CAPSULAR CONTRACTURE

Capsular contracture is a condition that sometimes occurs after breast augmentation. Capsular contracture can cause breasts to rise to become distorted and can make them painful and hard to the touch.

The body responds to any implant (medical or cosmetic) by forming scar tissue, or a “capsule,” around it as part of its normal healing process. This is the body’s immune system response to any foreign object it detects. In the case of a breast implant, this capsule of scar tissue is usually pretty thin, and it helps keep the breast implants in place. In some patients, the capsule becomes thicker and contracts around the implant, which places the implant under pressure. As the capsule tightens, the implant can rise to a higher position on the chest, making the breast look tight and artificially round, like a baseball. In more advanced cases, the implant can feel firm or even painful.

What Causes Capsular Contracture?

There are a number of theories on the exact cause of capsular contracture, though it does seem to vary from patient to patient.  It is important to understand that capsular contracture is not caused by breast implants being toxic or dangerous.  It can happen after any kind of medical implant is inserted into the body (i.e. hips, knees, etc), and this condition is not unique to breast augmentation surgery.  Furthermore, capsular contracture is not generally dangerous to a patient’s health.  It is, however, troubling secondary to the appearance of the breasts or if the patient experiences pain as a sequelae of advanced capsular contracture.

Though we do not know the exact cause of capsular contracture, we do know that certain things increase the risk of capsular contracture.

Biofilm

Biofilm is a thin layer of bacteria that develops around implants after bacteria has been introduced to the breast cavity during surgery. This bacteria can cause a chronic, low-grade infection that can result in increased scar tissue production, leading to capsular contracture.  It is important to note that this contamination does not necessarily result from a non-sterile working environment.  It can occur from bacteria that is always present on the patient’s skin and does not usually cause symptoms.  We use multiple methods of ensuring the most sterile skin environment for our patient during surgery to avoid development of these biofilms.

Hematoma and Seroma

Hematomas and seromas are rare complications of breast surgery. Specifically, these are collections of fluid that accumulate in the breast pocket.  These fluid collections are thought to supply nutrients to bacteria, which encourage the growth of biofilm and increase the risk of capsular contracture.  To avoid fluid collections, we perform meticulous surgery intraoperatively and may leave drains postoperatively.

Inflammation

Increase in inflammation in the breast pocket can cause capsular contracture. Causes of inflammation include bacterial infection or fluid collection.  In addition, ruptured silicone or remnants of silicone from an old rupture can also stimulate inflammation in the breast pocket.

Smoking

Smoking is known to increase the risk of capsular contracture. We require that our patients be willing to stop smoking before and after surgery to reduce this risk.

Implant Placement

Placement of the implant under the chest muscle has been shown to lower the risk of capsular contracture by 4-8% compared with over the muscle placement of the implant.

Is Capsular Contracture Dangerous?

No, capsular contracture is not typically dangerous but can cause unsightly surface abnormalities on the breast due to contracting scar tissue squeezing the breast implant. Capsular contracture can pose health risks when the capsule is so tight that it ruptures the breast implant.

Does Capsular Contracture Hurt?

In extreme cases, capsular contracture can cause pain in the breasts.

How Is Capsular Contracture Treated?

Capsular contracture requires surgery to remove the implant and the affected capsule. Since the capsule encapsulates the entire implant, the implant is removed with the capsule. Once the capsule is removed from the implant, a new implant can be replaced back into the breast pocket.   Sometimes we will recommend the use of surgical mesh around the implant, which has been shown to significantly decrease the recurrence of capsular contracture.