Capsular contracture is a complication of breast implant surgery. In a study published by the National Institutes of Health (NIH), researchers found this complication occurs in 10.6% of patients. The condition develops when scar tissue from placing an implant forms a tight or constricting capsule that contracts the implant, causing it to become hard or misshapen. The condition is often uncomfortable, painful and significantly affects the shape and appearance of the breast.
Dr. Pablo Prichard is a premier board-certified plastic surgeon in Scottsdale who performs a range of breast procedures, including corrective surgery capsular contracture treatment. He is the Chief of Plastic Surgery at John C. Lincoln Hospital, has authored numerous articles, and has been voted Top Doc by Phoenix magazine. If you have developed capsular contracture after breast implant surgery, you can have confidence in Dr. Prichard’s dedication to surgical excellence and his caring approach to his patients.
What Is Capsular Contracture?
Capsules form around all breast implants. Scar tissue is the natural response of the body when a foreign object has been surgically placed within the body. Capsular contracture only develops when the scar tissue tightens or contracts, restricting the movement of the implant. This is caused by excessive fibrotic reaction (scarring). It is the most common reason for corrective surgery following the placement of breast implants.
As stated by the U.S. Food and Drug Administration (FDA), there are four grades of capsular contracture, called Baker grading I through IV:
- Grade I: Breast looks natural and is normally soft.
- Grade II: Breast is somewhat firm but still looks normal.
- Grade III: Breast is firm with abnormal, visible distortion.
- Grade IV: Breast is hard and painful with greater abnormal distortion.
Risk Factors for Capsular Contracture
The precise cause of capsular contracture is not yet known, although a number of theories have been proposed, of which the most widely-accepted is low-grade infection. According to the FDA, it may occur more frequently following infection, hematoma (collection of blood), or seroma (collection of the watery portion of the blood). In the study published by NIH, researchers identified certain risk factors for this condition, including:
- Use of smooth vs. textured implants
- Subglandular vs. submuscular placement
- Silicone vs. saline-filled implants
- Previous radiotherapy to the breast
Symptoms of Capsular Contracture
Most cases of capsular contracture occur within two years following breast implant surgery. Symptoms often begin within months of the original surgery, but they can happen at any time, even many years after the implants are placed. In the case of a gel-filled implant, capsular contracture many years later may be a sign that the implant has ruptured.
Symptoms typically emerge slowly. The breast may appear misshapen or be riding high. It may begin to feel tight or painful as the firmness of the breast increases. There may be visible rippling, and the breast may appear round and ball-shaped.
Capsular Contracture Treatment
Non-surgical treatment may be beneficial in certain cases of capsular contracture. Non-surgical treatment options include external ultrasound, antibiotics, massage, vitamin E, while some physicians prescribe the off-label use of leukotriene inhibitors (asthma medication) such as Accolate and Singulair.
The standard treatment for capsular contracture is surgery. Surgical procedures include:
- Capsulotomy: The capsule surrounding the implant is cut into pieces surgically, and the implant is reused in some cases.
- Partial Capsulectomy: A portion of the scar tissue capsule is removed. The amount removed depends on the degree of contracture and the surgeon’s preference. In many cases, a new implant is placed in this procedure.
- Total Capsulectomy: An inframammary incision is made in the crease of the breast to remove the entire capsule with the implant enclosed, and to help prevent contamination of the new implant. This procedure produces the lowest capsular contracture reoccurrence rate.
- Acellular Dermal Matrix (ADM): Sheets of collagen/protein matrix that have been de-cellularized are used to create a pocket for the implant. Placing this matrix redirects the way collagen is laid down and helps prevent the capsule from tightening around the implant.
If you are experiencing excessive firmness, tightness, or distortion after breast augmentation surgery, schedule a consultation with Dr. Pablo Prichard. After careful evaluation and one-on-one consultation, he can recommend the most appropriate capsular contracture treatment for you.