Capsular Contracture

Jul 26, 2010 by admin

What is capsular contracture?

When breast implants, or any other foreign object, are placed in the body, the body forms a lining around it. This lining, or capsule, is formed by your own living tissue. Many people refer to this lining as the “capsule”, “tissue capsule”, or “scar capsule”, although it is not exactly the same thing as scar tissue. This is the body’s natural response to a foreign object.

Capsule contracture, the most common complication of breast augmentation surgery, can happen at any time, but seems to be more common in the first several months after surgery. At the time of the initial surgery, a pocket is made for the implant. During the healing process, a capsule forms, which is comprised of fibrous tissue. The body is genetically programmed to shrink scar tissue somewhat. Under normal conditions, the pocket remains open, thus allowing the implant to look and feel natural. However, in some people, the capsule will tighten, and squeeze the implant. This makes the breast implant feel hard, and distorts the appearance of the breast. In the later stages, the implant feels very firm, and may take on a “ball-like” look. It is important to remember that it is not the implant that has hardened. The shrinking of the capsule compresses the implant, causing it to feel firm/hard. However, once the implant is removed, it is just as soft as it was the day it was inserted.

What causes capsular contracture?

Currently, the causes for capsule contracture are still very unclear. The following are thought to put you at greater risk for developing capsule contracture:

1) Transient germ contamination. Germ contamination and/or long-term bacterial contamination of the implant shell can cause an inflammatory reaction, thus leading to the shrinking of the capsule.

2) Subglandular placement. Breast implants placed above the muscle tend to have higher capsular contracture rates, versus breast implants placed in behind the muscle, also known as submuscular placement.

3) Infection. Capsule contracture seems to be more likely following an infection.

4) Seroma. If you have had seroma, you may be at more risk for capsular contracture.

5) Hematoma. Hematomas can cause an inflammatory reaction, which can lead to capsule contracture.

6) Smoking. Smoking decreases the oxygen levels in the blood, which could result in delayed healing, and possibly an inflammatory reaction.

Baker Grading System – 4 Grades of Capsular Contracture

Baker Grade 1 - The breast is normally soft, and looks natural. (Basically, we all have this, since we all have a “capsule”.) It is only when the capsule starts shrinking/contracting that capsule contracture occurs.
Baker Grade II – The breast is a little firm, but appears natural.
Baker Grade III – The breast is firm, and is beginning to appear distorted in shape.
Baker Grade IV – The breast is hard, and has become quite distorted in shape. Pain/discomfort may be associated with this level of capsule contracture.

How Can I Prevent Capsular Contracture?

Hopefully from the information above you can conclude that it is a naturally occuring risk asscoiated with breast augmentation. It can not be prevented.

However, there are things that you can do to reduce your risks.

Choose the partial or complete submuscular placement instead of over the muscle placement. Breast implants placed on top of the muscle have been proven to have a higher incidence of capsular contracture. Implants placed over the muscle come into contact with the breast ducts, which are known to harbor bacteria.
Textured breast implants were invented in hopes of preventing, or at the very least, reducing the incidence of capsular contracture. However, there have been several studies that have shown that when textured breast implants are placed under the muscle, there is really no difference in contracture rates between smooth and textured implants. Textured implants do seem to have a slightly lower risk of contracture than smooth implants when placed above the muscle.
Silicone gel breast implants, especially those with a smooth shell, seem to have a higher rate of capsular contracture than saline breast implants.
Post-operative massaging of the implant. Some surgeons recommend massaging to their patients, who usually have smooth implants. The vast majority of surgeons do not recommend massaging textured implants, as the implant is supposed to adhere to your own tissues, and massaging can interfere with that process.Massaging is thought to help keep the pocket open. There are no studies that prove or disprove that massaging helps to prevent capsular contracture, but many surgeon’s don’t see the harm in allowing their patients to do it. If this something you’d like to do, you should discuss it with your surgeon.
Taking oral vitamin E daily. Vitamin E is said to soften collagen fibers. Collagen fibers make up the capsule. There are no studies that prove that Vitamin E can prevent capsular contracture, nor are there studies that prove or disprove that it lessens the effects of capsular contracture. It is important to remember that Vitamin E thins the blood and that it should not be taken prior to surgery without your surgeon’s approval. The same advice applies to the early post-op period. Talk with your surgeon prior to taking vitamin E or any other supplement or medication that thins the blood.
Compression bras and exercises. Some women wear compression bras or sports bras that “flatten” their implants, which helps keep is thought by some to help keep the pocket open. Others do compression exercises such as laying flat on the floor on their tummies, which has the effect of mashing the implant. Again, this is something you will need to discuss with your surgeon. There are many surgeons that are quite particular about the types of bras their patients were post-operatively. Additionally, compression exercises, which can include various types of massage, should be discussed with your surgeon before you begin doing it.

Please discuss this with your Surgeon and get permission to try anything concerning your implants. Do not do anything without your surgeons consent and permission. They generally know what works and what doesn’t. Every patient, surgeon and surgery is different.