Understanding Capsular Contracture

August 07, 2024 - By Dr. Jules Feledy

Overview: Capsular contracture is a condition that can occur after breast implant surgery. When an implant is placed in the body, the immune system reacts by forming a protective capsule of scar tissue around it. Normally, this capsule is thin and helps keep the implant in place. However, sometimes the capsule thickens and tightens, compressing the implant and leading to capsular contracture.

Causes: The exact cause of capsular contracture is unclear, but several factors may contribute to its development:

• Autoimmune Factors: A family history of autoimmune diseases might increase the risk.
• Biofilm Formation: A thin layer of bacteria on the implant's surface may increase risk.
• Fluid Accumulation: Fluid (seroma) or blood collections (hematoma) in the breast pocket may elevate the likelihood of capsular contracture.

Signs and Symptoms: Identifying capsular contracture involves recognizing specific signs and symptoms as well as undergoing a clinical evaluation. Key indicators include:

1. Breast Hardening: The breast may feel firmer due to the thickened capsule around the implant.
2. Breast Shape Changes: The shape of the breast may become distorted or uneven.
3. Pain or Discomfort: Pain or discomfort in the breast area can range from mild to severe.
4. Decreased Range of Motion: Reduced range of motion in the shoulder or chest area if the implant is placed under the chest muscle.
5. Visible Distortion: Severe cases may cause the breast to appear misshapen or unnaturally rounded.
6. Changes in Sensation: There might be changes in sensitivity or sensation in the breast or nipple area.

Diagnostic Steps:

1. Physical Examination:
• A healthcare provider will assess breast firmness, shape, and any signs of pain or discomfort.
• The doctor will palpate the breast to detect abnormal hardness or thickened areas of the capsule.
2. Imaging Studies:
• Mammogram: Helps evaluate the implant and surrounding breast tissue.
• Ultrasound: Visualizes the capsule around the implant and assesses its thickness.
• MRI: Provides detailed images of the breast tissue and implant, helping identify capsular contracture and its severity.
3. Patient History:
• Reviewing medical and surgical history, including previous breast implant surgeries and symptoms.
4. Capsular Contracture Scoring Systems:
• Baker Classification: A common system grading capsular contracture severity from Grade I (normal) to Grade IV (severe contracture).

Consultation with a Specialist: If you suspect capsular contracture, consult with a qualified plastic surgeon or healthcare provider. Early diagnosis and intervention can manage symptoms effectively and prevent further complications.

Is it okay to live with a Capsular Contracture? Living with capsular contracture is possible but may come with challenges. The decision to address it depends on the severity, impact on quality of life, and associated symptoms.

Considerations for Living with Capsular Contracture

1. Severity of Symptoms:
• Mild to Moderate Contracture: Monitoring without immediate intervention if it does not cause significant discomfort or affect appearance.
• Severe Contracture: Often requires treatment to alleviate symptoms and improve breast appearance.
2. Impact on Quality of Life:
• Physical Discomfort: Treatment may improve quality of life if it causes pain, discomfort, or functional limitations.
• Aesthetic Concerns: Addressing contracture can restore confidence and satisfaction with breast augmentation results.
3. Risk of Complications:
• Infection Risk: Severe cases can increase the risk of implant rupture, potentially leading to infection.
• Monitoring: Regular follow-ups are essential to monitor the condition and address changes or complications.
4. Personal Preferences and Lifestyle:
• Individual Decisions: Personal preferences, lifestyle, and comfort with the current condition play a significant role in deciding whether to seek treatment.
• Informed Choices: Discussing options with a plastic surgeon helps make informed decisions based on individual situations and goals.

When to Seek Treatment

• Persistent Pain or Discomfort: Consult with your surgeon if it affects daily activities.
• Significant Aesthetic Changes: Address the issue if it impacts self-esteem or body image.
• Progressive Symptoms: Seek evaluation and potential treatment if symptoms worsen or new ones develop.

Regular Monitoring and Consultation Even if you choose to live with capsular contracture, regular monitoring by a healthcare professional is important to track changes and advise if treatment becomes necessary. The decision to address capsular contracture should be made in consultation with a healthcare provider.

Who is likely to get a capsular contracture? Certain factors may increase the likelihood of developing capsular contracture:

1. History of Autoimmune Diseases: Family history may predispose individuals to aggressive scarring and capsule formation.
2. History of Implant Complications: Previous infections or fluid accumulation around the implant can increase risk.
3. Implant Factors: Textured implants and implants placed above the chest muscle may have higher risks.
4. Surgical Factors: The surgeon's skill and technique, as well as post-surgical care, can influence risk.
5. Genetic Predisposition: Some individuals may be genetically predisposed to pronounced scarring.
6. Time Since Implantation: Risk may increase with the length of time the implant has been in place.
7. Lifestyle and External Factors: Smoking and inadequate aftercare can impair healing and increase risk.

Preventive Measures: While some risk factors are uncontrollable, certain measures can reduce the likelihood of capsular contracture:

• Choose an Experienced Surgeon: Select a board-certified plastic surgeon with experience in breast implant surgeries.
• Minimize Bleeding: Controlling bleeding during surgery reduces complications.
• Antibiotic Irrigation: During surgery, this may minimize the risk of infection.
• Careful Handling: Limits implant handling during surgery to reduce contamination.
• Muscle Placement: Placing the implant under the chest muscles can lower risk.
• Follow Post-Operative Care: Adhere to all instructions to minimize complications.
• Regular Monitoring: Attend follow-up appointments to ensure proper healing.

How do you fix a capsular contracture?

Treatment Options for Capsular Contracture: Fixing capsular contracture typically involves surgical intervention. Common methods include:

1. Capsulectomy: Removal of the thickened capsule, with or without implant replacement.
2. Capsulotomy: Incision in the capsule to release pressure, less invasive than capsulectomy.
3. Implant Exchange: Replacing the compromised implant with a new one.
4. Pocket Revision: Moving the implant to a different position or new pocket.
5. Antibiotic Irrigation: Flushing the breast pocket with antibiotics during surgery to reduce infection risk.

Post-Treatment Recovery: Recovery involves managing soreness, swelling, and bruising. Follow-up care is essential to monitor healing and ensure no recurrence of capsular contracture.

What are the costs for treating capsular contracture? 

Costs for treating capsular contracture vary, typically ranging from $5,000 to $15,000.

Conclusion: The choice of treatment depends on the severity of the contracture, type of implant, and patient’s overall health. A qualified surgeon can help determine the most appropriate approach. For personalized advice, schedule a consultation with a qualified surgeon.