What is Capsular Contracture of Breast Implant?

This is an exaggerated inflammatory response of the immune system. To explain it, we need to talk about the healing process. When the body detects a foreign material within itself - in this case around the chest muscles - it triggers an immune reaction that creates a capsule of scar tissue around the object. The purpose is to isolate the material and prevent it from travelling to other parts of the body where it can supposedly do some harm. This is a normal part of the healing process.

When it comes to breast implant surgery, this naturally occurring tissue is actually a good thing because it can help to prevent the implant from slipping and wandering around. However, in some people, the body goes a little overboard with the task, generating more scar tissue than usual. It gets extremely hard and wraps up around the breast implants. This is known as capsular contracture.

In 75% of the cases, capsular contracture occurs in the two years following breast surgery since it happens during the healing process. Very rarely, it can develop later in life. The condition has four different stages that can be assessed using the Baker Scale Grade:

• Grade I of baker classification - This one is asymptomatic. The breast looks and feels normal; it’s soft to the touch. Its size and shape are unaffected.
• Grade II of baker grading – Minor symptoms are manifested. The breast looks normal but is firm to the touch. There is no pain.
• Baker Grade III - With this one, the breast looks abnormal and is firm, with the nipples being out of shape. If there is any pain, it’s not going to cause much trouble. Most of the patients feel slight discomfort but not pain.
• Grade IV - Baker Grade IV capsular contracture presents with visible symptoms. The breast appears abnormal and distorted; it’s hard and painful to the touch.

Capsular contraction affects breast augmentation patients with silicone breast implants and saline-filled breast implants alike. It can occur in one or both the right breast and left breast.

What Are the Early Signs of Developing Capsular Contracture around Breast Implants?

So, what is capsular contracture characterised by? At the early stages of the condition, you will have tightness in the chest which may or may not be accompanied by pain.

As capsular contracture progresses, indications will become more obvious and persistent:

• High-riding breast
• Increasing firmness of the breast
• Asymmetry
• Change in the shape of one breast
• Rippling in the upper part of the breast
• Discomfort and pain when lying on your stomach

What Causes Capsular Contracture Development?

It could be said that genetics and the body’s unique healing process are the main culprits for capsular contracture after breast augmentation. Some people have a tendency to form excessive fibrotic tissue to foreign materials placed in the body (and therefore develop capsular contracture). External factors may contribute to this, such as the use of one surface over another, as is the case with breast augmentation implant surgery (smooth vs textured implants).

Moreover, the capsular contracture rate might be elevated by radiation therapy. It happens in breast cancer patients who have breast reconstruction with silicone-gel filling or saline-solution implants. The risk of complications and reconstructive failure increase if radiation is administered following immediate reconstruction. This is why delaying implant surgery may be the best option.

In addition, breast augmentation complications like blood clots could increase the occurrence of capsular contracture.

How Is Capsular Contracture Diagnosed?

In most cases, capsular contracture is found through clinical examination. An MRI scan and an ultrasound test provide more accuracy and can help confirm the diagnosis. If you recently underwent implant surgery and are now experiencing symptoms, speak to your family physician who will likely refer you to another specialist.

Is Capsular Contracture Dangerous?

Luckily, the condition is not dangerous or life-threatening (unless it’s preceded by an implant rupture). It can cause some pain and discomfort, as well as frustration. Of course, it needs to be addressed once it’s detected because this can affect the cosmetic outcomes of breast augmentation surgery.

In the case of implant ruptures, there is a high risk of infection. This can be dangerous if not attended to in time. Therefore, steps should be taken to remove the implants and clear the leakage from the system.

Can Capsular Contracture Go Away by Itself?

Unfortunately, this is not a condition that can settle on its own. The processes that are initiated by the immune system when capsular contracture develops will not dwindle unless the problem breast implant capsule is removed. This means that the skin has to be broken through to allow access to the affected implant.

The surplus of scar tissue is excised but oftentimes this doesn’t resolve the issue. Hence, the entire implant has to be taken out and replaced by a clean one.

Capsular Contracture Treatment

Not all cases of established capsular contracture require treatment. Grades I and II should be observed but not necessarily treated. Severe capsular contracture will need to be addressed.

Aspen therapy

This is a non-invasive treatment that works by delivering controlled ultrasound into the breast tissue to stimulate healthy collagen growth. It helps to soften the breast as it brings back elasticity. When combined with antibiotic treatment, the Aspen therapy has shown to be quite effective in reducing capsular contracture and preventing it from happening again in the future. However, it does not work for grade four capsular contracture.

Breast implant encapsulation removal

If capsular contracture has led to breast deformity and other problems, plastic surgeons recommend removing the breast capsule. It is called total capsulectomy or breast implant encapsulation removal.

It consists of removing the capsule and the implant. The affected area should be free of scar tissue. Then, the doctor places a new implant into the breast. Alternatively, the plane of insertion could be changed to avoid further problems.

NSAIDS and steroid injections

For people who are reluctant to go under the knife, NSAIDs may be offered for treating capsular contracture. NSAIDs are non-steroidal anti-inflammatory drugs like aspirin and ibuprofen. They can be taken for 6 months.

Another possible way to treat capsular contracture includes the administration of steroidal injections directly into the scar tissue under the guidance of ultrasound technology. However, there is a lot of scepticism regarding this treatment and a lack of evidence that it is indeed effective.

How to Prevent Capsular Contracture of Breast Implants

Here is what you and your surgeon can do to reduce the capsular contracture incidence.

• Implant size. One way to prevent the development of capsular contracture is to choose the implants size wisely. If your breasts are naturally small, going for large implants will put a lot of pressure on the skin and the tissue sitting underneath. It is recommended that you gradually increase the size over time.
• Implant surface. Another factor to reduce capsular contracture is the implant type. Studies demonstrate that smooth implants are more likely to cause capsular contracture than textured implants. Thus, you should lean towards textured implants whenever possible. It should be noted that aggressively textured implants and macrotextured implants could lead to other issues, for this reason, the patient's anatomy should be considered before making a decision. In addition, polyurethane-coated implants are said to cause less occurrence of the condition. A 30-year study examining said type of implants revealed that when the amount of polyurethane coating was decreased, severe contracture was found more frequently in patients with breast implants.
• Implant touching. The other thing in preventing capsular contracture is, that you don’t want the implant to be handled too much before it is inserted into the body, as this can lead to contamination. By choosing an accredited plastic surgeon, you can lower your risk of complications like capsular contracture and infection. They will opt for surgical techniques that are more appropriate for your unique case.
• Implant placement of saline or silicone gel implants. Some doctors also prefer to use submuscular implant placement (beneath the pectoralis major muscle) to lower the incidence of capsular contracture. However, studies have shown that this is not entirely effective and still poses a risk for the condition, albeit smaller.
• ADM. According to a meta-analysis, the use of acellular dermal matrix (ADM) and porcine acellular dermal matrix (pADM) during breast implant surgery can lower the risk of capsular contracture.[4] This is a surgical graft that can be placed under the implant to act as a supportive sling. It is usually made of animal or human tissues. Additional research is still needed to assess the effectiveness of the suggested method in breast reconstructive surgery alone.

It's worth noting that sometimes, despite the surgeon's best effort, patients do get capsular contractions after prosthetic breast reconstruction. Postoperative complications are rare but existent even when you go to the best surgeons.

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