When breast implants or any other foreign devices, such as a pacemaker or artificial joint, are placed in the body, capsules of collagen fiber form around the device as part of the body's immune response. Capsular contracture occurs when the capsule surrounding a breast implant contracts and squeezes the implant, leaving it misshapen and uneven. It is problematic, not only because of its aesthetic consequences, but also because it causes pain in the patient.

If you suspect you are experiencing symptoms of capsular contracture, you should seek medical attention immediately and follow up with a board certified cosmetic surgeon to correct the problem before it worsens.

There is a four-grade scale, known as the Baker Scale, demonstrating the severity of capsular contracture in breast augmentation patients.

  • Grade 1 - the breast is usually soft and looks natural in size and shape
  • Grade 2 - the breast is a bit firm, but looks normal
  • Grade 3 - the breast is firm and looks abnormal
  • Grade 4 - the breast is hard, hurts to be touched, and looks abnormal

What Causes Capsular Contracture?

The exact causes of capsular contracture are unknown. Conditions associated with capsular contracture include bacterial infection or exposure to other pathogens, rupture of the implant's shell, the leakage of silicone gel filling, and internal bleeding or hematoma. It is not known if rupture, leakage, and hematoma are causes of contracture or effects. There is strong indication that bacterial infection is causative of contracture.

Preventing Capsular Contracture

There are several surgical methods that have been shown to reduce the occurrence of capsular contracture in breast augmentation patients. These include:

  • Placing the implants below the pectoralis major muscle.
  • Using either polyurethane-coated or textured implants, which prevent the capsule from gripping the implant and distorting its shape.
  • Placing saline implants rather than silicone gel implants.
  • Controlling the germ factor by limiting contact with implants and the pocket in the chest before insertion.
  • Coating the surgical site with antibiotic solutions.

After surgery, patients may follow these post-operative instructions to reduce the risk of capsular contracture:

  • Breast massage: Regulary massaging the breast implant may reduce the formation of scar tissue.
  • Compression garments: Compressing the breasts after surgery may help reduce the formation of scar tissue.
  • Antibiotics: Taking antibiotics after breast augmentation may reduce the risk of infection, which is thought to be a causal factor of capsular contracture.

Treating Patients with Capsular Contracture

Treatment of capsular contracture involves breast implant revision surgery. The capsulectomy technique may be used to to remove the collagen capsule. In other cases, the capsulotomy technique may be used to open the capsule and reduce the constriction.

During surgery, the implant will be removed, and if the patient desires, replaced. If the previous implants were placed subglandularly, the new ones may be placed below the pectoralis major muscle to reduce to reoccurrence of capsular contracture.

Another option is the use of an Acellular dermal matrix. ADM is a product that is basically a net made of collagen and is placed near the lower part of the implant to prevent contracture. The upper part of the capsule and implant is covered by vascularized muscle and is less likely to contract.

To find out if breast implant revision surgery is right for you, contact Dr. Paul Pin.