Capsular Contracture – Causes and Prevention

Breast augmentation is a commonly sought-after surgical procedure for enhancing breast size and shape. It’s important for individuals considering having breast implant surgery to be informed about potential complications that can arise. This guide focuses on two complications associated with breast augmentation: capsular contracture and implant issues.

Breast capsular contracture involves the tightening of scar tissue around the breast implant, leading to discomfort and breast distortion. Understanding its causes, signs, prevention, and treatment is crucial. Additionally, implant issues, including rupture, leakage, or displacement, can occur over time.

Knowing the causes, signs, prevention, and treatment options for these complications empowers individuals to make informed decisions regarding their breast health. Consulting with a qualified plastic surgeon is essential for personalised guidance in addressing these concerns.

What is Capsular Contracture?

Capsular Contracture Images

what does capsular contracture look like
Deformity of the right breast due to capsular contracture. (Baker grade IV) Courtesy of Walter Peters, Ph.D., M.D., F.R.C.S.C., University of Toronto. Available on the United States Food and Drugs Administration’s website (www.fda.gov)

Capsular contracture is an abnormal response of scar tissue that forms around breast implants, a common complication after breast augmentation. This scar tissue tightens and contracts, creating a firm and tight capsule around the implant. This can result in noticeable breast hardness, distortion in shape, and capsular contracture pain. It can affect the appearance, comfort, and lifespan of the breast implants. Early detection and timely treatment are essential to address this issue and prevent further complications.

Capsular Contraction: Causes and Treatment

Before delving into the causes and treatment of breast capsular contracture, it’s essential to differentiate between two related terms: capsular contraction and capsular contracture. These terms are often used interchangeably, but they refer to distinct phenomena.

Capsule Formation vs. Capsular Contracture

  • Capsule Formation: This refers to the natural and expected development of scar tissue (a capsule) around a breast implant during the normal healing and recovery process after breast augmentation surgery.
  • Capsular Contracture: In contrast, capsular contracture specifically describes an immune response that causes excessive scar tissue to contract around the breast implant. This condition can lead to various issues, including breast hardness, discomfort, and distortion in shape.

In summary, a “capsule” represents the normal healing process, while “capsular contracture” is an abnormal and problematic response of the immune system, resulting in excessive scar tissue formation and tightening around the breast implant.

Causes

Several factors can contribute to the development of capsular contracture, including:

  1. Bacterial Contamination: Bacterial contamination can be introduced during the surgical procedure or from an infection elsewhere in the body, and can trigger an inflammatory response. This response may lead to the excessive formation of scar tissue, resulting in capsular contracture.
  2. Genetic Predisposition: Some individuals may have a genetic predisposition that influences their susceptibility to capsular contracture. Your genetic factors can play a role in determining how your body responds to foreign objects like breast implants.
  3. Postoperative Recovery Instructions: Failure to follow postoperative recovery instructions provided by the surgeon can increase the risk of complications. Proper post-surgical care is essential to ensure that the implant settles correctly and that the capsule forms normally.

It’s crucial for individuals considering or having undergone breast augmentation surgery to be aware of these potential causes and take appropriate measures to minimise the risk of capsular contracture.

Grading & Treatments

The severity of capsular contraction is categorised into grades 1 to 4.

Grade 1 (mild) and 2 (moderate): Treatment involves monitoring and conservative management. This could include techniques such as massage, medication, or other non-invasive methods to alleviate symptoms and prevent further progression.

Grade 3 (severe): Non-surgical treatments can often be used to attempt to provide relief. These treatments may include more aggressive massage, anti-inflammatory medications, or even ultrasound therapy.

Grade 4 (most severe): Significant breast distortion and discomfort means that revisional surgery is necessary for complete resolution. This surgical procedure typically involves removing the hardened breast implant capsule and replacing the implant. The surgeon may also consider changing the implant position or type to reduce the risk of future contracture.

Capsular Contracture Causes

Biofilm Formation

Bacterial biofilm is a potential trigger. Bacteria can stick to the implant and cause inflammation. This inflammation can cause breast implant hardening also known as capsulated implant. To reduce this risk, it is important to prevent bacteria from forming around the implant.

Implant Placement

Breast implant placement can significantly impact the risk of capsular contracture. The implant’s position affects how it interacts with the area around it and how much pressure is on the implant.

  • Subglandular placement (above the muscle) may increase the risk.
  • Submuscular placement (below the muscle) might lower the risk.

Infection and Hematoma

Infections that occur during or after breast augmentation surgery can potentially lead to capsular contracture. This infection can make the body create too much scar tissue around the implant.

Hematomas are when blood collects and builds up in that area. This can cause inflammation which can contribute to capsular contracture.

Genetics and Immune Response

Genes can affect your immune response and whether you get capsular contracture. Your body’s reaction to the implants can be different from other people.

Capsular Contracture Signs and Detection

Early Signs of Capsular Contracture

  • Increased breast firmness.
  • Mild discomfort or tightness.
  • Subtle changes in breast shape.

It’s important to note that in the initial stages, there may be no noticeable capsular contracture symptoms at first. Monitoring any changes in breast texture or shape and consulting with a healthcare professional if you have concerns is advisable to address the condition in its early stages.

Visual and Textural Changes

It is important to be aware of changes in your body, which can include:

  • Visible rippling or wrinkling of the skin.
  • Asymmetry between the breasts.
  • Unnatural appearance of the breasts.

If you notice these symptoms of capsular contracture you should talk to a surgeon quickly so they can help.

Grading Systems

The Baker Scale is a commonly used grading system for assessing the severity of capsular contracture

  • Grades I and II indicate mild contracture.
  • Grades III and IV indicate more severe contracture.

Grading involves assessing changes in the shape, feel, and mobility of the breasts, helping healthcare professionals determine the appropriate treatment approach based on the severity of the condition.

Capsular Contracture Prevention and Risk Reduction

Dr Doyle’s Preventative Measures for Capsular Contracture

Dr Doyle aims to reduce capsular contracture occurring as a complication of surgery using the following techniques:

  • Patient Screening: Dr Doyle does not recommend surgery if you have health conditions that may increase your risk of hematomas. Also, if you are not willing to give up smoking – you may not be eligible for surgery. This is because smoking impairs the healing process. It also increases the likelihood of haematoma formation.
  • Minimal Implant Handling: If an implant is handled before placement into your breast tissue, your risk of bacterial contamination is higher. Dr Doyle limits how many times the implant is touched before it’s placed. He also operates out of sterile hospital facilities to further reduce the risk of contamination.

Proper Implant Placement Techniques

problems with breast implants under the muscle

Correct implant placement is crucial to minimise the risk of complications in breast augmentation. Surgeons must carefully consider factors such as tissue coverage, patient anatomy, and implant size.

Submuscular placement, where the implant is positioned below the muscle, is often preferred as it can reduce the risk of capsular contracture and implant malposition. Partial under-the muscle placement results in an 8 -12% lifetime risk. This is opposed to 12-18%, with above the muscle implant placement.

Follow-up Care and Monitoring

  • Patient Education: Understanding factors that contribute to the issue, such as avoiding heavy lifting and sleeping positions that apply pressure to the surgical site.
  • Massage Therapy: Massage therapy may help prevent capsular contracture by promoting blood flow and reducing swelling. We include a lymphatic drainage massage before and after each surgery in order to promote healing.
  • Post-Surgical Caution: Avoid hugging, squeezing the breast area tightly, or engaging in strenuous activities during the healing process to prevent bleeding and excessive pressure on the surgical site.

Capsular Contracture Treatment Options

Capsular contracture can be effectively treated through various approaches. It’s best to seek advice from an experienced plastic surgeon specialising in breast surgery.

Capsulectomy

The surgical removal of thick and hardened tissue around breast implants. This procedure is done to soften the look and feel of breast implants. You may choose to replace your implants at the time of surgery.

Capsulectomy: Remove and Replace Implants

This procedure treats capsular contracture by removing the implant, followed by breast implant replacement. It’s essential to be aware that additional surgery to address capsular contracture may increase the risk of recurrent contracture, as it introduces new factors and potential complications.

breast implant replacement before and after images
Before and After Images of Breast Implant Replacement Patients – by Dr Mark Doyle

En Bloc Breast Implant Removal: Comprehensive Solution

Dr Mark Doyle advocates for the en bloc technique which is used during breast implant removal surgery and removes the implants and the scar capsule as a single unit. This approach aims to ensure that no residual scar tissue remains in the body, potentially reducing complications associated with capsular contracture and improving overall outcomes.

Exploring Non-Surgical Ultrasound Therapy

An emerging non-surgical option for capsular contracture involves multiple ultrasound sessions to enhance the elasticity of the breast capsule. Promising results have been reported, but it’s crucial to consult with a plastic surgeon before considering this treatment to assess its suitability for your specific situation and needs.

Breast Implant Complications

Complications with breast implants can arise following breast augmentation surgery, impacting the appearance, texture, and positioning of the implants. A frequent complication is breast implant malposition, characterised by improper placement or rotation of the implants.

Breast Implant Malposition and Rotations

Complications with breast implants can arise following breast augmentation surgery, impacting the appearance, texture, and positioning of the implants. A frequent complication is breast implant malposition, characterised by improper placement or rotation of the implants.

Breast Implant Malposition and Rotations

Breast implant malposition pertains to the improper positioning of implants within the breast pocket, often involving implant rotations where the implant turns or shifts from its intended placement. Such malposition and rotations can result in issues like breast asymmetry, discomfort, and aesthetic concerns.

Types of Malposition

  • Subglandular malposition occurs when the implant is above the chest muscle.
  • Submuscular malposition occurs when the implant is below the chest muscle.
  • Double-bubble malposition occurs when the implant slips below the natural breast crease, causing a distinct double-bubble appearance.

Causes and Risk Factors

Malposition of breast implants can result from surgical technique errors, such as inaccuracies in creating the implant pocket. Additionally, factors like capsular contracture, trauma, and improper healing can contribute to implant malposition. Genetic factors, implant size, and the patient’s individual anatomy also play a role in influencing the risk of malposition.

Symptoms and Visual Changes

Symptoms and visual changes associated with breast implant malposition include asymmetry, which results in uneven positioning of the breasts, as well as the visibility of implant edges or ripples. This can lead to the breasts appearing excessively high, low, or misshapen.

Corrective Procedures

Surgical correction for breast implant malposition typically entails modifying the placement of the implant and adjusting the shape of the implant pocket. In some cases, correcting malposition may involve repositioning or replacing the implant. The primary goal of these procedures is to restore a natural and aesthetically pleasing breast symmetry.

FAQs

How to avoid capsular contracture?

There are 3 techniques to reduce your risk.

  1. Opt for the appropriate implant size and type
  2. Limit implant points of contact
  3. Select submuscular placement for the implant to avoid problems with breast implants under the muscle

How long does the recovery process typically take after breast implant surgery?

Breast augmentation recovery usually takes a few weeks to return to regular activities, with complete healing often taking several months. The timeline can vary based on individual factors and the surgical technique.

Are there any considerations for breastfeeding if I have breast implants?

Breast implants may affect breastfeeding, with variables like surgical technique and implant type playing a role. It’s advisable to consult with your surgeon and a healthcare professional if you plan on breastfeeding with implants.

Contact Us

If you have any concerns or questions about complications with breast implants, please contact us. Our team can provide personalised advice and guide you through the best options for your situation.

Medical References

  • Tamboto H, Vickery K, Deva AK. Subclinical (biofilm) infection causes capsular in a porcine model following augmentation mammaplasty. Plast Reconstr Surg. 2010; 126(3):835-842.
  • What is capsular contraction and how can it be treated? – American Society of Plastic Surgeons

About Dr Mark Doyle FRACS (Plast) – Queensland Plastic Surgeon

Servicing patients in Gold Coast, Brisbane, Sunshine Coast, Cairns and New South Wales NSW – Northern Rivers, Byron Bay, Ballina, Lismore and more.

Dr Mark Doyle is a Specialist Plastic Surgeon with over thirty years of experience performing BreastBodyFace and Nose surgery. Dr Doyle is a fully qualified Specialist Plastic Surgeon with 30+ years of experience. He has completed all required training and only carries out approved surgical practices. There are absolutely NO undertrained doctors or cosmetic doctors acting as surgeons in our clinic.

As a highly esteemed plastic surgeon, Dr Mark is committed to achieving the best possible results for all his breast, body, face and nose patients, both men and women.

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