Capsular Contracture – Causes and Prevention

what is capsular contracture

Breast implants can cause Capsular Contracture. This is a condition that causes the breast to become misshapen and painful. This article will discuss Capsular Contraction, its causes and how it can be prevented.

Capsular contracture occurs when the body reacts to a breast implant. It usually distorts the shape of the breast and causes pain. Early signs may include a firm or tight sensation, pain, or asymmetry. As Capsular Contraction worsens, you may notice more obvious symptoms. These include:

  • Breast pain
  • Asymmetry
  • Firmness
  • Tightness
  • Round or ball-shaped breasts
  • High-riding breasts
  • Misshapen breasts

What is Capsular Contracture?

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 refers to the hardening of breast tissue around a breast implant. It is the most common complication of breast augmentation surgery. Capsular contraction can cause pain, implant malposition and deformity.

How Does Capsular Contracture Form?

Capsular Contracture happens when the body reacts to a breast implant. Your body forms scar tissue around an implant as a defence mechanism. This can cause tightness or hardness in your breasts after breast augmentation.

Capsules can form as soon as one month after breast augmentation surgery. However, it can occur anytime following your breast surgery. Capsular Contraction does not happen with every patient. Some patients never experience this problem at all.

Causes of Capsular Contracture

There are many causes of Capsular Contraction, but the most common reasons include:

Low-Grade Bacterial Infection

– Biofilm (a thin film of microorganisms growing over an implant). This bacteria comes from when the implant is placed in your surgery. Dr Doyle always uses the 14-point antibacterial plan to reduce implant contamination.

Your Body’s Immune System

– Capsule contracture is often caused by your own body’s response to an implant. Antibodies or white blood cells may form around the implant which causes inflammation. This happens in about 30% of breast augmentations.

Haematoma and Seroma

– Capsular contracture is also related to bleeding and fluid around the implant. This can occur as a result of trauma or from blood-thinning medication. Blood and fluid feed the biofilm which can result in capsular contracture occurring.

Genetic Predisposition

Capsular contracture can also be a result of genetics.  Some women are more prone to capsular contracture than others due to their genetics. Thick scar tissue or a family history of autoimmune disease may increase your risk.

Bad Luck

It is also possible that this condition can arise with no identifiable source. This comes down to nothing more than chance.

The Bottom Line – Causes of Capsular Contracture

In order for a Capsule to occur, there must be an inflammatory response. This can be from a foreign body reaction – ie. your body rejecting the implant. Or exposure to bacteria. This results in solid hard masses formed by scar tissue over time.

Signs and Symptoms of Capsular Contracture

How to know if you have capsular contracture

Symptoms associated with Capsular Contracture include: 

  • pain
  • hardness or firmness around your implants
  • tightness in your chest wall (chest muscles)
  • inability to rotate your shoulders back
  • discomfort when wearing a bra or swimsuit top
  • the rippling of your breasts along the bottom edges of the implant pocket area.

Early signs might be mild but symptoms will become obvious with time if present at all. Signs and symptoms will depend on the severity of capsular contracture — from minor to severe.

Grading Capsular Contracture Severity

The severity of capsular contracture is rated using a grading system:

  • Grade 1:  A grade one capsule is asymptomatic (produces no symptoms). It does not interfere with breast size, shape or texture. The breasts are soft to the touch and they still look natural too.
  • Grade 2: Symptoms of grade two capsular contracture are firm breasts that feel hard to the touch. At this stage, there are usually no cosmetic changes visible.
  • Grade 3: Grade three capsular contracture presents with breasts that feel firm. They also appear abnormal – usually solid and round and/or a change in nipple shape. Some women notice pain while others don’t get any reaction at all. Grade 3 capsular contracture usually doesn’t cause much discomfort.
  • Grade 4: Grade four capsular contracture causes the breasts to become hard and misshapen. Patients with grade four capsular contracture also experience breast soreness. Their breasts will often be tender and painful to the touch.

First Signs of Capsular Contracture

Breast pain or tenderness is usually the first sign of Capsular Contracture. While this might appear normal, it can become painful and worrisome with time.

More Severe Symptoms of Capsular Contracture

In more severe cases, Capsule Contracture can cause rippling of your breast implants.  This is due to the stretching of scar tissue over implant pockets. Capsular Contracture is a common complication after breast augmentation surgery. If severe, it can be serious and painful.

Prevention Techniques for Capsular Contracture

Capsular contracture happens because your body recognises an implant as foreign material. It then tries to wall off the implant with scar tissue. Early signs are subtle but you may notice firmness or swelling around your implants. If you notice this firmness, it is a good idea to look into these prevention techniques:

Be Cautious While Healing

As you heal, make sure that you don’t hug or squeeze the breast area too tightly. This can cause bleeding which could then lead to Capsular contracture later on down the road. This also includes lifting heavy objects or straining yourself. These activities will put excess pressure on an already fragile surgical site. This may cause internal bleeding which can result in Capsular contracture over time.

Massage Therapy

Massage therapy can be helpful at preventing Capsular Contractures. It encourages blood flow and lymphatic drainage which reduces swelling. It is also believed to help break down hard tissue from around the implants.

Note* This method has not been proven effective in any major studies. Never disturb your surgical site without first getting permission from your surgeon!

Education

Prevention also involves being aware of what causes Capsular Contracture. If you don’t lift heavy, or sleep on your front (adding pressure to the surgical site) – your risk may be lower.

Dr Doyle’s Preventative Measures

how-long-does-a-breast-augmentation-last

Capsular contraction can also happen as a result of the techniques used in your surgery. Breast surgeons may have a high or low rate of capsular contraction complications.

Dr Doyle aims to reduce capsular contracture occurring as a complication of surgery. He does this 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.
  • The Use of “Under the Muscle” Placement. Placing implants below the chest muscle can significantly lower the risk of capsular contracture. Partial under-the muscle placement results in an 8 -12% lifetime risk. This is opposed to 12-18%, with above the muscle implant placement.

Treatment Options for Capsular Contracture

If you have concerns about Capsular Contraction – it’s critical that you’re evaluated as soon as possible. Always see an experienced plastic surgeon who specialises in breast surgery procedures.

Capsular contracture is a common complication that can successfully be treated with surgery. Capsular contracture treatment options may include:

Remove and Replace Implants with Capsulectomy 

A capsulectomy is the surgical removal of thick and hard tissue that forms around breast implants. This usually requires removing your implant followed by replacement during surgery. It’s important to note that another surgery makes the body vulnerable to a second bacterial invasion. So, unfortunately, it’s not uncommon to experience a repeat incidence of capsular contracture.

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

Removing breast implants entirely is also a treatment option for Capsular Contraction. Dr Doyle always uses the En Bloc breast implant removal technique. This technique removes the breast implants and the scar capsule in one piece. Scar tissue is never left behind in the body.

Ultrasound Therapy

Recently, there have been suggestions that multiple sessions of ultrasound breast therapy might be an effective non-surgical way to treat capsular contracture. This is believed to increase elasticity within the breast capsule, making the breast tissue soft again. This technique is still under investigation, but research shows it to be promising. Always seek advice from your plastic surgeon. 

Capsular Contraction: Causes and Treatment

One of the most common risks following breast augmentation is capsular contraction. This can lead to a hardening around your implant. This can be caused by either bacteria, genetics and/or not following your recovery instructions.

The severity of this complication ranges from grades 1 to 4. Grade 3 capsules can usually be treated without surgery while Grade 4 requires revisional surgery for complete resolution.

If you are experiencing symptoms of capsular contracture, please contact Dr Doyle’s office. He will help you find an appropriate solution.

Medical References