Capsular contracture is a common complication following breast implant surgery. This condition occurs when the body’s natural response to a foreign object, like a breast implant, leads to the formation of a scar tissue capsule around it. This capsule can tighten and squeeze the implant, causing the breast to feel hard, appear distorted, and become painful. Understanding and implementing various preventative strategies is important to minimize this risk.
Pre-Surgical Decisions
Careful consideration of choices made before surgery significantly influences the likelihood of capsular contracture.
Implant Type and Surface
The type and surface of the implant chosen play a role in this risk. Historically, textured implants were believed to result in lower rates of capsular contracture. However, their association with Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has led to a shift towards smooth implants. Smooth implants generally offer a softer and more natural feel, and their contracture rates can be similar to textured implants when placed in the submuscular plane.
Filling Material
The implant’s filling material also bears consideration. Silicone implants have historically shown higher rates of capsular contracture compared to saline implants, though newer cohesive gel silicone implants have reduced these rates. Many patients and surgeons prefer silicone for its more natural feel and appearance.
Implant Placement
Another decision involves the implant’s placement within the breast. Submuscular placement, where the implant is positioned partially or entirely beneath the pectoral muscle, is generally associated with a lower risk of capsular contracture. This positioning provides an additional layer of tissue coverage, which may help mitigate the body’s inflammatory response. Conversely, subglandular placement, with the implant placed above the muscle but behind the breast tissue, may carry a slightly higher contracture risk.
Surgeon Selection and Patient Health
Selecting a board-certified plastic surgeon with extensive experience in breast augmentation helps reduce complications. Prior to surgery, disclosing a complete medical history and adhering to all pre-operative health guidelines helps ensure the body is in optimal condition for healing.
Surgical Techniques and Environment
Meticulous surgical techniques employed during the operation help prevent capsular contracture.
Minimizing Trauma and Infection
Minimizing tissue trauma, performing precise dissection, and carefully handling tissues during the procedure reduce inflammation and bleeding within the surgical site. These factors can contribute to the formation of a reactive capsule. Maintaining a strictly sterile environment and implementing robust infection control measures are also necessary. Bacterial contamination, even at a subclinical level, is a recognized contributor to capsular contracture.
Implant Insertion Methods
Surgeons often utilize a “no-touch” technique during implant insertion, which involves using specialized devices like the Keller Funnel to minimize any direct contact between the surgeon’s gloved hands or the patient’s skin and the implant. This method reduces the risk of introducing bacteria, thereby lowering the incidence of contracture. Furthermore, irrigating the surgical pocket with antiseptic or antibiotic solutions before implant placement, such as a Betadine-containing wash, helps reduce the bacterial load. Temporary placement of surgical drains may be considered to prevent the accumulation of fluid or blood, known as hematoma, which can also trigger an inflammatory response and contribute to capsule formation.
Post-Operative Management
Following breast augmentation, diligent post-operative care plays a significant role in preventing capsular contracture.
Breast Massage
Post-operative breast massage is frequently recommended by surgeons to help maintain the softness and pliability of the developing capsule. While scientific evidence on its definitive efficacy varies, many practitioners believe it helps prevent the capsule from hardening. The technique typically involves applying gentle but firm pressure to the implant from various directions—pushing down, up, and side-to-side, as well as performing circular movements. Patients are often instructed to begin massage a few days to a week after surgery, performing it for approximately five minutes, two to three times daily for several months, and sometimes on an ongoing basis.
Medications and Supplements
Various medications and supplements may also be advised by a surgeon to aid in prevention. Leukotriene inhibitors, such as Montelukast (Singulair) and Zafirlukast (Accolate), are sometimes prescribed off-label. These medications work by inhibiting inflammatory responses and reducing the activity of myofibroblasts, cells involved in scar tissue formation, thereby preventing or softening capsular contracture. Additionally, Vitamin E may reduce inflammation and scar tissue formation, with some studies indicating a minor reduction in contracture rates; a common recommendation for Vitamin E is 1000 IU twice daily for up to two years. Arnica, a homeopathic remedy, is often used to minimize post-surgical bruising and swelling, and can be taken orally or applied topically, avoiding broken skin. All medications and supplements should only be taken under the specific guidance of the operating surgeon.
Activity Restrictions and Follow-Up
Adhering to activity restrictions is another aspect of post-operative care. Patients are typically advised to avoid strenuous activities, heavy lifting, and intense exercise for at least four to six weeks following surgery to minimize stress on the healing tissues. Wearing supportive garments, as directed by the surgeon, also helps provide stability to the breasts during the healing period. Regular follow-up appointments with the surgeon are important for monitoring the healing process and detecting any early indications of contracture, allowing for timely intervention. Maintaining overall health through a balanced diet, avoiding smoking—which is a known risk factor for contracture—and ensuring adequate hydration can contribute to the healing environment and reduce the risk of capsular contracture.