Capsular contracture is a common complication after breast implant surgery, involving the formation of a tightened scar capsule around the implant. This article explains the condition, its resolution, and management strategies.
What Is Capsular Contracture?
Capsular contracture occurs when the body’s natural response to a foreign object, like a breast implant, results in the formation of an overly tight and constricting scar tissue capsule. While a thin, soft capsule normally forms around an implant to hold it in place, problems arise when this tissue thickens and contracts, compressing the implant.
Common symptoms include a noticeable firmness or hardening of the breast, which can progress to pain or discomfort. The breast might also appear distorted, misshapen, or take on an unnatural, spherical appearance. In some cases, the implant may shift position or show visible rippling of the skin.
The severity of capsular contracture is classified using the Baker Scale, which has four grades. Grade I indicates a breast that feels normally soft and appears natural. Grade II describes a breast that is slightly firm but still looks normal. Grade III involves a breast that is firm to the touch and appears abnormal in shape. Grade IV is the most severe, characterized by a hard, painful, and visibly distorted breast.
How Capsular Contracture Is Addressed
Capsular contracture rarely resolves on its own, and medical intervention is usually required, especially for more severe cases. While mild instances (Baker Grade I or II) may not need immediate aggressive treatment, they typically do not improve spontaneously. Various non-surgical and surgical approaches are employed to manage this condition.
Non-surgical methods are primarily considered for milder cases. Massage techniques, such as closed capsulotomy, involve external compression to attempt to break up scar tissue, though their use has declined due to potential risks and varying success rates. Medications like Zafirlukast (Accolate) and Montelukast (Singulair), which are leukotriene inhibitors, have been used off-label to reduce inflammation and soften the capsule, showing promise for early contracture. Additionally, ultrasound therapy, sometimes referred to as the Aspen Rehabilitation Technique, can increase elasticity within the breast capsule and may be effective for Baker Grade II and III cases.
Surgical intervention is necessary for advanced cases (Baker Grade III or IV) or when non-surgical treatments fail, with capsulectomy, the surgical removal of the scar tissue capsule, being the primary approach. This can involve removing part of the capsule (partial capsulectomy) or the entire capsule (total capsulectomy). An en bloc capsulectomy, where the implant and capsule are removed as a single unit, is often reserved for specific complications like implant rupture or breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). After capsulectomy, implants are often removed and replaced. The choice of new implant type and placement, such as submuscular, is considered to reduce recurrence risk.
Long-Term Outlook and Prevention
While treatable, recurrence is possible even after successful intervention. Long-term outcomes depend on several factors, including the contracture’s initial severity, treatment method, and individual healing. Managing expectations and focusing on preventive strategies can improve results and reduce future issues.
Several strategies can minimize the risk of capsular contracture developing or recurring. Meticulous surgical technique during the initial breast augmentation is important; this includes minimizing implant handling, maintaining a sterile environment, and using antibiotic washes. Implant placement also plays a role, with submuscular placement generally associated with a lower lifetime risk of contracture compared to subglandular placement. Following post-operative care instructions from the surgeon is also important. This may include avoiding strenuous activities and adhering to guidelines for massage, though the efficacy of massage in prevention is debated. Prophylactic use of medications like Zafirlukast or Montelukast post-surgery can also help prevent capsular contracture.