- What is capsular contracture?
- What causes capsular contracture?
- What are the symptoms of capsular contracture?
- When does capsular contracture occur?
- Is capsular contracture dangerous?
- What is capsular contracture surgery?
- Can capsular contracture be treated without surgery?
- What about closed capsulotomy?
- Will capsular contracture get better on its own?
- How can I prevent capsular contracture?
- Can capsular contracture happen more than once?
- Capsular contracture can happen at any time, even years after surgery.
- There are many non-surgical methods for treating capsular contracture, but not all of them are effective.
- Surgery may be necessary to remove scar tissue.
What is capsular contracture?
Whenever there is a foreign object inside of your body — a breast implant or pacemaker, for example — your body reacts by creating a thin layer of scar tissue around it. This capsule is soft, flexible, and totally normal.
In some cases this scar tissue becomes thick and hard, pulling on the surrounding tissue. This pulling then constricts tissue, making it less flexible.
When this happens with breast implants, a once soft breast begins to feel stiff. As the condition worsens, the breast also becomes misshapen and can appear hard and round against the chest.
Capsular contracture is most commonly associated with breast augmentations, but it can happen any time a capsule is formed around a foreign object in the body.
What causes capsular contracture?
Sometimes the cause is clear. Trauma to the breast, radiation, and infection can all result in capsular contracture. Post-surgical hematoma — a severe form of bruising — has also been linked to an increased chance of developing capsular contracture.
Capsular contractures without a clear causes are commonly referred to as “silent” capsular contractures. Researchers theorize that bacterial contamination of the implant is the most likely culprit in such cases: bacteria on the outside of the implant may trigger a greater than normal physical reaction, leading to the overdevelopment of scar tissue.
There are also a few risk factors that could indicate how likely you are to develop capsular contracture:
- Autoimmune disorders — If you have an autoimmune disorder, like lupus, your body already has an overactive immune system. It is likely to overreact to an implant.
- Pregnancy — Researchers have noted a positive correlation between pregnancy and incidences of capsular contracture.
- Subglandular implant — This implant, placed beneath the mammary glands but above the pectoral muscle, also increases the risk of capsular contracture.
- Periareolar incision — This incision is located around the nipple. Researchers theorize this type of incision leads to a greater risk of bacterial contamination.
- Silicone implants — This is particularly true for older models of silicone implant. Silicone molecules sometimes seep out of the breast implant, a process known as gel bleed. This cause inflammation in the surrounding tissue.
- Implant size — Implants that are too large for the available skin are at a greater risk of capsular contracture.
» There’s no one-size fits all approach. Learn about the various incision techniques and breast implant options before undergoing breast enhancement surgery.
What are the symptoms of capsular contracture?
As mentioned previously, the body will form a scar capsule around all implanted devices, including breast implants. The types of capsule that form around breast implants are classified following the Baker grading system:
- Grade I — Breast is soft and natural looking. The patient cannot detect that there is a capsule present at all. This is a normal capsule formation and, essentially, what every breast augmentation patient hopes to have.
- Grade II — Breast is slightly firm. It may be possible to feel the implant. Breast still looks natural.
- Grade III — Breast is very firm and appears misshapen. Implant can easily be felt. There may be mild discomfort.
- Grade IV — Breast is hard and very misshapen. Implant is painful, especially when pressure is applied. Different women experience different levels of pain with capsular contracture and these different degrees of pain lay within this category. You could find the pain to be entirely manageable or simply unbearable.
Grade III and grade IV are considered capsular contractures.
When does capsular contracture occur?
Capsular contracture can occur at any time. That means that your implants could be perfectly fine for years before it happens. However, the vast majority of people who develop the condition do so within the first few months after surgery.
Symptoms tend to develop gradually, even in cases of trauma. It’s highly unlikely that you’ll experience any symptoms of capsular contracture just weeks after your surgery. If you’re experiencing firmness that early on, it’s probably because your implant hasn’t settled yet.
Is capsular contracture dangerous?
Capsular contracture itself is not dangerous. When women seek medical help for the condition it’s largely due to discomfort and the shape of the breast.
That being said, it is important to consult your doctor if you think that you might have capsular contracture. The earlier you treat the condition, the better your chances are of a successful outcome via non-surgical methods. Don’t rush yourself to an emergency room, but do make an appointment with a cosmetic doctor as soon as possible.
Sometimes capsular contracture can result from a silicone implant rupture. Some ruptures may be picked up by ultrasound but, in many cases, an MRI is the only test sensitive enough to give a clear diagnosis.
Although studies have shown that ruptured implants do not put your health at risk, removing or replacing ruptured implant is recommended.
What is capsular contracture surgery?
You may not want to hear this, but the only truly reliable solution to capsular contracture is the total removal of scar tissue, also known as a capsulectomy.
It’s further recommended that the implant be removed as well, as it could have been a bacterial contaminant on the surface of the implant that triggered the capsular contracture. However, the implant can be replaced during the same procedure.
Some doctors may also recommend a capsulotomy, not to be confused with the closed capsulotomy mentioned below. This procedure does not remove all of the scar tissue, but simply goes in and breaks it up. This too has largely fallen out of favor in recent years, but some surgeons still recommend it when the scarring is minimal.
Recovery from either of these procedures is similar to recovery from a regular breast augmentation.
Can capsular contracture be treated without surgery?
There are some non-surgical strategies for dealing with capsular contracture. However, none of them are guaranteed. Many are not thoroughly tested, but considered to be safe nonetheless.
- Ultrasound — Some doctors will use sound waves to soften the scar tissue around the implant. This method is also said to render the bacteria on the surface of the implant more vulnerable to your body’s immune system.
- Vitamin E — Take this one with a massive grain of salt. Despite claims, vitamin E has not been shown to soften scar tissue. This treatment is unlikely to yield the results that you are looking for, but it’s also unlikely to do any harm. Pairing vitamin E with a method that’s been proven more effective is generally recommended.
- Anti-inflammatory drugs — Doctors may prescribe Accolate or Singulair, two drugs used to treat asthma. These drugs have been shown to soften scar tissue in some patients. However, the evidence has only been anecdotal. These drugs are unlikely to work in more advanced cases.
- Massage — Doctors seem to be hot and cold on the subject of massage. Some plastic surgeons swear by it as a method for both preventing and treating early stage capsular contracture, whereas others don’t find it at all worthwhile.
What about closed capsulotomy?
This used to be a fairly standard practice for treating capsular contracture but it has since fallen out of favor — and for good reason. Since you may well have come across this term in your research, let’s talk about why you needn’t bother asking your doctor about it.
During this procedure, a doctor would squeeze the breast with great force, breaking up the scar tissue around the implant. When the scar tissue breaks, there is an audible popping noise accompanied by a great deal of pain.
However, this isn’t the main reason why the procedure has lost favor in the medical community. The closed capsulotomy is rarely performed as it comes with a high risk of rupturing the implant. This is dangerous as it can result in internal bleeding.
Will capsular contracture get better on its own?
It may get better with the help of some of the non-surgical methods listed above. However, even that is uncertain. If you do nothing to treat it, though, it won’t go away on it’s own and will likely only get worse.
How can I prevent capsular contracture?
There are variety of steps that you and your surgeon can take during and after surgery to reduce your chances of developing capsular contracture. If you are getting breast implants, be sure to talk to your plastic surgeon about your concerns beforehand.
Have your implant placed beneath the pectoral muscle. In theory, the movement of the muscle over the implant will massage the area and inhibit scar tissue growth.
The rough surface on textured implants is also said to inhibit scar tissue growth. The advantage of lower capsular contracture with textured implants only applies when placed over the muscle. When placed under the muscle, textured implants have shown no decrease in rates of capsular contracture when compared with smooth implants.
It should also be noted that in a very small number of cases, textured implants have been associated with ALCL, a rare non-Hodgkin lymphoma, which is a cancer of the immune system.
This method for conducting a breast augmentation involves opening the implant packaging just prior to inserting it into the body. Great care is taken not to allow the implants to touch any bare skin or medical instruments. It should only come into contact with gloved hands and the inside of the breast.
The idea is to minimize any opportunity for bacteria to latch on to the outside of the implant.
Both pre-soaking the implant to be inserted, and washing the breast implant pocket that is surgically created prior to its insertion with a combination of cefazolin, gentamicin, and bacitracin, have been shown to decrease the incidence of capsular contracture.
The Keller Funnel is a device that aids with the insertion of a silicone implant through what is typically a small incision in the breast. It furthers the no-touch technique by preventing the implant from touching any contaminants that may be on the skin.
This is similar in principle to the no-touch method. In short, the surgeon uses a closed system to fill saline implants. At no point is the saline exposed to air (and outside contaminants).
Your surgeon may instruct you in how to massage your breasts after the procedure. When you begin and how often you do it will depend on the size and nature of your implants. However, people typically start a week after surgery and massage themselves daily for the first few months.
In your research, you may have come across polyurethane-coated implants. At one time these implants were popular for the prevention of capsular contracture and proven largely effective. The foam covered implants acted like textured implants, deterring scar formation.
A 30-year study involving 382 patients noted that the more coating on an implant the less likely the patient was to experience capsular contracture. However, researchers also noted that the polyurethane had a tendency to be absorbed by the body, raising some health concerns. As a result, they were discontinued in the United States. They have since been reintroduced, but are not widely used.
Can capsular contracture happen more than once?
Absolutely. If the factors that led to the initial development are not addressed there is no reason why it couldn’t happen again.
That being said, full capsulectomies usually result in no further recurrences of the condition. This is one reason why they are favored over the capsulotomy. Put simply, removing all of the scar tissue is considerably more effective than simply breaking it down.
» If you think that you might be experiencing capsular contracture, contact a cosmetic doctor near you for a diagnosis and treatment options.
- Rosato, R. M., & Dowden, R. V. (1994). Radiation Therapy as a Cause of Capsular Contracture [Abstract]. Annals of Plastic Surgery, 32(4), 342-345. doi.org/10.1097/00000637-199404000-00002
- Adams, W. P. (2009). Capsular Contracture: What is It? What Causes It? How Can It Be Prevented and Managed? [Abstract]. Clinics in Plastic Surgery, 36(1), 119-126. doi.org/10.1016/j.cps.2008.08.007
- Dancey, A., Nassimizadeh, A., & Levick, P. (2012). Capsular contracture – What are the risk factors? A 14 year series of 1400 consecutive augmentations. Journal of Plastic, Reconstructive & Aesthetic Surgery, 65(2), 213-218. doi.org/10.1016/j.bjps.2011.09.011
- Wiener, T. C. (2008). Relationship of Incision Choice to Capsular Contracture [Abstract]. Aesthetic Plastic Surgery, 32(2), 303-306. doi.org/10.1007/s00266-007-9061-2
- Ultrasound Therapy Shows Promise in Treating the Most Common Breast Implant Complication, Capsular Contracture, Dr. Donald Kress, Plastic Surgery One. (2011, November 09). prweb.com/releases/2011/11/prweb8945023.htm
- Headon, H., Kasem, A., & Mokbel, K. (2015). Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Archives of Plastic Surgery, 42(5), 532. doi.org/10.5999/aps.2015.42.5.532
- Fanous, N., MD FRCSC, Salem, I., MD, Tawile, C., MD FRCSC, & Bassas, A. E., MD. (2004). Absence of capsular contracture in 319 consecutive augmentation mammaplasties: Dependent drains as a possible factor. Plastic Surgery, 12(04). doi.org/10.4172/plastic-surgery.1000410
- Castel, N., Soon-Sutton, T., Deptula, P., Flaherty, A., & Parsa, F. D. (2015). Polyurethane-Coated Breast Implants Revisited: A 30-Year Follow-Up. Archives of Plastic Surgery, 42(2), 186. doi.org/10.5999/aps.2015.42.2.186