What Is Capsular Contracture? Causes and Treatment

Capsular contracture is one of the most common complications following breast implant surgery. While breast augmentation typically has high satisfaction rates, capsular contracture can cause discomfort and affect the appearance of the breasts. If you're considering breast implants or already have them, it’s essential to understand what capsular contracture is, its causes, how to recognize the symptoms, and the available treatments. This article will explain everything you need to know about capsular contracture and what you can do if you experience it.

What Is Capsular Contracture?

Capsular contracture occurs when the scar tissue (capsule) that naturally forms around a breast implant tightens and hardens. After breast augmentation, it is normal for the body to form a protective layer of scar tissue around the implant. This capsule helps hold the implant in place. However, in some cases, the scar tissue becomes excessively thick or contracts, squeezing the implant and causing it to become firm or misshapen.

Capsular contracture can range from mild to severe and is classified into different grades using the Baker Classification system:

• Grade I: The breast is soft and looks natural.
• Grade II: The breast is slightly firm but still appears natural.
• Grade III: The breast is firm and starts to look distorted or misshapen.
• Grade IV: The breast is very hard, painful, and visibly distorted.

While Grades I and II are typically not a concern, Grades III and IV may require medical attention and treatment to correct the issue.

Causes of Capsular Contracture

The exact cause of capsular contracture is not fully understood, but several factors are believed to contribute to its development, including:

1. Infection:
Even a mild infection around the implant can trigger the body to form excess scar tissue, leading to capsular contracture. Proper hygiene and following post-surgery care instructions can help reduce the risk of infection.

2. Hematoma or Seroma:
A hematoma (collection of blood) or seroma (collection of fluid) around the implant can irritate the surrounding tissue and contribute to the development of capsular contracture.

3. Implant Placement:
Capsular contracture is more likely to occur when implants are placed above the chest muscle (subglandular placement) compared to being placed under the muscle (submuscular placement). Submuscular placement provides more tissue coverage over the implant, which may reduce the risk.

4. Implant Rupture:
A ruptured implant can cause the body to react by forming thicker scar tissue around it. Regular monitoring and imaging (such as MRI) can help detect silent ruptures in silicone implants.

5. Radiation Therapy:
Patients who undergo breast reconstruction following a mastectomy and receive radiation therapy are at a higher risk of developing capsular contracture.

Symptoms of Capsular Contracture

The most common signs of capsular contracture include:

• Hardening of the Breast: One or both breasts may become noticeably firmer than they were after surgery. This firmness can vary from mild to severe, depending on the grade of contracture.
• Change in Shape: As the scar tissue tightens, it can cause the breast to appear misshapen or distorted. In severe cases, the implant may look unnaturally round or shift to an abnormal position.
• Discomfort or Pain: As the capsule tightens, it may cause discomfort or pain, especially in Grades III and IV capsular contracture.
• Shifting of the Implant: In some cases, the implant may move or become displaced, affecting the symmetry of the breasts.

If you notice any of these symptoms, it’s important to consult your plastic surgeon for a diagnosis and to discuss treatment options.

Treatment Options for Capsular Contracture

Treatment for capsular contracture depends on the severity of the condition. Mild cases may not require any treatment, but more severe cases may need surgical intervention. Here are the most common treatment options:

1. Non-Surgical Treatments

• Massage and Medication:
  For mild cases, your surgeon may recommend massage techniques to help soften the scar tissue. Some medications, such as leukotriene inhibitors, may also be prescribed to reduce inflammation and prevent further tightening of the capsule.
• Ultrasound Therapy:
  Some doctors may use ultrasound therapy to break down scar tissue and improve the elasticity of the capsule. This treatment may help reduce discomfort and prevent the condition from worsening in early stages.

2. Surgical Treatments

• Capsulotomy:
  A capsulotomy involves making small cuts in the scar tissue capsule to release its tightness and allow the implant to move more freely. This procedure can be performed either as a closed capsulotomy (manipulating the breast externally) or as an open capsulotomy (requiring a surgical incision). However, the closed technique is rarely recommended as it can risk damaging the implant.
• Capsulectomy:
  In more severe cases (Grades III and IV), a capsulectomy may be necessary. This procedure involves removing the entire scar tissue capsule surrounding the implant. The surgeon may also replace the implant during this surgery to reduce the risk of recurrence.
• Implant Replacement or Removal:
  If capsular contracture is severe or recurs, your surgeon may recommend removing the implants entirely or replacing them with new ones. Submuscular placement and choosing different types of implants (e.g., textured or smooth implants) may help reduce the likelihood of the contracture returning.

Preventing Capsular Contracture

While capsular contracture can’t always be prevented, there are steps you can take to reduce your risk:

• Choose a Qualified Surgeon:
  Working with an experienced, board-certified plastic surgeon significantly reduces your chances of complications like capsular contracture. They will use advanced techniques to minimize the risk of scar tissue formation.
• Submuscular Placement:
  Placing the implants under the chest muscle provides additional coverage and has been shown to lower the risk of developing capsular contracture.
• Follow Post-Surgery Instructions:
  Proper post-operative care, including keeping the incision site clean, avoiding strenuous activity, and attending follow-up appointments, can help prevent infection and other complications.
• Consider Implant Type:
  Some studies suggest that textured implants may have a lower risk of capsular contracture compared to smooth implants. However, this can vary by individual, and your surgeon will recommend the best option for you.

Capsular contracture is a common but treatable complication of breast implant surgery. By understanding the causes, recognizing the symptoms early, and following your surgeon’s post-operative care instructions, you can minimize your risk of developing capsular contracture. If you experience discomfort, hardening of the breast, or changes in the appearance of your implants, consult your plastic surgeon for a proper diagnosis and to discuss your treatment options.

Frequently Asked Questions (FAQs) About Capsular Contracture

1. What is capsular contracture?
Capsular contracture occurs when the scar tissue (capsule) that naturally forms around a breast implant tightens and hardens, causing the breast to become firm or misshapen. It can range from mild to severe and may require treatment in more serious cases.

2. What causes capsular contracture?
The exact cause isn’t fully understood, but factors such as infection, hematoma (blood collection), implant rupture, and implant placement (above the muscle) can increase the risk. Radiation therapy and certain immune responses may also contribute.

3. How do I know if I have capsular contracture?
Symptoms of capsular contracture include hardening of the breast, changes in the shape or position of the implant, discomfort, and pain. In severe cases, the breast may feel very firm and look distorted.

4. Can capsular contracture be prevented?
While it can’t always be prevented, steps like choosing a skilled surgeon, opting for submuscular implant placement, following proper post-operative care, and monitoring for early signs can help reduce the risk.

5. How is capsular contracture treated?
Mild cases may be managed with massage or medications, while more severe cases may require surgical treatments such as capsulotomy (loosening the scar tissue) or capsulectomy (removing the scar tissue). In some cases, implant replacement may be necessary.

6. Does capsular contracture affect both saline and silicone implants?
Yes, capsular contracture can occur with both saline and silicone implants. The type of implant does not prevent the condition, though other factors like placement and surgical techniques can influence its likelihood.

7. Is capsular contracture painful?
In severe cases (Grades III and IV), capsular contracture can cause significant discomfort or pain due to the tightening of the scar tissue around the implant. Mild cases (Grades I and II) may not cause any pain.

8. How long after surgery can capsular contracture develop?
Capsular contracture can develop at any time after breast augmentation, though it is most likely to occur within the first few years after surgery. It’s important to attend regular follow-up appointments with your surgeon to monitor your implants.

9. Will I need to replace my implants if I have capsular contracture?
In severe cases, implant removal or replacement may be recommended, especially if the contracture recurs after treatment. Your surgeon will discuss whether implant replacement is necessary based on your situation.

10. How common is capsular contracture?
Capsular contracture is one of the most common complications after breast augmentation, with varying degrees of severity. However, advancements in surgical techniques have helped reduce its incidence over time.