Capsular contracture is a common complication following breast implant surgery, representing the body’s overreaction to the foreign material. The condition occurs when the normal, thin layer of scar tissue (the capsule) thickens and tightens. This tightening can squeeze the implant, leading to a breast that feels hard and may look distorted. Treatment aims to alleviate the symptoms and restore a natural feel and appearance, utilizing approaches from conservative management to surgical revision.
Defining the Degree of Contraction
Determining the appropriate treatment path begins with accurately assessing the contracture’s severity using the standard Baker Grading Scale. This four-point classification system helps surgeons categorize the condition based on the breast’s physical characteristics and the patient’s symptoms. Grade I represents a normal, soft-feeling breast where the implant is non-palpable and requires no intervention.
Grade II contracture is characterized by a breast that feels firmer than normal to the touch, though its outward appearance remains natural and undistorted. When the contracture progresses to Grade III, the breast becomes easily palpable and visibly firm, and the breast contour may begin to look abnormal. The most severe stage, Grade IV, involves a breast that is hard, often painful, and noticeably distorted in shape. This grading system directly informs the choice between non-invasive strategies and definitive surgical correction.
Non-Invasive Treatment Options
Conservative management strategies are reserved for milder cases, typically Baker Grades I and II, or for patients experiencing an early onset of Grade III contracture. One common non-surgical approach is external massage, often referred to as implant displacement exercises. The goal of these techniques is to manually stretch the developing scar capsule and maintain the implant’s mobility within the pocket.
Certain medications have been utilized off-label to treat early contracture, most notably leukotriene inhibitors like Montelukast or Zafirlukast. These oral drugs were originally developed to treat asthma, but their mechanism suggests a benefit in reducing fibrosis. By inhibiting leukotrienes, which are chemical mediators involved in inflammation, the medications may help soften the capsule tissue. While these methods offer a less aggressive option, their effectiveness is limited for cases that have advanced to severe, well-established contracture.
Surgical Intervention for Resolution
Surgery represents the definitive solution for moderate to severe capsular contracture, specifically Baker Grades III and IV, where non-invasive options are unlikely to succeed. The surgical approach focuses on addressing the constricting capsule and often involves exchanging the existing implant. There are two primary surgical techniques used to manage the scar tissue: capsulotomy and capsulectomy.
Capsulotomy vs. Capsulectomy
Capsulotomy involves making incisions or scoring the capsule to release the tension it exerts on the implant, allowing the breast to soften and regain a more natural shape. A capsulectomy, by contrast, is the complete removal of the entire capsule of scar tissue surrounding the implant. A total capsulectomy is frequently preferred for Grade III and IV contractures, as it ensures that all problematic tissue is excised, offering a lower risk of immediate recurrence.
Implant and Pocket Management
During the procedure, surgeons must make several interrelated decisions to optimize the outcome and reduce the chance of the condition returning. It is routine to replace the existing breast implant with a new one, as the surface of the old implant may harbor bacteria that contributed to the problem. Surgeons may also change the location of the implant pocket, often moving from a subglandular (over the muscle) to a submuscular (under the muscle) placement, which is associated with a lower rate of recurrence. The use of biological materials, such as an Acellular Dermal Matrix (ADM), may also be incorporated as a supportive mesh to help create a new, softer pocket.
Reducing the Risk of Future Occurrence
Capsular contracture has a notable risk of recurrence, so a major component of the “fix” involves implementing specific preventative measures during and after the revision surgery. Optimizing the surgical technique is paramount, beginning with minimizing the handling of the implant before insertion to reduce bacterial contamination. This can be achieved through “no-touch” techniques, such as using specialized insertion funnels to transfer the implant directly into the surgical pocket.
Preventative measures focus on reducing inflammation and bacterial load:
- The surgical site is irrigated with a specialized antiseptic or antibiotic solution before the new implant is placed to further reduce the presence of bacteria.
- The choice of implant placement is key, as submuscular positioning has consistently demonstrated lower contracture rates compared to subglandular placement.
- The role of implant texture is also considered, as textured surfaces were once thought to reduce risk, although this understanding has evolved with recent data.
- Post-operative care, including the placement of surgical drains, also helps minimize the risk by preventing the accumulation of blood or fluid (hematoma or seroma), which can trigger an inflammatory cascade.