Capsular Contracture Signs, Prevention, and Treatment | PreferredMD
Plastic Surgery

Capsular Contracture Signs, Prevention, and Treatment

Condition • By Biraj Patel

Capsular contracture is a common complication that can arise after breast implant surgery. It occurs when the scar tissue (capsule) that naturally forms around the implant tightens and compresses the implant, causing discomfort and changes in appearance. Let’s explore what capsular contracture is, its symptoms, causes, treatment options, and steps to prevent its occurrence.

What is capsular contracture?

Capsular contracture is a condition in which the scar tissue capsule that forms around a breast implant becomes excessively thick, tight, and constrictive. This tightening can lead to discomfort, pain, changes in breast shape, and even distortion of the implant. 

While the precise cause of capsular contracture remains a subject of research, it is believed to be a result of the body's natural response to the presence of a foreign object, such as a breast implant.

Capsular contracture symptoms

Identifying the symptoms and signs of capsular contracture is crucial for early detection and effective treatment. Some common symptoms include:

  • Increased firmness: One of the early signs of capsular contracture is a noticeable increase in the firmness of the breast. The breast may feel hard or rigid to the touch.
  • Change in shape: As the scar tissue tightens around the implant, it can cause the breast to appear distorted or misshapen.
  • Pain or discomfort: Capsular contracture can lead to varying degrees of discomfort or even pain in the affected breast.
  • Visible rippling: In some cases, the tightening of the scar tissue may cause visible rippling or wrinkling of the skin over the implant.

What causes capsular contracture?

The exact cause of capsular contracture is not fully understood, but several factors may contribute to its development.

#1 Implant rupture or leakage 

A ruptured or leaking implant can irritate the surrounding tissues and trigger the body's immune response, potentially leading to capsular contracture.

#2 Genetics and immune response

Individual variations in genetics and immune system responses can play a role in the development of capsular contracture.

#3 Implant placement 

Subglandular (above the muscle) implant placement has been associated with a higher risk of capsular contracture compared to submuscular (under the muscle) placement. Placing the implant under the muscle may create a more natural appearance and decrease the risk of excessive scar tissue formation.

#4 Implant size

Larger implants may create more tension on the surrounding tissues, potentially increasing the risk of capsular contracture.

#5 Surgical technique

Factors related to the surgical technique, such as excessive handling of the implant or inadequate removal of the breast tissue capsule, can influence the risk of capsular contracture.

#6 Bacterial contamination 

Bacterial contamination during surgery or in the immediate post-operative period can lead to inflammation and increase the risk of capsular contracture. Proper sterile techniques and antibiotic prophylaxis are important in reducing this risk.

#7 Hematoma or seroma formation 

Accumulation of blood (hematoma) or fluid (seroma) around the implant can trigger an inflammatory response, potentially leading to capsular contracture.

#8 Textured implants 

Textured implants, which were designed to reduce the risk of implant movement, have been associated with a higher incidence of capsular contracture compared to smooth implants.

#9 Post-operative care

Failure to follow proper post-operative care instructions, including massage and regular check-ups, could contribute to an increased risk of capsular contracture.

#10 Smoking

Smoking has been linked to an increased risk of capsular contracture. Nicotine can affect blood flow and oxygen delivery to tissues, potentially impairing proper healing.

It's important to note that while these factors may raise the risk of capsular contracture, not all individuals with these risk factors will develop the condition.

How to avoid capsular contracture

While capsular contracture cannot be entirely prevented, there are steps you can take to minimize the risk.

  • Choose implant placement carefully: Implants placed under the muscle may have a lower risk of capsular contracture.
  • Follow post-op instructions: Adhering to your surgeon's post-operative instructions, including massage techniques, can aid in preventing excessive scar tissue formation.
  • Regular monitoring: Regular follow-up appointments with your surgeon can help detect early signs of capsular contracture.

Capsular contracture stages

Capsular contracture is classified into four Baker grades:

Grade I: The breast is soft and looks natural.

Grade II: The breast is slightly firm but looks normal.

Grade III: The breast is firm, and its shape is distorted.

Grade IV: The breast is hard, painful, and visibly distorted.

Capsular contracture treatment options

Capsular contracture treatment can vary depending on the severity of the condition. Mild cases may respond to non-surgical interventions, while more advanced cases may require surgical procedures. 

Non-surgical treatments

#1 Massage and compression

Your surgeon may recommend specific massage techniques to help soften the scar tissue and reduce the contracture. Gentle pressure and manipulation of the breast can promote tissue flexibility.

#2 Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) or prescription medication such as Singulair (montelukast) may be prescribed to reduce inflammation and potentially alleviate symptoms.

#3 Ultrasound therapy

Ultrasound treatment can help break down scar tissue and promote tissue relaxation, potentially improving the flexibility of the capsule.

#4 External bracing

The use of external bracing devices or specialized bras may help prevent further contraction of the scar tissue.

Surgical treatments

#1 Capsulotomy

In this surgical procedure, the surgeon makes incisions in the existing scar tissue to release the constricted capsule. This can help relieve pressure on the implant and restore a more natural breast shape and feel.

#2 Capsulectomy

A capsulectomy involves the complete removal of the scar tissue capsule. This is often recommended for severe cases of capsular contracture. The surgeon may also remove the implant and replace it during the procedure.

#3 Implant replacement

If the implant is contributing to the contracture, your surgeon may recommend replacing it with a new implant. Smooth implants or those of a different type (saline vs. silicone) may be used to reduce the risk of recurrence.

#4 Implant pocket adjustment

In cases where the implant pocket needs to be repositioned, the surgeon may perform a procedure to change the implant's location (e.g., from above the muscle to below the muscle) to minimize the risk of contracture.

#5 Acellular dermal matrix (ADM)

In some cases, ADMs may be used to provide additional support to the implant and prevent further contracture. These are soft tissue grafts derived from human or animal sources.

Combination of treatments

Sometimes, a combination of non-surgical and surgical treatments may be recommended to achieve the best results and prevent recurrence.

Discuss capsular contracture with plastic surgeons in PreferredMD network

Capsular contracture is a potential complication of breast implant surgery that can impact both the physical comfort and aesthetic appearance of the breasts. Early detection and appropriate treatment are essential for addressing this condition effectively.

It's important to work closely with a board-certified plastic surgeon to determine the most appropriate treatment plan based on your individual situation. They will consider factors such as the severity of contracture, implant type, and your overall health when recommending a treatment approach. Early intervention and proactive management are key to addressing capsular contracture effectively.

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