsular contracture. There is some evidence to suggest that textured implants have a lower risk of contracture compared to smooth-surfaced implants. This is possibly due to the way the textured surface interacts with the surrounding tissue, potentially reducing the degree of scar tissue formation.
While the exact cause of capsular contracture is not always clear, certain conditions and circumstances have been identified as potential risk factors. Being aware of these can help you and your surgeon to take preventative measures where possible.
Some individuals may have a genetic predisposition that makes them more susceptible to developing capsular contracture. This could be related to how their body responds to foreign objects and heals after surgery. Although it’s difficult to predict who will be affected, a history of excessive scarring or keloids might indicate a higher risk.
People with autoimmune disorders may have an increased risk of capsular contracture. These conditions can affect how the body responds to foreign materials, including breast implants. While not all individuals with autoimmune disorders will experience capsular contracture, the altered immune response can contribute to the development of this condition.
Radiation therapy, especially when administered to the breast area, can change the characteristics of the skin and underlying tissues, making them less flexible and more prone to scarring. If breast reconstruction or augmentation is performed after radiation therapy, the risk of capsular contracture may be higher due to these changes.
The techniques used during breast implant surgery can also impact the risk of developing capsular contracture. For instance, the placement of the implant (above or below the muscle), the type of surgical incision, and how the implant pocket is handled can all influence the outcome. Anca has extensive experience in breast augmentation and adopts practices that minimise the risk of capsular contracture.
The symptoms of capsular contracture can vary in intensity from person to person. Early symptoms might be subtle, but they can progress, affecting the appearance of the breasts and causing discomfort or pain.
One of the first and most noticeable symptoms is a hardening of the breast, which may not be accompanied by pain initially. This hardening is due to the tightening of the scar tissue capsule around the implant. Over time, this can lead to the breast feeling unnaturally firm to the touch compared to normal breast tissue or the early post-operative period.
As the capsule tightens further, it can cause discomfort or pain, particularly when pressure is applied to the breast or during certain movements. This discomfort can range from mild to severe and may affect daily activities or sleep patterns. Pain might also be more noticeable during physical activities or when lying in certain positions.
Capsular contracture can lead to visible changes in the shape and appearance of the breast. These changes might include upward displacement of the implant, distortion of the breast shape, or an uneven appearance between the two breasts. Such aesthetic changes are often what prompt women to seek medical advice.
If capsular contracture occurs in only one breast, or if it progresses differently in each breast, it can lead to asymmetry. One breast may appear higher, firmer, or differently shaped than the other, which can be noticeable and distressing for the individual.
Diagnosing capsular contracture involves a combination of physical examinations and imaging tests. Anca uses these methods to assess the severity of the condition and to plan the best treatment approach:
The initial step in diagnosing capsular contracture is a thorough physical examination. During this exam, Anca will evaluate the firmness, shape, and appearance of the breasts. Anca will also ask about any symptoms such as pain or discomfort.
Imaging tests can provide valuable information about the condition of the breast implants and the surrounding tissues.
In some cases, if there’s a suspicion of an underlying issue such as an implant rupture or infection, additional tests may be recommended to rule out these conditions.
For less severe cases of capsular contracture, or when surgery is not an option, non-surgical treatments can offer relief and potential improvement.
In some instances, Anca may prescribe medications to manage symptoms or attempt to reduce the severity of the capsular contracture. Antibiotics might be used if there’s a suspicion of low-grade bacterial infection contributing to the condition. Anti-inflammatory medications can help reduce swelling and discomfort, though their effectiveness in reversing capsular contracture is limited.
Physical therapy, including massage and stretching exercises, may be recommended to maintain the breast’s flexibility and manage pain. While these methods might not eliminate capsular contracture, they can provide symptom relief and improve quality of life for some individuals.
Low-level ultrasound therapy has been explored as a treatment option for capsular contracture. It’s thought to help by increasing blood flow and promoting healing, which could potentially soften the scar tissue. However, results vary, and more research is needed to fully understand its effectiveness.
In cases where non-surgical treatments are not effective or when capsular contracture is more advanced, surgery may be necessary to address the condition:
Capsulectomy involves the surgical removal of the scar tissue capsule surrounding the implant. This procedure can be complete, where the entire capsule is removed, or partial. In many cases, the implant is replaced following the removal of the capsule to achieve the desired aesthetic outcome.
Surgical capsulotomy is a procedure where the capsule is incised or scored but not entirely removed. This can help relieve the pressure and improve the breast’s appearance and feel, though the risk of recurrence remains.
For some women, replacing the existing implant with a new one, potentially of a different type or texture, can be beneficial. In other cases, removing the implant altogether might be the preferred option, especially if the patient no longer desires to have breast implants.