What Is Capsular Contracture?
Capsular contracture is one of the most common complications associated with breast augmentation surgery.
This results from an excessive reaction of the immune system to foreign objects.
After breast augmentation, your body forms fibrous tissue that encapsulates the implant in an attempt to wall it off.
When the fibrous capsule tightens and squeezes the implant, capsular contracture occurs.
Signs and Symptoms
The signs and symptoms of capsular contracture commonly appear gradually and may first be observed as a high-riding or misshapen breast.
As firmness increases, the breast may feel tight or even painful, especially when you are lying on them.
The breasts can appear very round, almost ball-like, and visible rippling may also be noted.
Degrees of Severity
According to Dr. Baker, a renowned surgeon, capsular contracture is divided into four stages.
Baker staging of capsular contracture:
Baker Grade One: the breast looks and feels soft. During this stage the capsule has formed but it is not contracted (tightened).
Baker Grade Two: the breast looks normal but feels firm to some degree. During this stage there is already mild to moderate contracture (tightening) of the capsule.
Baker Grade Three: the breast not only feels firm but is also beginning to deform. The breast appears round like a ball due to the squeezing effect of the capsule. In some cases the implant is displaced from its original position, usually upwards. See Fig. 1
Baker Grade Four: the patient exhibits all the signs and symptoms of grade III with the addition of pain caused by the gradual tightening of the capsule.
Who Can Develop A Capsular Contracture?
Anybody can develop capsular contracture.
Research has shown that capsular contracture rates are extremely low, only occurring in about 5% of women.
However, if it happens to you, then it is a 100% for you, and you will be very disappointed.
There is no way that surgeons or medical devices can predict who among the patients will have a capsular contracture.
Are You At Risk?
The following factors may increase the risk of having capsular contracture:
- Autoimmune disorders
- Radiation therapy
- Severe trauma to the breast
- Bacterial contamination
- Implant leak
Reducing Your Risk
Because surgeons don’t know the precise cause of capsular contracture, there is yet no known method of preventing this. Some doctors suspect that the type of implant is a major factor, while others think that bleeding during and after surgery and/or subclinical bacterial infection are major causes of contractures.
There is a great deal of ongoing research attempting to discover the exact cause, for the mean time here’s what can be done to reduce your risk of getting a contracture:
- Choose submuscular implant placement. More and more evidence show that sub-muscular placement of the implant does better than Subglandular placement in the long term, but even this has not been scientifically proven.
- Choose the right size. Oversized implants may lead to capsular contracture.
- Take a good rest after surgery. Engaging in too much activity during the first few weeks after surgery increases your risk of bleeding. Minimal or profuse bleeding likely increases your risk of contracture.
- Choose a qualified surgeon who works at an accredited facility. A surgeon who specializes in breast augmentation surgery, and who works in a highly accredited hospital with strict infection control policies assuring more safety to the patients and decreases the risk of capsular contracture.
- Avoid smoking. Capsular contracture rates are about twice as high in smokers. Your plastic surgeon will insist that you stop smoking before the breast augmentation procedure. Continue avoiding tobacco use until full recovery has been achieved.
Capsular Contracture Corrective Surgery
Capsular contracture corrective surgery generally includes the following procedures:
- Open Capsulectomy – the contracted capsule is surgically removed.
- Open Capsulotomy – the contracted capsule is not removed but is separated from the implant by cuts made by the surgeon.
Non-Surgical Capsular Contracture Correction
Although corrective surgery has been the only known treatment for capsular contracture that has been proven effective, there are non-surgical treatments for capsular contracture may include:
- Closed Capsulotomy. The surgeon applies intense squeezing in an attempt to break the capsule.
- Regimen of vitamin E and steroid injections.
- Ultrasound – softening of the capsule with sound waves (ultrasonography)
- Use of prescription medications – e.g. Accolate
Most non-surgical capsular contracture treatments have not been studied enough to determine their reliability and effectiveness, so they typically are not recommended.
Because every patient is unique, responses to these treatments also vary from case to case. It is recommended that each patient should find time to have a full discussion on these information with his surgeon.