What is Capsular Contracture of the Breast?
A capsule is basically scar tissue. A capsule actually forms around every breast implant, silicone or saline. Scar tissue is the body’s natural response to the placement of any foreign object. It is only when this scar tissue thickens or contracts and restricts the movement of the implant, that the breast is said to have a contracture.
Symptoms of capsular contracture often begin within weeks of the original breast augmentation surgery, but capsular contracture can occur at any time. There are a range of signs and symptoms. The main sign of capsular contracture is increasing firmness of the effected breast. This can lead to upward displacement of the breast implant, altered size and shape of the effected breast, and pain. At its worst, the breast can become hard, painful, and distorted into a round and superiorly displaced position.
The majority of capsules occur within the first two years following surgery. Symptomatic capsular contracture rates appear to be lower with saline implants than with silicone gel implants. If a capsular contracture occurs around a gel implant many years after augmentation, it could be a sign of an implant rupture.
The technical definitions of capsular contracture are as follows:
- Grade I — the breast is normally soft and appears natural in size and shape.
- Grade II — the breast is a little firm, but appears normal.
- Grade III — the breast is firm and appears abnormal.
- Grade IV — the breast is hard, painful to the touch and appears abnormal.
Who’s at Risk of Developing Capsular Contracture?
Predicting who will develop capsular contracture and when it will happen is not possible. It occurs in about 10 percent of women who undergo breast augmentation with implants.
The cause of a “silent” capsular contracture — that is, one without an obvious precipitating event such as trauma, hematoma or radiation — is unknown. Many theories about capsular contracture have been proposed over the years, but currently the most widely accepted cause is a low-grade infection.
Other factors that may increase the risk of developing capsular contracture include:
- Postsurgical complications like hematoma (bleeding into the implant space), seroma (collection of fluid) and bacterial infection
- Severe breast trauma
- Radiation therapy
- Inadequate soft tissue coverage or using too large an implant for the amount of tissue coverage
- Silicone molecules that “bleed” into the implant space (primarily an issue with older silicone gel implants)
How can Capsular Contracture be Avoided?
Decreasing the risk of developing capsular contracture is the best way to avoid this complication. Most surgeons recommend placing the breast implants behind the pectoral muscles. The theory is that the constant movement provided by the pectoral muscles will discourage the growth of scar tissue around the implants.
Other techniques that have been used to reduce risk for capsular contracture include antibiotics during the surgery. Some surgeons promote gentle implant massage beginning shortly after surgery. Exercises that involve squeezing the implant to keep it flexible and loose may also be recommended. As well, antibiotics, anti-inflammatories, or Vitamin E may be recommended after surgery.
William Umansky, MD and Dr. Jeffery Umansky always discuss these and other options for avoiding capsular contracture with patients prior to breast augmentation surgery.