Capsular Contracture and Breast Implants

Causes, Prevention and Treatment

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A breast implant which sometimes results in capsular contracture
How can capsular contracture after breast implants be prevented and treated?. fStop Images/Getty Images

Capsular contracture is a common complication of breast implant surgery. A breast should be soft, flexible, and drape naturally, even if it is a reconstructed breast that was surgically created after a mastectomy. If you have saline or silicone breast implants, capsular contracture can cause your reconstructed breast to shift, change shape, or feel quite hard. If this happens in your case, you can get treatment to correct the problem.

Overview

Your body is smart—your immune system knows when a foreign object has been put into your tissues. When an intruder (such as a breast implant) is detected, a periprosthetic capsule is formed around it.

Think of it this way: Your chest muscles and skin don't readily accept an implant as a natural part of your breast. In order to isolate the implant and keep it from growing, spreading, or wandering around, your body creates a sac, or capsule of scar tissue around it, to seal it off.

A capsule around a breast implant is a naturally occurring tissue that can be of benefit. If that capsule contracts or thickens, however, it can squeeze your implant. This contracture is what will cause pain, shifting, distortion, and hardening of the reconstructed breast.

Possible Causes

Capsular contracture can happen around any type of breast implant. It occurs more often around silicone, rather than saline implants.

Sometimes it develops due to an infection that sneaks in during implant surgery. But other problems may also crop up, like a seroma (a pocket of blood serum within the surgical area) or a hematoma (a pool of blood below the skin). These may also contribute to the development of capsular contracture.

The longer an implant is in place, the greater the chance that a contracture will develop.

Baker Scale Grade

Capsular contracture is graded by the Baker scale and follows these criteria:

  • Grade I - the breast is soft and appears normal, and the capsule is flexible.
  • Grade II - the breast looks normal, but is somewhat hard to the touch.
  • Grade III - the breast is hard, has some distortion caused by contracture, or the breast becomes a rounded shape, or the implant is generally tilted upwards
  • Grade IV - similar to grade III but with greater hardening of the capsule

Diagnosis

The diagnosis of capsular contracture can often be estimated based on exam alone. Imaging studies can offer further insight, with MRI being the most accurate test in making the diagnosis.

Prevention

You and your surgeon can work together to prevent the development of a stiff capsule of tissue around your breast implant. Your surgeon may prescribe preoperative medications such as prednisone and vitamin E, so be sure to take these as directed. Implants can be located beneath the mammary gland or within a muscle pocket. Implants that are placed within muscle are less apt to develop capsular contracture. Your surgeon may use Alloderm (a piece of human tissue but which lacks DNA) to line the muscle pocket to further reduce the likelihood of scar tissue build-up around your implant.

If you have surgical drains to maintain after breast surgery, be sure to empty these on schedule, as this helps prevent seromas from developing. Finally, your surgeon may suggest that you do post-operative massage on the reconstructed breast. That said, studies thus far don't seem to find that massage is effective in reducing capsular contracture.

Recovery From Breast Surgery

There are a few things that you should avoid after breast implant surgery to ensure a healthy recovery, and minimize you risk of developing a contracture.

  • Quit smoking before surgery if you can, and don't smoke during your recovery period. Using tobacco products will delay healing and recovery from surgery.
  • Take it easy doing physical activities and avoid injury or impact to the newly reconstructed breast. The implant needs time to settle into place, so don't jostle, squeeze, or strike the surgical site at all.
  • If you know that you'll be having chest wall radiation after your mastectomy, consider delaying implant surgery until treatments are completed. Radiation following immediate construction is associated with a greater risk of reconstructive failure, other complications such as infections, and capsular contracture, so waiting may be well worth your time.

Treatments

If you develop stiff tissue around a breast implant, if the shape distorts, or if the implant wanders out of position, you can get help. A capsulectomy is surgery that removes the stiffened capsule, and the implant may be replaced during this procedure for best results.

A capsulotomy is surgery to loosen the scar tissue by slicing it, which allows for expansion.

Surgery may not always be needed, however, as conservative methods such as massage, ultrasound, and medications may help the stiff capsule relax. Talk to your doctor about your options.

Sources:

Bachour, Y., Verweii, S., and S. Gibbs. The Aetiopathogenesis of Capsular Contracture: A Systematic Review of the Literature. Journal of Plastic Reconstructive and Aesthetic Surgery. 2018. 71(3):307-317.

Malahias, M., Jordan, D., Hughes, L., Hindocha, S., and A. Juma. A Literature Review and Summary of Capsular Contracture: An Ongoing Challenge to Breast Surgeons and Their Patients. International Journal of Surgery Open. 2016. 3:1-7.

Pu, Y., Mao, T., Zhang, Y. et al. The Role of Postmastectomy Radiation Therapy in Patients With Immediate Prosthetic Breast Reconstruction: A Meta-Analysis. Medicine (Baltimore). 2018. 97(6):e9548.

Sood, A., Xue, E., Sangiovanni, C., Therattil, P., and E. Lee. Breast Massage, Implant Displacement, and Prevention of Capsular Contracture After Breast Augmentation With Implants: A Review of the Literature. Eplasty. 2017. 17:e41.