Capsular contracture is a breast implant deformity that occurs when the scar tissue (capsule) surrounding the implant contracts and tightens. Also known as breast contracture and capsular contraction, this is one of the most common breast implant complications affecting approximately 5%-10% of breast augmentation patients. If you have hardened breast implants and are wondering what to do, you're not alone. This blog aims to answer all of your questions so you can make an informed decision about your next steps.
Dr Hertess is a female plastic surgeon on the Gold Coast who specialises in the diagnosis and treatment of breast capsular contracture. She is also well versed in all breast surgeries, including breast augmentation and revision surgery.
Following a breast augmentation procedure, your body naturally forms a capsule of scar tissue around the new implant to protect it. This is a standard and healthy response, it’s the body's way of creating a snug, protective pocket.
However, capsular contracture occurs when this scar tissue tightens excessively around the implant, leading to discomfort, appearance changes, and sometimes pain in the affected breast.
It’s important to understand that while the formation of a breast implant capsule is a normal part of the healing process, the contraction—that tightening of the capsule—is what can cause issues, and requires further attention or treatment.
Capsular contracture is a result of the body's natural immune response to a foreign object. The most common causes of capsular contracture include:
Blood accumulation, bruising, or infections around the implant area can trigger an inflammatory response. The inflammation causes the capsule to become thicker and that forms tight scar tissue.
Implants with a sticky shell or "gel bleed" were found to elicit a more significant inflammatory reaction, contributing to a higher rate of capsular contracture. This is because the body detects small drops of silicone gel, and in response forms more scar tissue to protect the body.
Leakage or rupture of the implant is the most common cause of capsular contracture. This is because it causes a natural reaction to the foreign material (silicone) to stop it spreading within the body.
Breast implant contracture can manifest in several ways. The most common capsular contracture signs and symptoms include:
Keep in mind that it's completely normal to have some initial changes as your body adjusts post-surgery. However, if you notice any of these symptoms becoming persistent, it might be a good idea to consult with your surgeon for advice and possible treatment options.
Typically your surgeon will be able to recognise the condition, however diagnosing capsular contracture may require some further testing. Your surgeon will likely use a combination of the following methods to get a clear understanding of what's going on:
With these tools, Dr Hertess can accurately diagnose capsular contracture breast implants, guiding you towards the best treatment options.
The Baker Grading Scale is a widely used method for assessing the severity of capsular contracture in patients with breast implants. This baker capsular contracture scale helps surgeons classify the extent of the contraction and decide on the best course of action for treatment. Here's a brief overview of the scale:
This stage is the ideal scenario where the breast appears natural and soft, essentially indistinguishable from a breast without an implant.
There's no sign of capsular contracture at this level.
At this level, the breast may still look normal, but it starts to feel a bit firmer than usual.
Although there are signs of contracture, it typically doesn't require treatment unless the firmness is a concern for the patient.
This grade is when the contraction becomes more noticeable.
The breast not only feels hard but also begins to appear abnormal. Patients may start experiencing discomfort due to the tightness of the scar tissue around the implant.
The most severe form of capsular contracture.
The breast is hard, visibly distorted, and often painful. This grade usually necessitates treatment, which might include surgery or other methods to relieve symptoms and improve the breast's appearance.
Treatment options depend on a few factors. It's first important to know what's happening with the implant and why is the body reacting. It may be due to a rupture, leak, a foreign object that your body doesn't want to accept or an immune response against the implant.
The implant needs to be dealt with before the capsule. Regardless, capsular contracture surgery is required to alleviate the symptoms of this complication.
Treatment options include:
During breast implant replacement surgery, the old capsule is removed and a new implant is put in. The body then forms a new capsule within 24 hours, which ideally remains thin rather than contracts against it.
In some cases, it may be recommended to change the brand of breast implant to mitigate the risk of recurrence. Typically, the risk of recurrent capsular contracture is 3-20%.
If capsular contracture reoccurs after replacement surgery, then Dr Hertess recommends the complete removal of breast implants.
During breast implant removal surgery, the entire implant is removed along with the capsule to alleviate symptoms. This option may be recommended for patients who no longer wish to have implants or if capsular contracture reoccurs after replacement surgery.
This procedure refers to the surgical release of scar tissue around the breast implant.
In cases where the capsule is contracted on the lower edge and the implant itself is fine, a capsulotomy is performed to release the capsule. This allows the implant to fall back into position and a new capsule will form in the desired position.
Capsulectomy surgery relates to the surgical removal of excess scar tissue. En bloc refers to removal of scar tissue in cases where ALCL has been detected.
If you have concerns about hardened breast implants, it's recommended that you see Dr Hertess for advice and appropriate treatment.
A commonly asked question is "How do I avoid capsular contracture?" One of the most effective methods to minimise the risks of capsular contracture is to ensure proper postoperative care.
There are a few ways you can do this:
Massaging your breast implants after surgery can maintain the softness of the capsule and reduce the risk of contracture. Most plastic surgeons recommend routine self-massage for the lifetime of the breast implants.
As part of your surgery aftercare, avoiding heavy lifting after surgery is crucial. Engaging in strenuous activities or lifting heavy objects can strain your body and increase the risk of unwanted complications including capsular contracture.
New breast implants come with a dry shell surface that is less likely to cause an inflammatory response. This is because they cause less of a reaction in the body. Studies show that these improvements have significantly reduced the occurrence of capsular contracture.
Signs of capsular contracture include:
Unfortunately, no. Capsular contracture is a medical complication that requires surgical treatment to alleviate symptoms and prevent further complications.
Capsular contracture surgery is required to correct contracted breast implants.
If you are experiencing no discomfort, pain, or visible distortion of the breast, then it's ok to live with this condition. However, as it can get worse with time, it's recommended to seek treatment for this complication.
Yes, there is a chance that capsular contracture may recur even after corrective surgery. If it reoccurs, then complete removal of breast implants is recommended.
This condition typically gets worse with time, so it's recommended to seek treatment as soon as symptoms appear.
Pain or discomfort associated with capsular contracture can feel different for each individual. Some may experience a tightening sensation, while others may feel sharp pains. It's best to consult with Dr Hertess for an accurate diagnosis and treatment plan.
Capsular contracture can develop at any time after breast implant surgery. However, it's more likely to occur within the first two years after surgery.
Capsular contracture occurs in approximately 10% of breast augmentation patients. However, with modern implant improvements and proper postoperative care, this complication can be significantly reduced.
Capsular contracture is a common risk of breast implant surgery that can cause discomfort and change the way your breasts look. It's important to seek treatment from an experienced plastic surgeon like Dr Hertess. She can assess the extent of the contracture and then guide you towards the right treatment. Her goal is always to ease your symptoms and help your breasts regain their natural appearance.