What is capsular contracture?
If you’ve done your research about getting a breast augmentation, you may have run across the term “capsular contracture” as one of the possible complications of the surgery. Whenever a foreign object such as a breast implant is placed within the body, your tissue walls it off with scar or a capsule. This capsule is usually a thin, soft layer of scar tissue that delineates and encompasses the foreign object and is a normal response. On occasion however, this scar tissue can become thick and tight as a result of overgrowth or hypertrophic response. It would be analogous to a hypertrophic scar on the skin causing the skin to contract. In the case of breast implants, it’s called capsular contracture. It’s incidence ranges from 8-15% and increases each time you develop it.
What causes capsular contracture?
The prevailing theory is that a bacterial biofilm on the implant surface causes a sub-clinical, low-grade infection that induces chronic inflammation, leading to a thick capsule with tightly woven collagen fibers. Other factors common to its incidence include hematoma or seroma and silent ruptures of silicone implants.
What happens if I get capsular contracture?
If capsular contracture occurs, the breast would feel tighter and firmer with possible pain and breast disfigurement. Usually the implant becomes high riding on the chest wall. There are different degrees of severity for the condition and it’s graded based on the Baker scale:
- Grade I: the breast is soft and appears normal
- Grade II: the breast is a little firm but appears normal
- Grade III: the breast is firm and appears abnormal
- Grade IV: the breast is hard, appears abnormal and is associated with pain
What can be done to prevent it?
Limited handling of the implant intra-operatively, minimal contact with the chest skin before insertion, use of antibacterial solution in the breast pocket, meticulous control of bleeding points, peri-operative use of antibiotics and avoidance of gloves with talcum powder can help lower the risk of capsular contracture. Also, placing the implant under the pectoralis major muscle, use of textured implants and avoiding a peri-areolar incision have been associated with a reduced risk. Post-operative breast exercises for smooth implants to keep the pocket open and prophylactic use of leukotrienes (Accolate, Singulair) can be beneficial.
Treatment of Capsular Contracture
For severe cases like Baker grade III and IV, treatment usually involves surgery with removal of the capsule (capsulectomy) and exchange of the implant. Also, changing the plane of the pocket and use of acellular dermal matrix can be considered in certain cases. Medications like leukotrienes and Vitamin E can also be used as adjunctive measures.