Capsular Contracture is a tightening of the scar tissue that forms around the breast implant. The scar tissue is normal and is known as the 'capsule', and the tightening is referred as 'contracture'. This is also often known as 'hardening' of the breast due to breast implant surgery. Mild contractures can feel firm. More severe contractures can be painful and may distort the breast by pulling the breast implant up significantly.
There are several theories, all of which plays an integral part in the formation of capsular contracture.
Your body is smart - your immune system knows when a foreign object has been put into your tissues. In order to isolate the implant, your body creates a sac, or capsule of scar tissue around it, to seal it off. A capsule around a breast implant is a naturally occurring tissue that can be of benefit. If that capsule contracts or thickens, however, it can squeeze and misshapen your implant. This contracture is what will cause pain, shifting, distortion, and hardening of the breast. Some individuals are more prone to developing capsular contracture than others. There is some evidence that if you have had capsular contracture with breast implants, this may recur with replacement as this is the way your body deals with foreign objects.
Capsular contracture can happen around any type of breast implant (both saline and silicone). Sometimes it develops due to postoperative problems such as infection that sneaks in during implant surgery. But other postoperative issues, like a seroma (a pocket of blood serum within the surgical area) or a hematoma (a pool of blood below the skin), may also contribute to the development of capsular contracture.
There has been studies over recently, in the last few years to show that the formation of a biofilm (bacteria and their secretions) on an implant contributes to the formation of capsular contracture.
Capsular contracture can occur any time after implant surgery. Sometimes it occurs as soon as 12 months after surgery, other times, it may take years to develop.
There has been many studies done on capsular contracture. The factor with the most evidence is submuscular placement of the breast implant (under the muscle), which showed approximately 4% incidence of capsular contracture, compared to 14-20% incidence in subglandular (above the muscle) placement. There has been some evidence to show that textured implants have lower incidence, and that postoperative implant massage can decrease the likelihood of capsular contracture. Radiotherapy is definitely a contributing factor for high risk of capsular contracture in patients who have implant reconstruction.
Due to the theory on biofilms and capsular contracture, and a 14-point plan has been published for implant surgery to minimise implant complication such as capsular contracture.
The diagnosis of capsular contracture is most commonly based on clinical examination alone. Imaging studies can offer further insight, with MRI being the most accurate test in making the diagnosis. Often, capsular contracture is associated with implant rupture. Capsular contracture can be graded on severity by the Baker Scale:
Not all capsular contracture need to be treated. Baker Grade I is normal, while Baker Grade II can often be observed. However, if the breast shape is distorted, if the implant is pushed out of position, or if the hardening causes discomfort, surgery may be recommended. Usually, implant removal with capsulectomy (removal of the hard capsule) is required, and the implant may or may not be replaced during this procedure.
Talk to your surgeon about your options.
To find out more, visit our Breast Implant Revision page.
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