Capsular contracture (CC) is the most common complication following breast implant surgery, involving the abnormal hardening of the scar tissue that naturally forms around any foreign object placed in the body. This scar capsule is normally soft and helps keep the implant in position, but when it constricts excessively, it leads to noticeable changes in the breast’s feel and appearance. The condition can be painful and distort the breast shape, often requiring intervention. Understanding how this complication is classified and what treatment options exist is the first step toward finding a resolution.
Understanding the Severity and Symptoms
The severity of capsular contracture is determined using a four-grade classification system known as the Baker Grading Scale. This scale ranges from a soft, natural-feeling breast to one that is hard, painful, and visibly distorted. The classification guides the treatment approach, as less severe cases may be managed conservatively while advanced cases almost always require surgery.
In the initial stages, Grade I contracture means the breast remains soft and appears completely natural. Grade II is characterized by a breast that feels slightly firm to the touch, though its outward appearance remains normal. This change is often subtle, felt only upon palpation.
Progression to Grade III involves a breast that is firm and starts to exhibit noticeable distortion in shape, such as a rounder or tighter appearance. The most advanced stage, Grade IV, is marked by a breast that is hard, painful, and significantly misshapen. This severe constriction can displace the implant, sometimes pushing it higher on the chest wall.
Non-Surgical Treatment Options
For early-stage capsular contracture, specifically Grade I or mild Grade II cases, non-surgical methods may be attempted to soften the fibrous tissue. These techniques focus on disrupting the tightening capsule or reducing the inflammatory response thought to drive the condition’s development.
Manual techniques, such as therapeutic massage, aim to physically stretch or break up the stiffening scar tissue surrounding the implant. External ultrasound therapy is another approach, which uses sound waves to generate deep heat within the tissue, potentially helping to soften the collagen fibers that make up the capsule.
Pharmaceutical interventions also exist, most notably the use of leukotriene inhibitors like Zafirlukast or Montelukast. These anti-inflammatory medications, originally developed for asthma, block the body’s chemical signals believed to contribute to the excessive scar formation.
These conservative treatments have limited efficacy once the contracture has progressed to Grade III or Grade IV. Once the capsule has become thick, rigid, and causes significant cosmetic distortion, these methods are unlikely to provide meaningful, lasting correction. In such advanced situations, a surgical procedure becomes the most reliable and often the only effective solution.
Surgical Correction Procedures
When non-surgical management is insufficient, surgical intervention directly addresses the hardened capsule and provides the most definitive treatment. The two primary surgical methods are capsulotomy and capsulectomy, both performed as part of a revision surgery that usually involves removing or replacing the existing implant.
Capsulotomy involves the surgeon making strategic incisions into the capsule wall, which releases the tension and allows the contracted tissue to expand. This procedure is less invasive than a full removal and is sometimes chosen for less severe, recurrent contractures or when the capsule is thin.
A capsulectomy involves the complete removal of the scar capsule surrounding the implant. This procedure is considered the standard for Grade III and Grade IV contractures because it removes the entire source of the problem. A total capsulectomy removes the capsule in pieces, while an en bloc capsulectomy removes the capsule and the implant together as a single, intact unit. The en bloc technique is recommended when an implant rupture is suspected or if there is concern for Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).
During the revision surgery, the existing implant is typically removed, and the patient has the option to replace it with a new one. Surgeons may utilize this opportunity to change key variables to reduce the risk of future recurrence. This might include switching from a smooth-surface implant to a textured one, or changing the implant pocket from a subglandular (above the muscle) to a submuscular (below the muscle) position.
Strategies to Minimize Recurrence
Preventing the return of capsular contracture after a corrective procedure is a major focus for long-term success, as patients who have experienced it once are at a higher risk of recurrence.
One strategy involves changing the implant’s placement, often relocating it from above the chest muscle (subglandular) to a position partially or fully beneath the muscle (submuscular). This change in pocket is thought to provide a better blood supply and a protective layer of muscle tissue, which may reduce the inflammatory response.
Another measure is the use of an acellular dermal matrix (ADM), a supportive mesh material derived from human or animal tissue. The ADM is placed to line the new implant pocket, acting as an internal sling that supports the implant and provides a biological barrier. This material is intended to integrate with the patient’s tissue, reducing the body’s tendency to form a new, restrictive scar capsule around the implant.
Surgeons also employ meticulous surgical techniques, such as minimizing tissue trauma and using an antibiotic solution to irrigate the implant pocket before the new implant is placed. This step is important because bacterial contamination, often a biofilm on the implant surface, is believed to be a primary trigger for the inflammatory cascade. Post-operative care protocols may also include specific anti-inflammatory medications or massage regimens to encourage the capsule to heal softly.