What is a capsular contracture?
The body normally forms a layer of scar tissue to hold the implant in place (the implant “capsule”). Usually, this layer is very soft and pliable, and cannot be felt. In some cases, this layer can become thicker and less elastic. the amount of scar tissue in the capsule and its thickness determine how hard the breast will feel. This condition is classified as follows:
- Grade 1 : no capsule is palpable, and the breast feels soft. The implant is palpable but no hardness is perceived. (there is no grade 0)
- Grade 2: minimal stiffening of the capsule is noted. The breast has a normal shape and the implant is not altered in position or shape.
- Grade 3: the capsule is thick and clearly palpable. The breast feels harder and the shape is altered, sometimes looking more like a ball or pulling up in the chest to a higher position than the other breast.
- Grade 4: the implant capsule is thick, hard. The breast is altered in shape and position, and uncomfortable.
How often does capsular contracture present?
Breast implant capsular contracture is a relatively uncommon problem. The rate of breast implant capsular contracture varies in the literature from 4% to up to 12% for the initial breast augmentation procedure.
When does capsular contracture happen?
Early capsular contracture (within a year from breast augmentation surgery) is thought to be derived from a very slight infection in the area around the implant that may come from bacteria within the breast tissue and skin.
Late capsular contracture (after more than one year from breast augmentation surgery) may be caused by a series of possible problems like:
Trauma: hard falls or vehicle accidents may cause some blood to collect around the implant, which in turn can cause a thick scar to develop.
- Surgery in other areas of the body: bacterias can get into circulation and lodge around the implant, causing a very slight infection that is kept in check by the immune system. The body reacts by causing a thickening of the capsule scar.
- Rupture of a silicone implant: the silicone material exits the implant shell and may cause a signficant reaction in the tissue sorrounding the implant. This process in turn causes a thickening of the capsule and a contracture follows.
Why do some women develop capsular contracture and not others?
No particular reason. In fact, most times only one breast develops a capsular contracture. The variables affecting the formation of a thicker scar around a give implant are many and not all predictable.
What can be done to prevent capsular contracture?
Some implant types have a lower rate of late capsular contracture than others. Specifically, textured breast implants have a lower rate of capsular contracture than smooth implants when placed in the “in front” (pre pectoral) position.
- Placing the implant behing the pec muscle (sub pectoral) decreases the rate of capsular contracture, both early and late.
- Accurate, gentle implant placement with minimally traumatic technique. Shorter procedures with accurate preparation of the implant pocket and less tissue trauma lead to shorter recovery and less chance of thick capsule formation.
- Breast implant massage technique. Frequent massage of the implant is important to decrease the chance of a tight capsule forming around the breast implant. Breast implant massage should be performed regularly for the first 3 months to allow for a pliable pocket to develop.
I have a breast that is harder than the other after breast augmentation with implants. What are my options?
The most likely answer is that you have formed a capsular contracture. The next steps should include:
- A complete physical examination by an experienced plastic surgeon to determine the possible source of the capsular contracture or define any other ongoing process that may be notable on exam.
Mammogram or ultrasound to evaluate the breast tissue and rule out any ongoing breast process
Will I be smaller if the implants are replaced and the capsule removed?
Yes if the implants replaced are the same size as the original implants. This is due to the fact that some breast tissue is lost during and after the capsule removal procedure. The breast tissue thins out in response to the stretch imposed by the implant and breast size may actually decrease even though the implant replaced is the same size and type of the implant that was used initially.
To avoid a decrease in breast size after implant removal and replacement it is a good idea to use a slightly larger implant if the breast tissue and shape can adjust to a larger implant. Fat transfer is another valid option.
Will the capsule come back after the revision? How likely is that to happen?
The risk of recurrent breast implant capsular contracture is approximately 19-50%, depending on the kind of implant used, placement and cause of the capsular contracture.
Are there certain implants that have a higher rate of capsular contracture?
Yes. Silicone filled breast implant have a higher rate of capsular contracture (8-12%) than saline filled breast implants (4-9%). Textured implants have a lower rate of capsular contracture when the implants are placed in front of the pectoralis muscle.
Can I get capsular contracture with fat transfer?
No. Since no breast implant is used in breast augmentation with fat transfer no capsule forms and there is no risk of capsular contracture.
Will smoking affect my risk of capsular contracture?
Yes. Although this is anecdotal, multiple physicians describe a higher rate of capsular contracture in smokers than in women who do not smoke.