What is capsular contracture?

After breast augmentation surgery, it is normal for the body to generate a capsule of fibrous scar tissue surrounding the new implant. This process is a natural response of the body that seeks to protect itself by isolating any object it identifies as foreign. Usually, this capsule is formed in a soft or semi-firm way, being practically imperceptible and fulfilling a supporting function for the implant.

 

Occasionally, however, this scar tissue can become too stiff and dense, causing pressure on the implant, a phenomenon known as capsular contracture. After breast augmentation surgery, this condition can alter the shape of the implant and cause it to move to a higher position in the breast, in addition to generating chronic pain in some cases.

“…scar tissue can become too stiff and dense, causing pressure on the implant, a phenomenon known as capsular contracture…”

This scar “capsule” is a common and expected consequence of the healing process, appearing not only in breast augmentation surgeries, but also in other types of medical or aesthetic interventions involving the implantation of a foreign object into the body, technically called a foreign body. In most cases, it facilitates the stabilization of the implant, avoiding undesired displacements. However, a portion of patients may develop noticeable capsular contracture, with adverse aesthetic and physical manifestations.

It is worth mentioning that during the 10 years following the intervention, approximately one 17 a 22,5% of patients who undergo breast augmentation using silicone-coated prostheses may experience some degree of capsular contracture, as opposed to patients using polyurethane-coated breast prostheses in whom the risk of encapsulation is higher than in patients using silicone-coated prostheses. is around 1%. although not all cases manifest obvious symptoms. The severity of this phenomenon is categorized in grades from 1 to 4, with 1 being asymptomatic and 4 representing severe cases with pain and noticeable deformation in the affected area.

Who is at risk of developing capsular contracture?

The onset of capsular contracture may be influenced by a variety of factors, and the specific reasons that lead some individuals to develop this condition while others do not are not yet fully understood.

One of the recognized risk factors is having received radiotherapy treatments in the past, especially if it followed breast reconstruction surgery, as this can significantly increase the chances of experiencing capsular contracture. Other situations that may predispose a person to develop capsular contracture include:

– Type of coverage of the prosthesis: Polyurethane or Silicone.

– Post-surgical hematomas

– Infections or formation of a microbial biofilm on the implant

– Breast implant ruptures

– Genetic tendency

With regard to the type of coverage, it should be noted that during the 10 years following the intervention approximately 17 a 22,5% of patients who undergo breast augmentation surgery using silicone-coated prostheses may experience some degree of capsular contracture, compared to patients using polyurethane-coated breast prostheses in whom the risk of encapsulation is around 1%.

“…the risk of capsular contracture with polyurethane prostheses is around 1% and with silicone prostheses it is between 17 and 22.5%…”

It is vital to note that, despite the associated risks, breast implants are non-toxic and non-hazardous.

In this context, it is considered that genetics may play a significant role in the predisposition to develop capsular contracture. Those with a family history of autoimmune disease or a genetic predisposition to form thickened scar tissue may be at increased risk. However, it is essential to note that a large proportion of patients experiencing capsular contracture have no known family history of the condition.

Additionally, some experts suggest that capsular contracture may be related to bacterial contamination during the surgical procedure. Although surgeries are performed in sterile environments, it is virtually impossible to completely eliminate all bacteria from the surgical environment. Therefore, it is postulated that the presence of bacteria entering the body during surgery could be related to the development of capsular contracture, motivating surgeons to adopt special techniques to minimize the exposure of implants to possible bacterial contaminants during surgery.

Symptoms and Signs of Capsular Contracture

Early recognition of the symptoms of capsular contracture, which may manifest as increased firmness or tightness in the breast area, is critical. These signs may emerge a few months after a breast implant reconstruction procedure, or manifest themselves several years later. If you experience chronic pain, restricted range of motion, or alterations in the position and shape of the chest, you may want to consider corrective intervention.
There are four degrees of capsular contracture:

  • Grade I. The breast looks natural and is soft to the touch, there is no discomfort or pain. There is a non-symptomatic capsule.
  • Grade II. The breast has a normal appearance but is not soft to the touch, rather it is somewhat hardened, and patients may feel discomfort.
  • Grade III. The appearance of the breast is no longer normal, it manifests a malformation. It has hardened and when you touch it you can feel the prosthesis itself. The patient usually feels pain. It occurs when the implant begins to move out of position, usually upward.
  • Grade IV. The symptoms are very similar to those of grade III but the breast is completely hard and deformed, with an abnormal appearance. Patients usually present with pain.

Aesthetic Changes of Breast Capsular Contracture

One of the most obvious manifestations of breast capsular contracture is a change in the appearance of the breasts. Some of the most common aesthetic signs include:

Breast Asymmetry: Capsular contracture can cause one breast to appear higher, firmer or larger than the other, resulting in a noticeable asymmetry.

Breast deformity: Breasts affected by capsular contracture may have an irregular or distorted shape, which negatively affects the aesthetic appearance.

Abnormal Nipple Elevation: In some cases, capsular contracture can cause abnormal nipple elevation, which contributes to a disproportionate appearance of the breasts.

Pain and Discomfort: Patients may experience pain in the affected breast, which can be both physically and emotionally distressing.

Physical Manifestations of Breast Capsular Contracture

In addition to cosmetic changes, breast capsular contracture can also have physical manifestations that can affect patients’ quality of life. These manifestations may include:

Feeling of Stiffness: Breasts may feel harder or tighter than normal due to capsular contracture.

Pain or Discomfort: Pain in the affected breast is a common complaint among people with capsular contracture.

Limitation of movement: The contracted capsule can limit the mobility of the breast implant, which can be uncomfortable for patients.

Changes in Sensitivity: Some patients may experience changes in nipple or breast sensitivity due to capsular contracture.

Although the professionals at our Trusted Plastic Surgery Clinics in Spain strive to ensure safe and effective procedures, occasionally complications can arise during or after an intervention. Each individual is unique, and therefore, your body’s response to surgery may vary considerably. Factors such as the composition of the connective tissue and the individual reaction of the immune system to external stimuli can influence the healing process.

Today, thanks to significant improvements in surgical techniques and the ability to identify those patients most at risk of experiencing complications, these drawbacks are extremely rare. Advances in Cosmetic Surgery in Mallorca allow for personalized recommendations and the use of specific surgical techniques to minimize the appearance of visible scars.

Treatment and Prevention of capsular contracture

In cases of capsular contracture, treatment strategies are determined by the severity of symptoms. In many scenarios, a conservative approach is chosen, i.e. no surgical treatment, especially when symptoms are mild. However, for more severe cases, therapeutic options may include surgical procedures such as capsulectomy, a procedure that allows the removal of part or all of the scar tissue capsule.

…Surgery is not recommended for mild cases while severe cases can be treated….

Currently, the tendency is to remove the capsule, particularly when it is very thick, and in some cases its preservation is recommended, if it is considered that the risk of its removal may be too high. If it is removed, an anatomopathological study of the capsule is desirable to know the nature of the capsule.

In the context of prevention, several effective strategies to reduce the risk of capsular contracture are highlighted. One of them is the selection of textured breast implants, which seems to decrease the incidence of this complication compared to smooth implants. Although it is important to note that these implants carry their own set of potential risks. Thus, it should be noted that during the first 10 years after breast augmentation using silicone-coated prostheses there is a risk of capsular contracture formation between 17 a 22,5% compared to patients using polyurethane coated breast prostheses in whom the risk of encapsulation is around 1%.

In addition, following the postoperative instructions provided by your surgeon is vital. In this sense, the need for postoperative massage is debatable, since friction on the implants could induce capsule formation. Aesthetic medicine treatments in Mallorca may also include the prescription of specific post-operative medications to mitigate swelling and the risk of capsular contracture.

Thus we conclude that capsular contracture is a potential complication of breast augmentation surgery, which is relatively frequent. We have a range of effective strategies to prevent it and treat it if it occurs. If you are considering a breast augmentation procedure, we recommend that you discuss any concerns with your surgeon, who will be more than willing to assist you in creating an informed and personalized treatment plan.

If you wish to consult your particular case you can do so with Dr Garcia Ceballos who is a specialist in plastic surgery through this link.

Sources:
https://www.thieme-connect.de/products/ejournals/html/10.5999/aps.2015.42.2.186
https://www.sciencedirect.com/science/article/abs/pii/S1748681516000255
https://link.springer.com/article/10.1007/s00266-011-9826-5
https://link.springer.com/article/10.1007/s00266-006-0207-4
https://www.plasticsurgery.org/news/blog/what-is-capsular-contracture-and-how-can-it-be-treated