What is Capsular Contracture?A Simply Put Answer

What is Capsular Contracture

You may be very familiar with the word breast augmentation, and perhaps well educated on the different breast augmentation procedures, as well as various implants.  While breast augmentation is a commonly known procedure, capsular contracture is not a word that most women (or men) hear everyday. 

What Exactly is Capsular Contracture?

In general, The American Society of Plastic Surgeons describes capsular contracture as  the formation of a capsule of scar tissue around any kind of implant, either medical or cosmetic.  Capsular contracture deals with breast augmentation surgery, specifically breast implants.  Capsular contracture is when scar tissue is created by the body that forms around the breast implant, and creates a tissue capsule.  The body responds to foreign material (for example implants) by creating scar tissue.  The benefit of the tissue capsule is that it helps keep the implant in place. In some women, a tissue capsule capsule can develop that is hard and dense, which tightens around the implant and squeezes it.  As a result capsular contracture can lead aesthetic and or pain issues.  Capsular contracture can lead to chronic pain and change in the shape of the breast. It can also cause breast asymmetry.  Read more at  https://www.breastcancer.org/treatment/surgery/reconstruction/corrective/capsular-contracture

Grading:  The grading system helps classify the degree of severity for capsular contracture:

  • Grade 1: A patient with a grade 1 severity capsular contracture has a natural appearing breast that is soft when touched.  A grade 1 capsular contracture is asymptomatic, meaning they do not experience any symptoms/complaints. For grade 1, the formation of scar tissue around the implant does not interfere with the aesthetic appearance of the breast, including size, texture or shape. 
  • Grade 2: A patient with a Grade 2 capsular contractures has normal appearance of the breasts, but when palpated (touching the breast), some firmness is felt.  Grade 2 capsular contractures are typically associated with minor cosmetic symptoms. 
  • Grade 3: A patient with a grade 3 capsular contracture experiences obvious cosmetic symptoms.  The breasts will be both abnormal in the appearance and firm to touch. Patients with a grade 3 capsular contracture experience minimal to no pain.
  • Grade 4: A patient with a grade 4 capsular contracture experience both change in the appearance of the breasts, firmness, and pain.  These patients will have hard misshapen breasts.  They will also experience soreness of the breasts and complain of pain when the breasts are touched.

Why Does Capsular Contraction Occur?

A capsular contractor is not something that commonly occurs immediately post-operatively.  According to the American Society of Plastic Surgeons, approximately 75% of all capsular contracture occurs within the first 2 years of the patient’s implants being placed. However, while not common, a capsular can contracture can develop anytime after surgery, including years later.

What is the Cause of Capsular Contraction?

  • Genetics: underlying medical problems or certain family history of disorders may increase the risk of capsular contracture. 
  • Bacteria:  a capsular contracture can be caused by biofilm.  Biofilm is a thin layer of bacteria that grows around the foreign object (in this case the breast implant). Biofilm is created after bacteria enters the breast cavity during the surgical procedure. This typically leads to a low-grade infection that leads to growth of scar tissue.
  • hematomas/seromas:blood clots or the accumulation of blood under the tissue may increase the risk of capsular contracture.

What is the Treatment for Capsular Contraction?

Capsular contractures are typically diagnosed on physical examination by your surgeon.  When capsular contracture is diagnosed, your surgeon may perform a surgical revision, meaning removing the implant and scar tissue and afterward place a new implant after the body has healed. 

Another newer option involves a non-invasive approach, where a harmonizer, known as the Aspen Harmonizer is used.  This device helps loosen the scar tissue, improving the breast softness and shape.  Advantages to this and similar technology is that the patient does not require an additional surgery. Avoiding revision surgery helps decrease the risk of additional scar tissue forming and also decreases the risk of infection.   

Preventing Capsular Contraction

It is impossible to know for sure which patients will and willnot experience capsular contracture after breast augmentation surgery. Everyone’s body reacts differently. Fortunately there are steps that may help prevent capsular contraction from developing. 

  • Adequate patient screening: It is important that your doctor carefully screen you for underlying health disorders, especially bleeding related disorders or autoimmune disorders.  In addition, patients who smoke are not good candidates for breast augmentation, because smoking impairs the body’s healing process.  Your surgeon may still agree to perform plastic surgery, however he or she may require that you quit smoking for a few weeks or months prior to undergoing the surgery. 
  • Implants:
  • Selecting the appropriate implant: If too large of an implant is placed, it may increase the risk of the formation of a capsular contracture. Your surgeon will help you determine the implant size that fits best for you.
  • Increase sterility: the risk of bacterial infection can be reduced by limiting the number of people and times the implant is touched prior to implantation.  Discuss with the surgeon the environment that the procedure will be performed in. 
  • Using textured gel implants: may decrease the risk of your body forming scar tissue. Talk to your doctor whether or not textured implants are a good fit for you.
  • Using implants placed under the muscle: The American Society of Plastic Surgeons reports that the partial under the muscle implant placement results in a lifetime risk of capsular contracture of 8-12%.  The risk of capsular contracture is increased to 12-18% with implants placed over the muscle.  
  • Massage: Massage therapy can help prevent the capsule from hardening. It may not stop the process of tissue formation, but may be somewhat beneficial. Ask your plastic surgery about proper techniques for massage after surgery.  A plastic surgeon does NOT perform breast massages on his or her patients. He or she may have some great references and possibly massage therapist referrals for you.  Read more at Healthline, Can Massage Help Capsular Contracture After Breast Augmentation?

Applebaum MD

 While capsular contracture is a complication that can occur with breast augmentation, it is much more managable and more easily treated by plastic surgeons.  This is one reason why it is highly recommended that you carefully chose your plastic surgeon.  Choose a Board Certified Plastic Surgery who has years of experience in breast augmentiation. Dr. Robert Applebaum has over 25 years of experience in plastic surgery.  He practices at his office conveniently located in the center of Beverly Hills, California.  Take a look at Applebaum MD’s photogallery to familiarize yourself with Dr. Applebaums excellent work. The photogallery displays before and after photos of different breast augmentation.  He is extensively trained in cutting-edge surgical techniques and is an innovator in the field of laser surgery for plastic surgery procedures.

Take the First Step Today

During your consultation, Dr. Applebaum will discuss different options with you and review the technique he will be using.  Feel free to discuss how he manages possible complications such as capsular contracture. Schedule a complimentary consultation today at Applebaum MD.

Sources:

https://www.breastcancer.org/treatment/surgery/reconstruction/corrective/capsular-contracture

https://www.plasticsurgery.org/news/blog/what-is-capsular-contracture-and-how-can-it-be-treated

https://www.healthline.com/health/womens-health/capsular-contracture-massage

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