Breast implants are a common choice for enhancing or restoring breast volume and contour. A possible complication is capsular contracture, where the body’s natural response leads to tightening of scar tissue around the implant. This can cause discomfort and affect the breast’s appearance. Addressing encapsulated breast implants involves understanding this complication and exploring solutions.
Understanding Capsular Contracture
The human body naturally forms a fibrous capsule around any foreign object, including a breast implant. This capsule, composed of collagen fibers, normally remains soft and helps hold the implant in place. Capsular contracture occurs when this natural capsule thickens and tightens excessively, squeezing the implant. This can lead to symptoms like breast hardening, pain, tenderness, or distortion of the breast’s natural shape. The implant may also be displaced or shift from its position.
The severity of capsular contracture is commonly classified using the Baker scale, which ranges from Grade I to Grade IV. Grade I describes a breast that feels naturally soft and appears normal. Grade II indicates a breast that is slightly firm to the touch but still looks normal. Grade III means the breast feels firm and its appearance is noticeably abnormal. The most severe form, Grade IV, involves a breast that is hard, often painful, and significantly distorted in shape.
Factors Contributing to Capsular Contracture
Capsular contracture development is influenced by multiple factors. A significant contributor is subclinical infection, where low-grade bacterial presence, often forming a biofilm around the implant, can trigger an inflammatory response and scar tissue formation. Fluid collection (seroma) or blood collection (hematoma) within the surgical site after the procedure also increases the risk. Additionally, an implant rupture may lead to late-onset capsular contracture.
Implant characteristics also play a role; certain types of implants have been associated with a higher incidence. Surgical technique, including careful handling of the implant and the chosen implant pocket (e.g., subglandular versus submuscular placement), can influence the likelihood of contracture. Individual patient predisposition, such as a genetic tendency for thick scar tissue or a compromised immune system, further contributes to the risk.
Non-Surgical Strategies
For milder cases of capsular contracture, typically Baker Grade I or II, non-surgical approaches may be considered, though their effectiveness is limited. Breast massage, if recommended by a surgeon, aims to keep the capsule pliable and prevent further tightening. However, evidence for its effectiveness is not robust, and it should only be performed under medical guidance to avoid potential damage.
External capsular disruption involves manual compression to break scar tissue, but this method is largely abandoned due to pain, unpredictability, and risk of implant rupture or hematoma. Medications like Zafirlukast or Montelukast have shown some promise in reducing inflammation and possibly improving early-stage contracture, but they are generally less effective for advanced cases. Ultrasound therapy is another non-surgical option that may help soften scar tissue and improve elasticity.
Surgical Interventions
When capsular contracture significantly impacts comfort or appearance, surgical intervention is often the most effective solution. The primary surgical procedure is a capsulectomy, which involves removing the thickened scar tissue capsule. A total capsulectomy removes the entire capsule surrounding the implant. Partial capsulectomy, a less invasive option, involves removing only a portion of the capsule, leaving remaining sections in place. The choice between total and partial depends on the contracture’s severity and other clinical factors.
Another surgical approach is an en bloc capsulectomy, where the implant and the entire capsule are removed together. This technique is typically reserved for specific situations, such as suspected implant rupture or breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). During these procedures, surgeons often decide whether to remove the existing implant permanently or replace it. Replacement may involve changing the implant type, such as switching from silicone to saline, or altering the implant pocket, moving from a subglandular (above the muscle) to a submuscular (under the muscle) position to potentially reduce recurrence risk. Adjunctive procedures, like fat grafting, may also be used to improve breast contour and softness after capsulectomy and implant exchange.
Minimizing Recurrence and Post-Treatment Care
Preventing capsular contracture recurrence after treatment involves meticulous surgical technique and diligent post-operative care. Surgeons employ various strategies during revision surgery, such as minimizing implant handling, using antibiotic irrigation solutions, and sometimes utilizing acellular dermal matrix (ADM) to create a protective barrier around the new implant. ADM can help reduce inflammation and provide scaffolding for healthy tissue integration, potentially lowering the risk of re-contracture.
Post-treatment care often includes specific protocols tailored by the surgeon, which may involve continued gentle massage once healing allows, wearing supportive compression garments, and potentially short-term medication regimens. Regular follow-up appointments are important to monitor healing and detect any early signs of recurrence. While surgical intervention can effectively address existing contracture, patients should understand that recurrence is possible, as the body’s response to foreign materials can vary. Recovery typically involves managing pain and swelling, with gradual return to normal activities as advised by the surgeon.